Most of the burn injuries encountered are of minor degree. These usually involve the limbs and sometimes the body. Immediately after the burn, the involved part of the body should be cleansed with running water to remove any heat that may still remains in the skin. Except the most minor type of burn injuries, it is best for the patient to seek medical advice and treatment.
Minor superficial burns are managed with regular wound cleansing and application of appropriate dressings. For other more severe burns the patient would require admission to the hospital. Proper management of burn injury is important to avoid problems such as pain, infection and other complications. After the initial treatment of acute burn injury, the patient needs to undergo rehabilitation and physiotherapy. Improper management may lead to excessive scar formation later which will affect the function and appearance of the patient, especially those involve the face and limbs.
Cleft Lip and Cleft Palate
Cleft lip and palate is a relatively common congenital anomalies. The incidence in Asian population is 1.2 to 1.5 cases in every 1000 live births. Cleft lip can occurs in isolation or in combination with the presence of cleft palate. In some cases, cleft palate can occurs alone without cleft lip. In a smaller number of patients, cleft lip and palate are part of a syndromic condition with various other abnormalities in other part of the body.
Because of the location of the anomaly, cleft lip and palate can affect various structures. These include the upper lip, the hard and soft palate, the nose, the teeth, the maxillary bone and the middle ear. Potential functional disturbances resulting from cleft lip and palate are feeding, speech development, hearing, teeth and dental function. There may also be psychological problems as well resulting from the external appearance of the patient.
Management of cleft lip and palate is complex and long-term, involving doctors from various disciplines. It requires patience and long-term commitment from both the parents and doctors. The plastic surgeon usually repair the cleft lip at the age of 3 months. This is followed by palate repair at the age of 9 months before the speech starts to develop. Depends on the severity, nose repair may need to be performed as well during the lip repair. ENT referral is made to assess the middle ear. If there is speech impairment, then the patient will be referred to a speech therapist for the speech problem. The patient will be followed up continuously. If there is a cleft in the alveolar bone, alveolar bone graft will be performed at the age of 9 to 12 years old. Problem of teeth alignment will require orthodontic treatment. In cases with significant malocclusion, orthognathic surgery will be required to realign the malpositioned maxilla and mandible. Secondary rhinoplasty and lip revision may be performed in the late adolescence or early twenties to improve the external appearance of the nose and lip.
Facial Trauma
Facial trauma secondary to physical injury is a relatively common condition. Many patients sustain facial trauma from road traffic accident while other causes include fall, assault, household or industrial accidents. In many cases only the facial skin is involved in the injury. However the face serves a special function in appearance. Meticulous and skillful technique is required in repairing the facial skin in order to achieve optimal results with minimal scarring and tissue distortion. A number of important structures such as the eyelid, nose, lips and ears are located in relatively confined space of the face. Repair of these delicate structures demands high level of skills as the results would affect the appearance as well as the functions of these important structures.
Some patient may present with a previously repaired facial injury with residual problems such as scarring, tissue distortion and functional disturbance. These cases would require proper assessment and treatment with scar revision or tissue rearrangement.
Skin Tumours
Skin tumours can be divided into benign lesions and malignant lesions. Benign lesions usually grow slowly and do not spread to other places. On the other hand, malignant skin lesions (skin cancers) can spread locally and also to distant organs. Most of the skin tumours is treated by local excision.
Excision of skin tumour will create a defect on the skin. Most of these defects can be closed primarily with excellent functional and aesthetic outcome. However in certain cases the lesion is big and the defect after excision is large. Special surgical technique such as local flaps or skin graft are required to close to resultant defect. The goals of the treatment are to completely remove the tumour, to restore good function and to achieve satisfactory aesthetic outcome.
