PMC3111108_01
Postdebridement - showing healthy granulation tissue prior to grafting
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F1
A single thorough wound debridement was performed involving sharp excision of burned skin down to dermis and fat [Figure 1].
Skin placement following the principles of aesthetic units. For the nose and cheek, skin was harvested from the scalp. For the forehead and preauricular area, thigh skin was used. Note that fenestrations were made along the relaxed tension lines
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F2
For the forehead and preauricular area, skin from the thigh was used with acceptable skin match [Figure 2]. After securing the graft, fenestrations were made in the graft to drain any collection [Figure 2].
Appearance after 1st stage reconstruction showing missing right eyebrow and absence of anterior half of scalp
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F3
At our patient's first year visit, he had a missing right eyebrow and half his anterior scalp was absent [Figure 3].
Insertion of tissue expanders. The black line marks the hairline and the red line marks the superficial temporal artery
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F4
Two tissue expanders were inserted (500 and 700 ml) to restore hair-bearing scalp to the temporal and parietal areas [Figure 4].
Showing the absent eyebrow, harvesting from the nape of the neck, placement of the graft and the final reconstructed brow
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F5
A single-strip autograft was obtained from the inferior border of the hairline at the nape of his neck [Figure 5] taking care to match the orientation of the hair follicles by comparing with the unaffected eyebrow.
(a-e) Reconstruction of the right alar-facial groove. (a) Harvesting of composite antihelical chondrocutaneous graft; (b) Graft used to cover alar facial groove; (c) Conchal transposition flap used to cover donor site. Arrow shows direction of movement of flap; (d) After covering donor site with chondrocutaneous flap, a resultant secondary defect exists (marked with an asterix); (e) Secondary defect skin grafted. (f) the reconstructed alar-facial groove; and (g) The donor ear
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F6
The secondary defect was covered with a skin graft [Figure 6].