Post-Burn Contractures, Scar Revisions, and the Difficult Airway in Plastic Surgery — WACS Viva & Clinical Scenarios (Plastics & Dental)

Exam-style post-burn contractures, scar revisions, and the difficult airway in plastic surgery viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 19-year-old woman presents for elective surgical release of a Grade IV mentosternal contracture following an unmanaged childhood burn. Her chin is completely tethered to the manubrium sterni, her inter-incisor distance is 1.8 cm, and cervical flexion-extension is zero. She has no other comorbidities. How will you formulate, explain, and execute your pre-anaesthetic evaluation and primary airway management strategy?
• SCENARIO 2: A 6-year-old boy is scheduled for release of extensive perioral scarring and severe microstomia (mouth opening <1 cm) along with bilateral axillary contractures. He is extremely distressed and terrified of the operating theater. Outline your comprehensive anaesthetic induction, airway securing, intravenous access strategy, and perioperative maintenance plan.
• SCENARIO 3: An otherwise healthy 30-year-old male with a severe anterior neck and chest contracture is scheduled for release and flap reconstruction. A colleague attempts an inhalational induction with halothane, but as the patient deepens, complete upper airway obstruction occurs. The mask seal is impossible due to facial scarring, and bag-valve-mask ventilation fails with SpO2 dropping to 72%. How do you manage this acute 'cannot intubate, cannot oxygenate' (CICO) crisis in the presence of dense anterior neck scar tissue?
• SCENARIO 4: A 25-year-old male with extensive hypertrophic scar contractures over the chest wall, neck, and upper limbs presents for multi-stage scar revision under general anaesthesia. Preoperative spirometry shows a vital capacity of 45% predicted and FEV1/FVC of 86%. Explain how chest wall burn contractures alter respiratory mechanics and discuss your perioperative ventilatory and pain management strategy.