Refining facial burn care: How the management of facial burn injuries has changed over the last decade

Dr Andrea Issler-Fisher1,2,3, Dr Nicola Clayton1,4,5,6, Prof Peter  Maitz1,2,3

1Burns Unit, Concord Repatriation General Hospital, Sydney, Australia, 2ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia, 3Concord Clinical School, University of Sydney, Sydney, Australia , Sydney, Australia, 4Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia, 5School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia 6 Faculty of Health Sciences, University of Sydney, Sydney, Australia, 6Faculty of Health Sciences, University of Sydney, Sydney, Australia


Background: Severe burns to the face remain challenging due to resulting disfigurement and functional compromise. Circumoral burns may manifest as microstomia, leading to compromised airway&oral intake, whereas periorbital burns can manifest as eyelid ectropia with risk of ocular damage. Treatment approaches of panfacial burn injuries continue to evolve in line with advances in medical&surgical technology. We aimed to examine our surgical and non-surgical practices over the past decade (2010-2020) to describe the change in panfacial burn treatment patterns and how they relate to functional and aesthetic outcomes.

Methods: A case series review of panfacial burn treatment modalities (surgical and non-surgical) was conducted. Endpoints included primary burn wound treatments, dressing products utilised, surgical and non-surgical procedures as well as functional&aesthetic outcomes.

Results: The series illustrates a shift in facial burn management at Concord Hospital over the past decade. The transition from early grafting with reconstructive surgery, to the use of bio-engineered products with optimised wound care, to early ablative fractional laser therapy in conjunction with refined approaches of non-surgical scar management. The resulting effects of multidisciplinary&multimodal approaches seems to favour more recent adaptations due to optimised functional&aesthetic outcomes.

Conclusion: Treatment approaches of panfacial burn injuries have shifted from early grafting&surgical releases to restore facial function to a more multimodal, proactive &minimally invasive approach. Utilizing recent medical advancements, increased understanding of burn wound healing, as well as the underlying mechanisms of scar development, it is now possible to minimize surgical morbidity of facial burn injuries.


Dr. Andrea Issler-Fisher has over 10 years of surgical experience with a main focus on Burns & Reconstructive surgery.  She is passionate about scar reconstruction and has been the clinical lead of the Burns Scar Clinic at CRGH since 2015. Andrea is interested in novel scar modulation techniques, including ablative fractional CO2 laser. She is a Clinical Senior Lecturer University of Sydney, and recently submitted her PhD-thesis on: “Ablative Fractional Resurfacing for Burn Scars & the Impact on Reconstructive Burn Surgery: Exploring the Effects of a Novel Treatment Paradigm”.

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