title: Management of 2nd-degree facial burns using the Versajet(®) hydrosurgery system and xenograft: a prospective evaluation of 20 cases.
abstract: BACKGROUND
  There is no single therapeutic scheme for the management of intermediary 2nd-degree facial burns, which can cause problems because of their uncertain course. It is preferable to obtain optimal healing of the face in order to avoid functional or cosmetic sequelae. Some practitioners recommend early excision (first week) of these burns, whereas others prefer to wait and perform surgery later (after 2 weeks). The practice in our burns unit is early surgery (from the first week) associated with hydrosurgical excision and application of a biosynthetic dressing (xenograft). A prospective follow-up of 20 cases was carried out to evaluate the efficacy of our protocol.
  
  
  METHODS
  The prospective evaluation was performed with follow-up at 2 weeks and 3, 6 and 12 months. The patients included had intermediary 2nd-degree burns on at least 15% of the face and no life-threatening prognosis. The mean age in our series was 40.5 years (16-72), the mean percentage of burn surface area was 27.75% and the mean percentage of facial burn was 60.75%. Early excision was performed (day 5-10) using the Versajet(®) system, which allows tangential water-dissection. Porcine xenograft (E-Z Derm(®)) was applied immediately afterwards. Patients whose healing process was not complete at 2 weeks were then scheduled to receive a thin autograft. Patients were followed up 2 weeks, 3, 6 and 12 months after discharge.
  
  
  RESULTS
  Excision was performed at a mean 7.6 days, and mean initial healing time was 13.4 days. In three cases, a full-thickness skin graft was used, whereas healing occurred in the other patients without further grafts. Two patients had functional sequelae (ectropion) corrected later by repair surgery. The course of healing for the other patients proceeded normally.
  
  
  CONCLUSIONS
  There is no consensus about the management of intermediate depth 2nd-degree facial burns. We chose to perform early surgery using the Versajet(®) system, which allows fine, precise excision, leaving nearly all of the healthy tissue in place. The Versajet(®) is particularly adapted to facial contours and is clearly more efficacious than the customary dermatomes. The use of a xenograft may augment facial healing while reducing the number of dressings and lessening patient discomfort. Our protocol provides the advantages of early management (limitation of functional sequelae, reduced hospitalization time), while avoiding too extensive or deep an excision through use of the Versajet(®).
authors.affiliation: Service de chirurgie plastique et reconstructrice, Centre des brûlés, Hôpital Jean Monnet, CHU de Nantes, 44093 Nantes Cedex 01, France. franck.duteille@chu-nantes.fr
authors.forename: Franck
authors.initials: F
authors.lastname: Duteille
authors.forename: Pierre
authors.initials: P
authors.lastname: Perrot
mesh_terms: D000328:Adult; D000368:Aged; D001458:Bandages; D002056:Burns / Q000601:surgery*; D003646:Debridement / Q000295:instrumentation; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult