الفهرس 
SURGICAL ANATOMY OF FACIAL SKINOnly 14 pages are availabe for public view
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Abstract
T
he face is considered the window of our identity and the door through which others recognize us. It is fair to say, that the distinctive look of our faces define us, to and from others. Therefore, aesthetic reconstruction of the face is no longer a luxury, but a must.
Major Burns are amongst the worst injuries that a person may suffer with devastating functional as well as aesthetic effects.
Burns do not need to be extensive to cause significant aesthetic deformities or functional disabilities. Even a small burn poorly managed over an eyelid, oral commissure or over a single finger can be highly troublesome.
Severe contractures after burns cause gross facial deformity and severe functional disability. Goals of reconstruction are to obtain full range of neck movements and to restore the aesthetic appearance to the face and neck.
Color patches, small brides, hypertrophic and badly suited scars are the most common secondary problems that need revision, its incidence is increasing annually.
The tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. Contraction of the wound is a normal physiologic process of every wound, retraction is the consequence of contraction over the surrounding tissues and contracture is the final result of a vicious process of healing over joint areas affecting the function as well as the aesthetics of the surrounding area. Contractures should be treated by surgery and assisted by physiotherapy.
As aesthetic problems are the main concern in developed regions, in developing ones though aesthetics are also important, functional impairment is the first objective for surgery.
The best way to avoid secondary contractures is to prevent them, unfortunately, until primary care is universally dispended, surgeons will need to learn how to manage all these secondary contractures.
In this research the basis of wound healing and very especially the principles for the repair of extensive defects with flaps will be revealed.
Patient’s satisfaction versus surgeon’s satisfaction; this balance should always tip down towards the patient especially in facial reconstructive surgery.
Reconstructive techniques should no longer be restricted to the surgeon’s preference, but they should be tailored for the patient’s needs, expectations, co-morbidity, work conditions, and patient’s choice.
When planning an excision of facial post burn contracures, the surgeon should bear in mind several points regarding the aesthetic units and subunits of the face, placement of incisions, available reconstructive options, and above all the expectations of his patient.
The reconstructive ladder ceased to solve reconstructive options in the face in a classic way (i.e., the more complex the wound, the more complex the reconstruction). The reconstructive options are rather chosen according to the best aesthetic outcome.
Local flaps are considered to be the best option in most reconstructive cases.
Microvascular free flaps could be an option when local and regional conditions made the use of local and regional flaps an impossible procedure.
Tissue expanders not only give the opportunity to expand the skin and subcutaneous tissue to be used as a flap, but also the expanded skin can be equally used as a full thickness skin graft that will retain almost the same characteristics of the target area without deteriorating the donor region.
Facial allograft transplantation is considered a leap into the future of reconstruction, with many ethical, psychological, scientific, and identity issues need to be addressed.
Pressure therapy, Silicone gel sheeting, Intralesional injections of Corticosteroids, Cryotherapy, Radiotherapy, Laser therapy are of the new non-surgical methods for management of post burn contractures.