Surgical Treatment of Facial Soft-Tissue Deformities in Postburn Patients: A Proposed Classification Based on a Retrospective Study

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Background:Postburn soft-tissue defects or scars can cause disfigurement and functional impairment and constitute a major therapeutic challenge. In the past 30 years, developments in reconstructive techniques have improved the treatment outcomes. However, these techniques are selected mainly according to the surgeon’s preference. There is no classification for postburn facial deformities that might contribute to high-level evidence and optimize management.Methods:The authors reviewed the clinical cases of preexpanded local flaps, perforator flaps, and prefabricated flaps between January of 2005 and September of 2012 in their unit. Deformities were categorized according to their size and location, in accordance with the concept of facial aesthetic units, to show the relationship between different deformities and the indicated surgical techniques. The findings were assessed to develop a classification system.Results:The study included 174 patients with facial deformities ranging from partial unit to total face defects. The authors classified postburn facial skin and soft-tissue deformities as follows: type I, single partial unit defect; type II, total unit defect or deformities that partially involved two adjacent units; type III, multiunit defects; and type IV, total/subtotal defects. The authors recommended reconstructive techniques for each deformity and developed a system to score postoperative aesthetic and functional improvements.Conclusions:The authors have proposed a classification and scoring system for postburn facial deformities that will aid in the selection of reconstructive techniques. The proposed systems may facilitate multicenter studies with high-level evidence and improve the outcomes of postburn patients.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

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