EP-94 To see or not to see: A case of complex multidisciplinary surgical reconstruction

Abstract A 4 year-old child suffered catastrophic 60% total body surface area burn injuries affecting head and neck, trunk and limbs following sulphuric acid burns. He underwent limited treatment in his country consisting of first aid and debridement and grafting in upper and lower limbs and trunk, but no treatment to the facial and ocular areas. He was referred for assessment and reconstruction in the United Kingdom. Even though there were widespread burn scar contractures, his most severe injuries involved both eyes and adnexal structures with evidence of severe bilateral cicatricial ectropion and threat to vision. He required multidisciplinary plastic surgery and ophthalmic complex bilateral eyelid reconstruction in two separate procedures to restore anatomical and cosmetic integrity to both eyes. The initial procedure involved examination under anaesthesia of both eyes, release of the left upper and lower eyelids burns scar ectropion and resurfacing of the resulting defect with full thickness grafts from the left clavicular area. The grafts had full take with no evidence of infection and excellent cosmesis. A similar procedure was performed to reconstruct the right eyelids 6 weeks later. The vision of this eye was beyond salvage but the need for cosmetic eyelid symmetry was considered as an appropriate indication to proceed to reconstruction. This was found to be successful with excellent graft take and parental satisfaction. This case required coordination, expert holistic approach, complex surgery and extra efforts from the team to ensure compliance, communication and positive outcomes and highlights the importance of multidisciplinary team effort.