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Principles of burn reconstruction: Face, scalp, and neck

Jorge Leon-Villapalos, MD, FRCS
Peter Dziewulski, MD, FRCS
Section Editors
Marc G Jeschke, MD, PhD
Charles E Butler, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


The goals of reconstructive surgery for the burn patient are first to restore function, then to restore aesthetic appearances. Nowhere else in the body is it more important to achieve good functional reconstruction matched with perfect cosmetic appearance than in the head and neck, and specifically the face.

Following resuscitation and stabilization, management of the burn wounds becomes the next priority. The later effects of burns, which are related to loss of normal tissue and scarring, include limitation of movement, pain, disfigurement, and social embarrassment [1].

The following are the basic tenets for reconstruction of burns to the face, scalp, and neck regions:

Replace like tissue with like tissue (eg, the best replacement for scalp tissue is the scalp) when possible.

Multidisciplinary, realistic, well-timed reconstructive plan discussed with the patient.

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Literature review current through: Nov 2017. | This topic last updated: Jul 25, 2017.
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  1. Shelley OP, Dziewulski P. Late management of burns. Surgery Oxford 2006; 24:15.
  2. Klein MB, Moore ML, Costa B, Engrav LH. Primer on the management of face burns at the University of Washington. J Burn Care Rehabil 2005; 26:2.
  3. Leon-Villapalos J, Jeschke MG, Herndon DN. Topical management of facial burns. Burns 2008; 34:903.
  4. Siemionow M, Gordon CR. Overview of guidelines for establishing a face transplant program: a work in progress. Am J Transplant 2010; 10:1290.
  5. Błogowski W. Facial transplantation as an option in reconstructive surgery: no mountains too high? ANZ J Surg 2009; 79:892.
  6. Gordon CR, Siemionow M, Papay F, et al. The world's experience with facial transplantation: what have we learned thus far? Ann Plast Surg 2009; 63:572.
  7. Khalifian S, Brazio PS, Mohan R, et al. Facial transplantation: the first 9 years. Lancet 2014; 384:2153.
  8. Gault D. Post traumatic ear reconstruction. J Plast Reconstr Aesthet Surg 2008; 61 Suppl 1:S5.
  9. Kamal A, Kamel, AH, el Oteify, M. Early management of the burned auricle. Annals of burns and fire disasters. 2004; 17: 197. www.medbc.com/annals/review/vol_17/num_4/text/vol17n4p197.asp (Accessed on August 18, 2010).
  10. Skedros DG, Goldfarb IW, Slater H, Rocco J. Chondritis of the burned ear: a review. Ear Nose Throat J 1992; 71:359.
  11. Mueller RV. Facial trauma: soft tissue injuries. In: Plastic Surgery, 2nd, Saunders Elsevier, Philadelphia 2006. Vol 3, p.33.
  12. El-Khatib HA, Al-Basti HB, Al-Ghoul A, et al. Subtotal reconstruction of the burned auricle. Burns 2005; 31:230.
  13. Yamada A, Imai K, Nomachi T, et al. Total reconstruction of the burned auricle. Burns 2007; 33:112.
  14. Wilkes GH, Wolfaardt JF. Osseointegrated alloplastic versus autogenous ear reconstruction: criteria for treatment selection. Plast Reconstr Surg 1994; 93:967.
  15. Gentile P, Bottini DJ, Colicchia GM, et al. Burns: bone-anchored, extra-oral implantology. J Burn Care Res 2008; 29:627.
  16. Thorne CH. Otoplasty and Ear Reconstruction. In: Grabb and Smith's Plastic Surgery, 6th, Lippincott Williams & Wilkins, Philadelphia 2007. p.302.
  17. Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg 1967; 39:472.
  18. Bialostocki A, Tan ST. Modified Antia-Buch repair for full-thickness upper pole auricular defects. Plast Reconstr Surg 1999; 103:1476.
  19. Smith SB, Coffee T, Yowler C, Steinemann TL. Risk factors for ophthalmic complications in patients with burns. J Burn Care Res 2010; 31:911.
  20. Warden, GD, Warner, PM. Chapter 62 Functional sequelae and disability assessment. In: Total burn care, p.783.
  21. Mandrekas AD, Zambacos GJ, Anastasopoulos A. Treatment of bilateral severe eyelid burns with skin grafts: an odyssey. Burns 2002; 28:80.
  22. Malhotra R, Sheikh I, Dheansa B. The management of eyelid burns. Surv Ophthalmol 2009; 54:356.
  23. Morley AM, deSousa JL, Selva D, Malhotra R. Techniques of upper eyelid reconstruction. Surv Ophthalmol 2010; 55:256.
  24. Rubino C, Farace F, Puddu A, et al. Total upper and lower eyelid replacement following thermal burn using an ALT flap--a case report. J Plast Reconstr Aesthet Surg 2008; 61:578.
  25. Lin SD. Correction of the epicanthal fold using the VM-plasty. Br J Plast Surg 2000; 53:95.
  26. Motamed S, Davami B. Eyebrow reconstruction following burn injury. Burns 2005; 31:495.
  27. Omranifard M, Doosti MI. A trial on subcutaneous pedicle island flap for eyebrow reconstruction. Burns 2010; 36:692.
  28. Gandelman M. Eyebrow and eyelash reconstruction. Operative Techniques in Oculoplastic, Orbital and Reconstructive Surgery 2001; 4:94.
  29. Ayhan M, Aytug Z, Deren O, et al. An alternative treatment for postburn microstomia treatment: composite auricular lobule graft for oral comissure reconstruction. Burns 2006; 32:380.
  30. Zweifel CJ, Guggenheim M, Jandali AR, et al. Management of microstomia in adult burn patients revisited. J Plast Reconstr Aesthet Surg 2010; 63:e351.
  31. Grishkevich VM. Post-burn microstomia: anatomy and elimination with trapeze-flap plasty. Burns 2011; 37:484.
  32. Hassanpour SE, Davami B. Reconstruction of nose and lips with tubed cervical flap in electrical injury: a case report. Burns 2005; 31:510.
  33. Sakurai H, Soejima K, Takeuchi M, et al. Reconstruction of perioral burn deformities in male patients by using the expanded frontal scalp. Burns 2007; 33:1059.
  34. Menick FJ. Nasal reconstruction with a forehead flap. Clin Plast Surg 2009; 36:443.
  35. Bey E, Hautier A, Pradier JP, Duhamel P. Is the deltopectoral flap born again? Role in postburn head and neck reconstruction. Burns 2009; 35:123.
  36. Stan V, Antohi N, Isac F, et al. Post-burn upper, mid-face and nose reconstruction using a unilateral extended superficial temporal artery-based flap. Burns 2007; 33:927.
  37. Hassanpour SE, Shariati SM. Simultaneous reconstruction of upper and lower lip beside chin and nasal lobule: in a case of facial chemical burn. Burns 2007; 33:522.
  38. Chou TD, Lee WT, Chen SL, et al. Split calvarial bone graft for chemical burn-associated nasal augmentation. Burns 2004; 30:380.
  39. Hafezi F, Karimi H, Nouhi A. Aesthetic septorhinoplasty in the burned nose. Burns 2005; 31:223.
  40. Sinha M, Scott JR, Watson SB. Prelaminated free radial forearm flap for a total nasal reconstruction. J Plast Reconstr Aesthet Surg 2008; 61:953.
  41. Tiwari VK, Sarabahi S. Starplasty: an ideal method for correction of occluded external nares following burns. J Plast Reconstr Aesthet Surg 2006; 59:1105.
  42. Cole JK, Engrav LH, Heimbach DM, et al. Early excision and grafting of face and neck burns in patients over 20 years. Plast Reconstr Surg 2002; 109:1266.
  43. Atherton DD, Tang R, Jones I, Jawad M. Early excision and application of matriderm with simultaneous autologous skin grafting in facial burns. Plast Reconstr Surg 2010; 125:60e.
  44. Dorsey ER, Voss TS, Shprecher DR, et al. A U.S. survey of patients with Parkinson's disease: satisfaction with medical care and support groups. Mov Disord 2010; 25:2128.
  45. Klein MB, Engrav LH, Holmes JH, et al. Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns. Burns 2005; 31:257.
  46. McGregor JC. Face reconstruction after a major burn using tube pedicles: a 46-year follow-up. J Plast Reconstr Aesthet Surg 2007; 60:331.
  47. El Gawad A, Goodenough J, McArthur P, et al. Facial resurfacing using tissue expanded neck skin as rotational advancement flaps: a case series. J Plast Reconstr Aesthet Surg 2010; 63:e648.
  48. Lu F, Gao JH, Ogawa R, Hykusoku H. Preexpanded distant "super-thin" intercostal perforator flaps for facial reconstruction without the need for microsurgery. J Plast Reconstr Aesthet Surg 2006; 59:1203.
  49. Gao JH, Ogawa R, Hyakusoku H, et al. Reconstruction of the face and neck scar contractures using staged transfer of expanded "Super-thin flaps". Burns 2007; 33:760.
  50. Elshaer WM, Enab AA, Elmanawi HM. Endoscopic tissue expansion placement in face and neck burn scar reconstruction. Burns 2011; 37:474.
  51. Dalay C, Kesiktas E, Yavuz M, et al. Coverage of scalp defects following contact electrical burns to the head: a clinical series. Burns 2006; 32:201.
  52. Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116:54e.
  53. Oishi SN, Luce EA. The difficult scalp and skull wound. Clin Plast Surg 1995; 22:51.
  54. Seitz IA, Gottlieb LJ. Reconstruction of scalp and forehead defects. Clin Plast Surg 2009; 36:355.
  55. Sakai S, Soeda S, Terayama I. Subcutaneous pedicle flaps for scalp defects. Br J Plast Surg 1988; 41:255.
  56. Orticochea M. New three-flap reconstruction technique. Br J Plast Surg 1971; 24:184.
  57. Yang CC, Lin SD, Lai CS, Chou CK. Reconstruction of children's scalp defects with the Orticochea flap. Ann Plast Surg 1992; 28:584.
  58. Juri, J.. Chapter 4 - Temporoparieto-Occipital and Temporoparieto-Occipitoparietal Scalp Flaps. In: Grabb's Encyclopedia of Flaps, 2009.
  59. Davis WH. Sideburn reconstruction with an arterial V-Y hair-bearing scalp flap after the excision of basal cell carcinoma. Plast Reconstr Surg 2000; 106:94.
  60. Iida N, Ohsumi N, Tonegawa M, Tsutsumi Y. Reconstruction of scalp defects using simple designed bilobed flap. Aesthetic Plast Surg 2000; 24:137.
  61. De Haro F, Giraldo F. Bipedicled fronto-occipital flap for reconstruction of postoncologic defects of the lateral scalp. Plast Reconstr Surg 2001; 107:506.
  62. Sharma RK, Tuli P. Occipital artery island V-Y advancement flap for reconstruction of posterior scalp defects. J Plast Reconstr Aesthet Surg 2010; 63:410.
  63. Ioannides C, Fossion E, McGrouther AD. Reconstruction for large defects of the scalp and cranium. J Craniomaxillofac Surg 1999; 27:145.
  64. Beasley NJ, Gilbert RW, Gullane PJ, et al. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg 2004; 6:16.
  65. Motamed S, Niazi F, Atarian S, Motamed A. Post-burn head and neck reconstruction using tissue expanders. Burns 2008; 34:878.
  66. Sharony Z, Rissin Y, Ullmann Y. Postburn scalp reconstruction using a self-filling osmotic tissue expander. J Burn Care Res 2009; 30:744.
  67. Abbas Khan MA, Chipp E, Hardwicke J, et al. The use of Dermal Regeneration Template (Integra®) for reconstruction of a large full-thickness scalp and calvarial defect with exposed dura. J Plast Reconstr Aesthet Surg 2010; 63:2168.
  68. Frodel JL Jr, Ahlstrom K. Reconstruction of complex scalp defects: the "Banana Peel" revisited. Arch Facial Plast Surg 2004; 6:54.
  69. Gil T, Metanes I, Aman B, et al. Six tissue expansion sessions of the scalp for reconstruction of post-burn alopecia. J Burn Care Res 2008; 29:390.
  70. Di Mascio D, Castagnetti F, Mazzeo F, et al. Overexpansion technique in burn scar management. Burns 2006; 32:490.
  71. Tsai FC, Mardini S, Chen DJ, et al. The classification and treatment algorithm for post-burn cervical contractures reconstructed with free flaps. Burns 2006; 32:626.
  72. Grishkevich VM. Trapeze-flap plasty: effective method for postburn neck contracture elimination. Burns 2010; 36:383.
  73. Frame JD, Still J, Lakhel-LeCoadou A, et al. Use of dermal regeneration template in contracture release procedures: a multicenter evaluation. Plast Reconstr Surg 2004; 113:1330.
  74. Ninkovic M, Moser-Rumer A, Ninkovic M, et al. Anterior neck reconstruction with pre-expanded free groin and scapular flaps. Plast Reconstr Surg 2004; 113:61.