When considering the aesthetic reconstruction of post-burn facial scarring which has resulted in extensive textural abnormality but no deformity of anatomical features, which of the following would be your method of choice for skin resurfacing?
A. Full thickness excision in anatomic units and grafting with thick split thickness grafts using multiple quilting suturesSequential dermabrasion of entire sections of the face (lower, middle, upper third) and application of sheets of medium thickness skin using tissue glue and steri-strip fixation and no sutures. As in many aspects of reconstructive surgery there will be individuals who have a strong preference for certain strategies. In this question the problem of extensive textural abnormality is the focus of concern. As such, any extensive full thickness skin/scar excision will carry a significant risk of scarring secondary to infection and impaired healing. The alternative is to keep the bulk of the dermal matrix and to flatten the textural abnormality with dermabrasion or ablative laser therapy. Mechanical dermabrasion does carry health risks because of the associated aerosol spray but the use of protective masks and screens can prevent contamination. Using sequential dermabrasion of entire sections of the face and applying intact sheets of medium thickness graft and using an atraumatic fixation technique, optimal results can be achieved.