When considering burn reconstruction of the head and neck where the eyes, nose, mouth, ears and scalp are all significantly involved what would be the usual order for priority of reconstruction?a. Eyes, ears, nose, mouth, scalp
Eyes, mouth, scalp, nose, ears. Prioritizing is very important in reconstructive burns surgery and the concept of a ‘shopping list’ of problems is well established. In terms of anatomy, it is possible to look at problems objectively or, in terms of the patient’s perception of disability and deformity, it is possible to look at problems subjectively. In this question, we are focusing on the head and neck with involvement of a number of anatomical features. When we consider prioritizing the reconstructive strategy we have to look at the seriousness of the consequence(s) of the scarring and in this context the loss of vision must be considered the number one complication to avoid. The second complication of greatest significance would be loss of oral continence if there is lip ectropion or poor feeding and vocalisation if there is microstomia. There will always be debate about the priority of the other features but a general consensus would agree with eyes first, mouth second.