Smoke Inhalational Injury from Burns
Background info on what happens with burn related inhalation injury:
- Inhalation injury is the most important prognostic factor for mortality after burn injury
- Total Body Surface Area (TSBA) or patient’s age doesn’t matter
- After significant smoke inhalation, ciliary function ceases
- Epithelial cells separate from the basement membrane
- Edema of the airway
- serious pulmonary injury may exist without endoscopically apparent changes
- Fibrin casts form, may be revealed with repeat bronchoscopy.
- Surfactant is diminished resulting in decrease in lung compliance.
- Pulmonary fibrosis and airway stenosis is a late finding.
How is this related to our plastic surgical practice in Modesto, California?
Surgical Procedures on the face which require the use of the Bovie
We need to be aware that inhalational injury exists. When working on the face, the risk of a surgical fire is present in the operating room when there are anesthetic gases which can be flammable. Oxygen is one of the main culprits for a surgical fire. There are precautions to take by the surgical team when a surgeon uses the electrocautery device on the face for any surgical procedure – including cosmetic mole removal.
Consider evaluation by ENT colleagues.
Bronchoscopy can be done as part of the evaluation by ENT specialists (Ear, Nose, Throat) – along with follow up to rule out or manage smoke and thermal related airway injury. A bronchoscopy could also be done by a General Surgeon colleague who has the experience. Inhalational injuries may require ventilatory support.
Keep inhalational injury in mind
I think inhalational injury and ventilatory health is something to consider with any burns which occurs on the face, even with what seems to be a short duration burn with a small area injured.