Brandon A. Bosque, DPM, Highlights the Challenges of Facial Burns

In an interview with Wound Care Learning Network, Brandon A. Bosque, DPM, Aroa Biosurgery, spoke about challenges encountered when treating facial burns, especially when considering thinner facial tissue and airway management. Brandon A. Bosque, DPM, works as the Medical Science Liaison at Aroa Biosurgery. Dr. Bosque is highly trained in all facets of foot and ankle medicine and surgery treating patients of all ages. With a particular interest in sports medicine, biomechanics, and custom orthotics, he regularly utilizes state-of-the-art, modern treatment options such as the use of stem cells, PRP injections, laser, and hyperbaric oxygen therapy.

Q: Why are facial burns challenging to treat? Please consider facial coverage, the thinner tissues of the eyelid and lip, and airway management.

A: Facial burns have a whole host of challenges, both acute and long-term. The first, and most obvious, is that clinicians know when treating severe burns, the 2 most important proponents are fluid resuscitation as well as airway management. It is important to remember that the portal or the opening for the airway is affected when a patient sustains a severe burn to anatomical areas involving the face, head, and neck. Those areas of the body make accessing and maintaining an open airway very challenging for first responders when there is a burn to the face, head, and neck area.

The second aspect is the unique contours of the face, which makes a good, well-contouring secondary bandage, but it is difficult to place. If a patient sustains a burn to a limb (arm or leg), the limb can be wrapped and maintained with bandages; however, the facial region is much more difficult because of the unique contours of the face. Clinicians want to leave openings in the bandaging, to allow for the patient to see, breathe, and hear, which adds a new challenge that you might not otherwise think of when you are simply applying bandages to those regions.

The face is well-vascularized, which lends to adequate healing—a great mechanism—but clinicians know there are some unique epithelial and soft tissue compositions of the face. Like I previously mentioned, the eyelids and lips, with their thinner layers of epidermis, are challenging. The stratum corneum or the outermost layer of the epidermis, which is the most protective layer, tends to be a lot thinner on the eyelids and lips compared with other areas of the skin.

Those are some of the challenges in the short term when treating facial burns, but the long-term challenges include the physical appearance or facial identity and how it is linked to a person’s sense of self. If a patient has a severe facial burn, it could be disfiguring. It could also lead to posttraumatic stress, mental health disorders, social withdrawal, or social stigmatization for the patient. Receiving timely and advanced treatments to treat burns on the face to minimize thick, painful, disfiguring scars is very important for the long-term prognosis of mental health, let alone the physical health of patients. Facial burns could be devastating injuries, so it makes cost-effective and clinically effective treatment options very important to these patients; hopefully, successful treatment outcomes will help the patient lead a happy, joyful life.

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