Late Outcomes After Grafting of the Severely Burned Face
Bibliographic record
Abstract
Many approaches to surgical management of the severely burned face are described, but there are few objective outcome studies. The purpose of this study was to perform a detailed evaluation of the late outcomes in adult patients who have undergone grafting using a standardized surgical and rehabilitation approach for full-thickness (FT) facial burns to identify areas for improvement in the treatment strategy of authors. This was a prospective observational study in which patients who had undergone grafting for FT facial burns by the senior investigator at a regional burn centre between 1999 and 2010 were examined by a single evaluator. The surgical approach included tangential excision based on the facial aesthetic units, temporary cover with allograft then autografting with scalp skin preferentially, split grafts for the upper eyelid, and FT grafts for the lower eyelid. Rehabilitation included compression (uvex and or soft cloth), scar massage, and silicone gel sheeting. Of 35 patients with facial grafts, 14 subjects (age 43 ± 16 years with 22 ± 21% TBSA burns) returned for late follow-up at 40 ± 33 months (range, 5-91 months). A mean of four facial aesthetic units per patient were grafted (range, 1-9 units), with six full facial grafts performed. Scalp was used as donor in 10 of 14 cases. Scalp donor sites were well tolerated with minor alopecia visible in only one case although the donor site visibly extended slightly past the hairline in two cases. Color match with native skin was rated at 8.8 ± 0.8 of 10 when scalp skin was used compared with 7.5 ± 1.6 with other donor sites (P = .06). On the lip and chin, hypertrophic scars were significantly worse compared with the rest of the facial grafts (Vancouver scar scale 8 ± 2 vs 3 ± 1, P < .01). Sensory recovery was poor with overall moving two-point discrimination at 11 ± 3 mm (range, 4-15 mm), and monofilament light touch was 3.8 ± 0.6. Graft borders were significantly more elevated than graft seams. On the forehead, the most notable problem was a gap between the graft and hairlines of the frontal scalp and eyebrows (range, 0-40 mm). Grafted eyelids required one or more subsequent ectropion releases in the majority of cases. The most common problem for the nose was asymmetry of the nostril apertures. The most problematic late outcomes that the authors identified after facial grafting for FT facial burns included relatively poor sensory return, elevation of graft edges, eyelid ectropion, gaps between grafts and hairline, and marked hypertrophic scarring around the mouth and chin. The results indicate that possible areas for quality improvement include greater attention to the limits of scalp harvest, more attention to pressure application to graft borders and the lip and chin during rehabilitation, greater accuracy in excision and graft placement on the forehead to avoid gaps with the hairlines, and counseling of the patient regarding the high probability of diminished facial sensation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".