RESUMO
Background: Eyebrows play an important role in protecting the eyes, and also transmit facial expression. Restoration of eyebrow loss after deep thermal burns is a challenging task because a scarred recipient area may affect the success rate of the hair transplantation outcome. Trials to improve this outcome via preparation of pretransplantation recipient area are mandatory. Methodology: Seventeen patients (20 eyebrows) with partial or total postburn eyebrow loss were recruited. Nanofat injection was done as a preparatory step before hair transplantation. Patients were followed up monthly for 6 months after follicular unit extraction. The outcome was assessed both objectively by phototrichoscopy and patient satisfaction, and by incidence of complications. Results: The mean eyebrow density of the recipient side was found to be 88.60â ±â 29.96 hair follicle per cm2, compared with 133.95â ±â 38.38 on the control side. The mean eyebrow thickness of the recipient side was found to be 0.07â ±â 0.01 mm, compared with 0.06â ±â 0.01 on the control side, The overall satisfaction was 60% regarding the density, 80% regarding direction, and 65% regarding symmetry. However, when it comes to texture, 45% were satisfied. Conclusions: Restoration of eyebrow loss after deep facial burn is a challenging procedure. Improving the recipient area before hair transplantation is recommended to achieve a satisfactory outcome. Waiting until maturation of the scarred tissue of the recipient area and preparation of it with nanofat can achieve a satisfactory outcome.
RESUMO
BACKGROUND: Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique. PATIENTS AND METHODS: A prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS - Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively. RESULTS: The percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer's overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001). CONCLUSION: The Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive.
