بررسی نتایج بازسازی اسکارهای سوختگی وسیع گردن و صورت با متسع‌کننده‌های بافتی در بیمارستان پانزده خرداد تهران

Abstract Background: Face and neck skin is commonly exposed to flame burns, boiling water, steam, and other combustible materials. Neck reconstruction is considered as one of the most important and most difficult surgeries in cosmetic and reconstructive surgery. Because in our country there is no information about theresults of such treatments, this study was carried out to determine the results of reconstructive surgery of extensive face and neck burn scars using tissue expanders. Methods: In a descriptive prospective study, 36 patients with extensive burn scars in the neck and face who underwent reconstructive surgery between October 2009 to September 2010 in the Department of Plastic and Reconstructive Surgery at “Fifteenth Khordad Hospital” were enrolled. In preoperative visits, the donor tissue was assessed regarding tissue expander insertion, its type and size and the required incision. Operation for tissue expander insertion was performed under general anesthesia and tissue distension started two or three weeks later, depending on the patient's incision. After sufficient time had been accorded for tissue expansion, the expanded flap was used to cover the lesion under general anesthesia together with the removal of the expander and excision of the lesion,. A total of 43 cosmetic surgeries were done. Results: The age of patients was 27±8 and 67% of patients were female. Causes of scar formation were burns (85%), and crash (9%) and others (6%). Locations of scar were face (54%) and the neck (36%). The diameters of the largest and smallest lesions were 18±6 and 13±6 cm, respectively. Rectangular expanders were employed in 74% of patients in 61% ofpatients its location was the neck. The initial volume was 322±183ml. which was extended to the final volume of 865±624 ml. The average time from surgical placement of prosthesis to the reconstruction surgery was 191±67days. Complications were seen in 5 patients (14%) exposure of the prosthesis was the most common complication. The results of the reconstructive surgery including assimilation of flap’s color with the surrounding skin (in 78% of cases), assimilation of its consistency (in 92%), and its thickness with the surrounding skin (in 81%), were satisfactory. Scar tissue at the reconstruction site and flap donor site were acceptable in 94% and 98% of cases respectively. For the reconstructed skin complications occurred in 5 patients (14%). The most common complication was inadequate coverage. Most patients (78%) were satisfied by the operative results. Conclusion: It seems that using tissue expanders in tissue reconstruction of extensive neck and facial burn scars are associated with very good results. With this method, one can reconstruct the scars in a way that is associated with acceptable results in terms of beauty from the patient’s and his/her family’s points of view and improve the patient's appearance. Keywords: Reconstruction, Face and neck burn scar, Tissue expander.