Management of pediatric facial burns.

The acute management of pediatric facial burns is not uniform. Many surgeons prefer to wait until primary wound separation occurs before grafting. Concerns over early excision are accentuated in small pediatric patients. The possible benefits of early excision results have led to adoption of this technique at our facility. This study presents our recent experience with early excision and grafting. Sixty-six patients with a mean age of 6.2 years underwent early excision and grafting of facial burns. Patients underwent grafting a mean 12.7 days after burn. Procedures were done in two stages. All grafts were dressed open. There were no episodes of acute airway decompensation. No patient required regrafting. Patients wore pressure masks a mean of 15.5 months after grafting. Thirteen patients had releases (10 eyelids, three lips/commissures) in the first postoperative year. These results demonstrate that early excision and grafting of facial burns can be carried out safely in pediatric patients with burns. The benefits of early wound coverage can thus be applied to facial burns in this population of patients.