title: Successful management of deep facial burns in a patient with extensive third-degree burns: the role of a nanocrystalline silver dressing in facilitating resurfacing.
abstract: Full-thickness burns of the face are notoriously difficult to repair and their management poses a series of problems to the surgeon. We present the case of a 49-year-old man (only survivor of a catastrophic airport accident) with third-degree flame burns to >80% of total body surface area and extensive face damage who achieved a fully satisfactory outcome after a treatment plan based on gradual escharectomy followed by application of artificial dermis and, later, grafting with sheets of cultured keratinocytes. Re-epithelialisation was already visible at day 16 after admission and all facial wounds were closed by day 56, the treatment continuing on the scalp. Within 6 months of the accident, the patient had recovered functional and cosmetic features (including re-growth of skin appendages) that were beyond expectations. The use of nanocrystalline silver-coated dressings during the escharectomy and resurfacing phases was important, as part of a multifaceted strategy, in ensuring excellent antimicrobial control, thus avoiding the need for autologous grafting and contributing to a rapid healing and complete restoration of the face and head skin.
authors.affiliation: Department of Tissue Therapy, Niguarda Ca' Granda Hospital, Milan, Italy. mario.marazzi@ospedaleniguarda.it
authors.forename: Mario
authors.initials: M
authors.lastname: Marazzi
authors.forename: Armando
authors.initials: A
authors.lastname: De Angelis
authors.forename: Adriano
authors.initials: A
authors.lastname: Ravizza
authors.forename: Marco N
authors.initials: MN
authors.lastname: Ordanini
authors.forename: Leonarda
authors.initials: L
authors.lastname: Falcone
authors.forename: Anna
authors.initials: A
authors.lastname: Chiaratti
authors.forename: Francesca
authors.initials: F
authors.lastname: Crovato
authors.forename: Donata
authors.initials: D
authors.lastname: Calò
authors.forename: Silvio
authors.initials: S
authors.lastname: Veronese
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rapisarda
mesh_terms: D001458:Bandages; D002056:Burns / Q000628:therapy*; D002478:Cells, Cultured; D005151:Facial Injuries / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D015603:Keratinocytes / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000627:therapeutic use*; D011095:Polyethylenes / Q000627:therapeutic use*; D017768:Skin, Artificial
chemical_list: C117408:Acticoat; D011091:Polyesters; D011095:Polyethylenes