Combined technique of anesthesia in early and late neck reconstruction.

Once the notion of the "quality of life" has been used in deliberations about straight-forward cases, it may be given wider application. It may be invoked in intensive care, in care of the handicapped and in any of medicine's specialist areas. In severe burns to keep the patient alive occurs at the cost of a degree of discomfort and disability caused by scar formation and following deformities. Severe anterior neck burn scar contracture issues in serious functional embarrassment, requiring early neck reconstruction based on three principles: releasing shrinked area, restoring contour of the mento-collical angle and preventing recurrence. Performing the surgical procedure demands endotracheal intubation which is impossible to accomplish because of chin adherent to jugulum. Combined technique of anesthesia using intravenous introduction (Ketalar) with or without local infiltration of the anterior neck scarring and immediate cutting through to the healthy muscle layer is necessary. Then follows insertion of endotracheal tube. The interval between incision and insertion may be rather crucial, as will be demonstrated in one of the cases treated in the Prague Burn Center during the last two decades.