Traitement des séquelles de brûlures : brûlures de la face

As a result of the development of tissue expansion techniques, the surgical treatment of facial burn sequelae has been substantially improved over these past 20 years: expanded skin is used for the reconstruction of aesthetic zones of the face, as full-thickness skin grafts and expanded local flaps. In order to complete cosmetic results, tissue expansion should be associated with aesthetic surgical techniques such as rhinoplasty, lifting, autologous fat injection or tattooing. Satisfactory social life is recovered only after multiple surgical interventions and long-term rehabilitation and physiotherapy.     

Traitement des séquelles de brûlures : généralités

Management of burn sequelae must comply with two fundamental therapeutic principles: the first is functional, the other cosmetic. Surgical reconstruction of such lesions may be considered after scar maturation is achieved. During the maturation process, the use of specific drugs may be helpful in treating some of the symptoms associated with burn sequelae. Crenotherapy may improve the softness of the scars and facilitate subsequent surgery. Early surgery may be considered in a child when growth is likely to be compromised or in case of functional impairment due to burn sequelae. Local flaps and full-thickness grafts are the most commonly used means for the surgical correction of burn sequelae, whatever the time necessary for their management.     

Évaluation de la qualité de l’os dans les allogreffes de main

Five bilateral forearms allograft have been performed between January 2000 and July 2009 in Lyon (France). The first four patients (three males, one female) have been the subject of an assessment of the bone quality of those allografts. The techniques selected for this study were: radioclinical analysis, bone scintigraphy, MRI, bone densitometry and High Resolution peripheral Quantitative Computed Tomography (HR-PQCT). Histology has been performed only on the first patient unilaterally grafted in 1998 who did not take part in this clinical research protocol, after amputation of his rejected graft. On the clinical, radiological and scintigraphical aspects, donor bone integration in hands allograft are good on a macroscopic point of view considering the healing and the general reaction of the bone in situation of fractures, infection and growth. The scintigraphy does not show important variations compared to the ones we can observe on contact with osteosynthesis material or during bone autografts. MRI found neither focal nor periosteal anomaly on grafted bone. The bone densitometry did not show significant difference with secondary osteoporosis one can observe in other grafted patients under immunosuppressive treatment. The HR-PQCT showed for the three males patients, a higher loss in volumetric density, for grafted bone than in the recipient patient control skeleton. Due to the few patients of this series, and the discrepancies in follow-up duration, the presented data have to be confirmed with further studies.