title: Reconstructive Management of Devastating Electrical Injuries to the Face.
abstract: BACKGROUND
  Devastating fourth-degree electrical injuries to the face and head pose significant reconstructive challenges. To date, there have been few peer-reviewed articles in the literature that describe those reconstructive challenges. The authors present the largest case series to date that describes the management of these injuries, including the incorporation of face transplantation.
  
  
  METHODS
  A retrospective case series was conducted of patients with devastating electrical injuries to the face who were managed at two level-1 trauma centers between 2007 and 2011. Data describing patient injuries, initial management, and reconstructive procedures were collected.
  
  
  RESULTS
  Five patients with devastating electrical injuries to the face were reviewed. After initial stabilization and treatment of life-threatening injuries, all five underwent burn excision and microsurgical reconstruction using distant flaps. Two of the patients eventually underwent face transplantation. The authors describe differences in management between the two trauma centers, one of which had the availability for composite tissue allotransplantation; the other did not. Also described is how initial attempts at traditional reconstruction affected the eventual face transplantation.
  
  
  CONCLUSIONS
  The care of patients with complex electrical burns must be conducted in a multidisciplinary fashion. As with all other trauma, the initial priority should be management of the airway, breathing, and circulation. Additional considerations include cardiac arrhythmias and renal impairment attributable to myoglobinuria. Before embarking on aggressive reconstruction attempts, it is advisable to determine early whether the patient is a candidate for face transplantation in order to avoid antigen sensitization, loss of a reconstructive "lifeboat," surgical plane disruption, and sacrifice of potential recipient vessels.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Columbus, Ohio; Dallas, Texas; and Boston, Mass. From the Departments of Plastic Surgery of Ohio State University Wexner Medical Center, the University of Texas Southwestern Medical Center, and Harvard Medical School.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Janis
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khansa
authors.forename: Craig R
authors.initials: CR
authors.lastname: Lehrman
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
mesh_terms: D000293:Adolescent; D000328:Adult; D002058:Burns, Electric / Q000601:surgery*; D005151:Facial Injuries / Q000601:surgery*; D054445:Facial Transplantation / Q000379:methods*; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult