![]() ![]() With aging, the skin loosens and thus is more tolerant of shrinkage. Contractures are more of a problem in children since their skin lacks laxity. Since the head is usually flexed or at least in a neutral position, neck contractures are another common problem. Even small burns such as those seen after chewing an electric cord that leads to a commissure burn leave permanent scars. The eyelids are prone to forming ectropions, and shrinkage of the commissures or eversion of the lips is not uncommon. This problem is particularly important for eyelids and lips since they provide little resistance to the forces of contraction. Any small but deep burn in these areas tends to shrink with little resistance and is more prone to contractures. The remainder of the face sits on fat and muscle and is highly mobile. Deep burns may lead to exposed skull, which becomes a very difficult problem. Burns to the forehead tend to contract less than burns in other areas. The forehead skin sits mostly on bone and has little flexibility. There are some anatomic issues that affect the ultimate outcomes of face burns. The increased blood supply should also be kept in mind when excising the face since bleeding exceeds that of any other area of the body. The face is extremely vascular so that heat is dissipated to reduce severity of injury. The more blood supply, the greater the ability to dissipate heat and reduce the depth of injury. The fourth factor is blood supply of the skin. Face skin is relatively thick in most parts, except for the eyelids, and thus burns are not usually as deep as thinner areas. The third factor is the thickness of the skin. Since there is rarely any clothing on the face, duration of contact is minimized. ![]() In addition, any material that absorbs the heat and stays in contact with the skin will deepen the burn. The second, duration of contact, can be reduced since people tend to protect their faces by shaking or wiping off any hot material as soon as possible. The first, the temperature of the inciting agent, cannot be altered. Four factors are classically described to determine the depth of a burn injury. Fortunately, the face has some protective characteristics that can reduce the depth of injury. Spilled liquid from high places will reach the head and face of children. For instance, flash burns, such as those from explosive fumes (propane, natural gas or butane) will burn any exposed skin but spare those covered with clothing. Therefore, any exposure to heat in the vicinity of the face may cause a burn. The face is at a higher risk of burn injury because it is rarely covered by clothing or other protective gear. ![]()
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