Reduction mammaplasty in postburn breasts.

Thermal injury to the anterior chest in the adolescent girl can lead to severe disfigurement of the breasts. Just as in certain non-burn female patients, mammary hyperplasia can occur in patients with previous full-thickness burns of their breasts. Most plastic surgeons have been reluctant to perform reduction mammaplasty in these patients for fear of devascularizing the skin graft or the nipple-areola complex. A series of six patients with full-thickness burns of the breasts and subsequent skin graft coverage before reduction mammaplasty is reported. Four patients had bilaterally burned breasts requiring reduction. Two patients had one burned breast reduced, and one required a balancing procedure on the unburned side. Reduction mammaplasty was performed using the inferior-pedicle technique. The mean amount of tissue removed for the left and right breasts was 454 and 395 g, respectively. There was no nipple loss, hematoma, infection, or major loss of skin flaps. Reduction mammaplasty in this group of patients is safe and carries minimal risk if certain key concepts are followed carefully.

Total eyelid reconstruction with free dorsalis pedis flap after deep facial burn.

A case of severe facial and corneal burns with complete loss of upper and lower eyelids is reported together with the acute management and surgical options for total eyelid defects secondary to thermal injury. An acutely burned man with 78 percent total burn surface area presented with complete exposure of the left cornea. Because of the severe thermal injury, no facial tissues were available as donor sources for reconstructing the eyelid. A free dorsalis pedis flap was used to cover the exposed cornea after bilateral conjunctival advancement flaps, with septal cartilage graft for structural support. A conjunctivodacryocystorhinostomy was performed at the time of the coverage. The patient was unable to perform an exact visual acuity test; however, his gross vision was intact.

The role of computed tomographic scanning in the management of facial trauma.

OBJECTIVE: To determine how often the management of patients with blunt facial trauma was altered by plain roentgenograms or facial computed tomographic (CT) scans compared with findings from physical examination. METHOD: This is a retrospective review of consecutive patients admitted with blunt facial trauma and evaluated by the Division of Plastic Surgery from 1988 to 1994. Physical findings were correlated with fractures detected by plain roentgenograms or facial CT reports. Treatment plans were reviewed to determine how management was altered by radiographic studies. Hospital charges were determined for the various studies. RESULTS: One hundred thirty-seven records were reviewed. Thirty patients had only lacerations and no fractures. Two hundred forty-three fractures were detected on physical examination among 98 patients (91.5%). One hundred two patients (95.3%) had facial CT scans and 85 patients (79.4%) had facial plain films obtained. Radiographic findings identified a total of 255 fractures among 107 patients (78%). Ninety-four patients (87.9%) required operative interventions for these facial fractures. Only 19 patients (17.8%) had management altered by radiographic findings: CT scan (7 patients) and plain films (12 patients). The management of 88 facial fractures (34.5%) in this series did not appear to be altered by x-ray findings. Computed tomography was most beneficial in the management of orbital fractures (N = 7). Plain films affected mostly the evaluation of mandibular injuries (N = 7). Selective use of CT scan could lead to hospital savings estimated at $11,864 for the diagnosis of facial fractures after blunt trauma. CONCLUSION: Physical examination reliably assessed the facial skeleton for clinically significant fractures in the majority of patients. In an alert and cooperative patient, CT scan is not required before operative repair in all cases. CT scans are expensive, time-consuming, and labor-intensive and in selected cases add little clinical information to that obtained by physical examination and plain films.