http://news.bbc.co.uk/2/hi/health/3736874.stm

Surgeons 'rebuild' patient's face

A piece of skin from the burn patient's back was used, the American Society of Plastic Surgery conference heard.

Standard practice is to use several skin grafts, but this is not always successful, especially if the burn has caused severe damage to the face.

UK experts said the finding offered hope for other burns patients.

A 54-year old man was treated by the team at Tokyo's Metropolitan Hiroo Hospital after sustaining severe burns from gasoline which affected his face, neck, chest and arms.

He was initially given skin grafts to close the wound and a tracheotomy to help him breathe. However he was left with a partial loss of his nose and severe damage to his ears.

In the study, doctors "stretched" skin on the patient's back using a tissue expander - where a silicone balloon expander is inserted under the skin and filled with salt water, causing the skin to stretch and grow - for six months.

The patch of skin had its own unique blood supply.

'Ability to smile'

Surgeons removed the scarred facial skin, removed the skin flap, measuring 28 by 27cm from the back, and transferred it to the face.

The patient before his surgery
The patient before his surgery
It was large enough to cover the face completely. Uniquely, it had extra tissue to create a nose.

In the past, burns patients have required separate surgery to create a nose, increasing trauma for the patient, and the risk they will experience physical damage such as scarring and infection around the site that the skin is taken from.

The arteries and veins supplying the skin flap were connected to those of the neck and face.

The team closed the donor site on the back and, because the skin had been expanded, they were able to do so without having to take skin grafts from the leg to close the wound, eliminating huge scars that accompanied previous techniques.

The team, led by Dr Hiroyki Sakurai, said: "To our knowledge, this is the first case of a successful total face reconstruction, including the nose, with one flap."

Dr Thomas Stevenson, president of the Plastic Surgery Educational Foundation and a member of the American Society of Plastic Surgeons, said: "The difficulty with previous techniques was harvesting a thick, uniform piece of skin and closing the wound where the incision was made, to minimise scarring.

"Through this combination of surgical techniques, a burn patient has only one operation rather than multiple procedures, reducing pain and recovery time."

He added: "Many burn patients who successfully complete facial reconstruction can close their eyes again, relieving the dryness around their eyes.

"They stop drooling because their lips have been rebuilt, and they can finally smile."

Dr Stevenson said: "By rebuilding the face, they can feel better about themselves and are more accepted socially once their abnormality is less dramatic.

"This procedure is an important step to help burn patients overcome their trauma."

'Very useful'

Mr Peter Baxter, a consultant plastic and reconstructive surgeon at the Royal Free Hospital in London, told BBC News Online: "This shows that it is a viable option for patients with severe facial injuries.

The site where the skin was removed from
The skin was taken from the patient's back
"Often people are very sick after suffering acute burns, they may be in the intensive care unit, and be on a ventilator."

Mr Baxter said UK surgeons had the technology and expertise to carry out the procedure.

He added: "It may not be something that is appropriate for all patients, but it is certainly something that could be considered."

Iain Hutchison, head of the Facial Surgery Research Foundation's clinical research centre in London, said the team had used existing techniques, such as tissue expanding, to achieve their success.

"They have achieved something which could be very useful indeed.

"The good thing about it is that is has obviated the need for face transplants, where the face is taken to someone else. It takes away the inherent problems with transplants such as the need for immunosuppressant drugs."

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