Tra Vinh, Vietnam - Ian Wilson, Webster Fellow and plastic surgeon: Huynh is a good example of what Interplast does best via a team approach emphasizing teaching and airway safety.
This lady got burned when she was a child in a house fire, sustaining major burns to her face, neck, arms, and chest . She survived this significant burn but developed horrific burn contractures and scarring because of the limitation of primary burn care available to her here in Tra Vinh, Vietnam. This neck contracture does not allow her to tilt her head backwards, and she has significant functional limitations because her chin is really stuck on her chest. Even her lip has been forced out of her mouth. Over the years she has had a number of surgeries but other teams were reluctant to deal with her neck contracture because of the difficulties involved.
We successfully released her neck burn contracture and reconstructed her neck with a large piece of skin from her belly. She essentially underwent an abdominoplasty to harvest the skin graft and leave her with a nice thin scar on her belly wall. This is a very good use for this supposedly cosmetic operation.
The real important part of her operation consisted of getting a secure airway. Interplast personnel have developed a lot of experience with these challenging cases. We have found that the best way to do this in these challenging situations is as follows.
We use local anesthesia and some sedation with Ketamine to keep the patient comfortable while the burn scar contracture is released. The patient is breathing normally during this initial stage and even appears awake but has no discomfort. Then the neck can be fully extended allowing the breathing tube to be placed without too much struggle. Once this is done, the general anesthesia is delivered much like any other routine case.
Her operation took a few hours to perform safely and she now is doing well on the hospital ward while her skin graft heals. Next week, we will make a nice comfortable collar for her to reduce the risk of the contracture recurring. She might not look as beautiful as she once did, but she will probably have normal functionality, giving her the chance to live a normal life.