Rebuilding the burned face.

Many of the methods and techniques used throughout the whole field of reconstructive plastic surgery owe their origins to problems first encountered in the severely burned patient. Gillies first used the tubed pedicle flap in reconstructing the face of a naval seaman burned in World War I. Axial pattern flaps such as the deltopectoral are widely used in the treatment of head and neck cancer and the one-stage free flap obviously has an exciting future. In many burned patients such flaps cannot be utilised owing to the non-availability of suitable vessels in either donor or recipient areas. Random pattern flaps such as the tube pedicle must therefore continue to play an important role in treating these cases. The plastic surgeon who undertakes the repair of the burned face must have wide experience of all methods of tissue replacement, whether by free graft or flap transfer. In resurfacing the nose the author has used Wolfe grafts when the cartilages are not involved or a tubed flap from the arm if this is not so. A long tubed pedicle flap from the back is preferred for resurfacing the chin and upper neck providing contour as well as excellent skin cover. Some extremely deep burns such as occur in epileptics or alcoholics may need bone-grafting, and the help of a good prosthetics department will be needed when the orbit has been destroyed.