Annales de chirurgie plastique et esthétique
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Hand burns are common. Aesthetic and functional consequences are mixed together. ⋯ Hand burns are frequent. Functional sequelae are often important: retractions, amputations. The orthopaedic treatment of these retractions is unspecific. We often use collagen substitute in our unit. The patient must be involved in his treatment, because it is very long and difficult.
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The use of microsurgery in the management of burn sequelae is not a new idea and free flaps have been used in this context since the 1970s. New technologies like negative pressure treatment and skin substitute have certainly decreased the indication of free flaps. ⋯ From a technical point of view, they find that realizing a free flap for these patients is more complicated (venous damage, lack of donor site who has been burned…). Despite this, microsurgery must still belong in the decision tree and there are some irreplaceable indication specially for hand reconstruction.
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Cervical and facial burns can be responsible of social and professional exclusions, functional limitations and psychological repercussions. Composite allotransplantation has become a reality for complex facial reconstructions. The purpose of this study is to evaluate the sequelae of third degree facial burns that might fit into a facial transplant program. ⋯ Third degree burns sequelae concerned mainly the neck and the lower third of the face. The indication of facial allotransplantation remains rare in the burn patient. The deep carbonisation and the very extensive burn patient with severe functional sequelae where the standard reconstructive procedures are inefficient might be eligible for a facial allotransplant program.
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The external ear is a complex, delicate structure and treatment of burned ears should not be neglected. We will detail the different scenarios a surgeon can encounter and present a therapeutic algorithm. ⋯ Reconstruction of one or both ears is often the last step in a rehabilitation process after burns. It is ideally performed after wound healing has been achieved, and by a team well trained in microtia treatment and post-traumatic reconstruction.
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Burn contractures are common after deep burns of the limbs. When rehabilitation fails to restore joint function and normal range of motion, surgical contracture release should be performed. ⋯ Surgery can also be used in case of esthetic concerns. Available surgical techniques and indications are presented.