What is the initial evaluation and treatment of facial burns?

Updated: Jan 10, 2018
  • Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Especially in adolescents and adults, the deep sweat and sebaceous glands of the central face make it likely that most second-degree burns will heal well with adequate topical wound care. Many reasonable management options are available, including topical silver sulfadiazine or bland antibiotic ointments. [43] Burns around the eyes can be dressed with topical ophthalmic antibiotic ointments. [19] If grafting is a possibility, reserve thick donor skin with optimal color match for facial resurfacing. [46] Often, the "blush" areas, such as the upper back and shoulders, make good facial donor sites.

The most important point of early management of deeply burned ears is prevention of auricular chondritis. This is a serious complication in which the cartilage becomes infected and quickly liquefies. Twice-daily cleansing and the application of topical mafenide acetate, which penetrates the eschar, can minimize the condition. Subsequent management of the ear is based on the depth of injury.

Deep corneal burns are obvious during the physical examination. [19] The cornea has a clouded appearance. More subtle injuries can be detected only with topical fluorescein application. After facial edema resolves, lid retraction may occur with variable degrees of exposure of the globe or ectropion. When this is relatively mild, no intervention is required beyond ocular lubricants. Should keratitis occur, early lid release is advised.


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