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A Ten-Year Experience With Pediatric Face Grafts

Greenhalgh, David G. MD, FACS; Hinchcliff, Katharine MD; Sen, Soman MD; Palmieri, Tina L. MD

Journal of Burn Care & Research:
doi: 10.1097/BCR.0b013e3182a22ea5
Original Articles
Abstract

The authors reviewed their 10-year experience of performing face grafts in children with burns. They sought to compare different methods for aesthetic outcome and need for reconstruction. In addition, they determined the efficacy of using allograft skin or Integra as temporary covers. They performed a review of 160 pediatric patients who underwent acute facial excision and grafting for burns between 2000 and 2010. Of the 160 patients with a mean age of 5.8 ± 4.8 years, 96 were males. The mean burn size was 39.4 ± 24.61%, of which 36.5 ± 25.4% was third degree. Overall length of stay was 72.1 days, intensive care unit length of stay was 44.2 days, and the mortality rate was 13.75%. Ninety patients had their entire face burned, 42 burned half, 15 burned their foreheads, and seven had other combinations. The interval between injury and grafting was 13.9 ± 13.19 days. Sixty-three percent patients required one face graft, 23% had two, 8% had three, and 6% four or more. For their initial procedure, 105 patients underwent autografting, 28 had allografting, and 23 received Integra. The authors performed a two-stage procedure in 20.4% and a 1-day procedure in 79.6%. Ten patients had a contiguous “U-shaped” graft wrapped around the face. At least partial regrafting was performed in 21.1%. Allograft and Integra were used for massive burns (69.9 ± 14.5%, 62.6 ± 18.3%, respectively). Of these, 39% died, 17% developed an Integra infection, and 43% required regrafting before autografting. Overall, 24.5% of patients underwent facial reconstruction during their first admission, and 57.1% during subsequent admissions. No difference in the rate of reconstructive surgery was noted between patients receiving Integra or autografting. Autografting face burns as an initial, one-stage procedure works well. The “wrap-around” autograft leads to excellent cosmetic results. When there is a shortage of autograft, allograft or Integra are good options but Integra does not reduce the need for reconstructive surgery.

Author Information

From the Shriners Hospitals for Children—Northern California, Sacramento; Firefighters Regional Burn Center at University of California, Davis; and Department of Surgery, University of California, Davis.

Presented in part as a Poster at the 43rd Annual Meeting of the American Burn Association, Chicago, Illinois, March 31, 2011.

Address correspondence to David G. Greenhalgh, MD, FACS, Shriners Hospitals for Children—Northern California, 2425 Stockton Boulevard, Sacramento, California 95817.

© 2013 The American Burn Association