CONSEQUENCES OF BURN INJURY OF ADNEXA IN CHILDREN. THE EFFECTIVENESS OF SURGICAL TREATMENT

Abstract

Аim. Тo assess the effectiveness of surgical treatment of consequences of burn injury of adnexa in children. Material and methods. The analysis of clinical material over the past 10 years. The clinical group consisted of 59 patients (44 - male, 15 - female) with the consequences of burn injury of adnexa in age from 2 months to 18 years (m = 9.17 ±3.23 years). The burn trauma were the following: thermal (flame, hot objects, gas explosion) - 43, chemical (acid, alkali) - 11, combined (melted lead/glass) - 5. The time that has passed after the burn until the first stage of surgical treatment ranged from 1 month to 2 years (m= 9.7 ± 5.1 months). The author describes in detail the clinical picture, noting that significant lagophthalmos is dominated by the consequences of thermal burns, the consequences of chemical burns occurred entropion, symblepharon, leucoma. 11 patients had anophthalmos. In all, 121 operations were performed in 59 patients (1 to 4 stages, m = 2,1±1,1) with an interval from 3 to 12 months (m=8.3 months): removal of lagophthalmos with method of local plastics or free skin grafting; elimination of symblepharon or reconstruction of the conjunctival cavity with lips/cheeks’ mucous grafting; the strengthening of the eyelids’ edges, eyelashes plastic. The technics of the operation is described. Follow up period for patients from 6 months to 13 years (m=6,7±2,1). Results. Wound healing in all cases took place in the usual time. Skin sutures were removed after 7-9 days, traction sutures in 3 weeks, blepharorophy in 1-6 months. Engraftment of the transplanted free skin and mucous’ grafts was without a significant reduction. Visual function were preserved and improved in all the cases (44 patients). Cosmetic contact lenses were chosen in 4 patients with Vis = 0. A stable position of the prosthesis achieved in patients with anophthalmos. Conclusion. Consequences of burn injury of adnexa in children are diverse and require a differentiated approach to the choice of timing, priority, and methods of surgical treatment. Eyelid plasty is advisable to perform in the “cold” period after the completion of processes of scar tissue formation in the absence of threats to the condition of the eye.. Reconstruction should be performed at any time to prevent the development of ulcers or perforation of the cornea in the presence of the inversion of eyelids, symblepharon, significant lagophthalmos causing suffering of cornea.

Keywords

adnexa of the eye / outcome of burn injury in children / eyelid reconstruction / skin and mucous autografts

References

[1] Нероев В.В., Гундорова Р.А., Макаров П.В., Ченцова Е.В., Слепова О.С., Кашников В.В. Ожоги глаз: Руководство для врачей. М.: ГЭОТАР-Медиа; 2013.

[2] Пучковская Н.А., Якименко С.А., Непомнящая В.М. Ожоги глаз. Одесса; 2001.

[3] Гундорова Р.А., Кашникова В.В., Нероев В.В. (ред.). Травмы глаза. Клинический атлас. Новосибирск; 2005: 108-24.

[4] Гундорова Р.А., Бордюгова Г.Г., Травкин А.Г. и др. Ожоговая травма глаз. М.; 1989.

[5] Reim M., Kuckelkorn R. Chemical and thermal lesions in the orbital region. Bull. Soc. Belge. Ophthalmol. 1992; 245: 21-8.

[6] Still J.M.Jr., Law E.J., Belcher K.E., Moses K.S., Gleistmann K.Y. Experience with burns of the eyes and lids in a regional burn unit. J. Burn.Care. Rehabil. 1995; 16 (3 Pt1): 248-52.

[7] Stern J.D., Goldfarb I.W., Slater H. Ophthalmological complications as a manifestation of burn injury. Burns. 1996; 22 (2): 135-6.

[8] Szweda E., Stafiej J., Cislinska I. Late results of the treatment of eye burns. Klin. Oczna. 1992; 94 (4): 106-7.

[9] Bosun I., Tarsorrhaphy is necessity. Oftalmologia. 1995; 39 (3): 221-4.

[10] Раменснайдер Дж. П. Закрытие ожоговой раны и биологические повязки. Ожоги у детей. Карваял Х.Ф., Паркс Д. Х. Ред. Пер. с англ. М.: Мир; 1990: 246-63.

[11] Ягурский Е.Е. Термические ожоги. Ташкент; 1987.

[12] Bell E, Sher S., Hull B., Merrill C. еt al. The reconstruction of a living skin. J. Investig. Dermatol. 1983; 81: 25-105.

[13] Gorvin-Yehudainn J., Moscona R., Peled Y. Treatment of eyelid burns and results. Harefuah. 1993; 124 (10): 611-67.

RIGHTS & PERMISSIONS

Eco-Vector