RECONSTRUCTIVE SURGERIES
Burns and Post Burn Reconstruction
When Should This Surgery Be Avoided?
Early Burn Care: Burns that are not properly managed in the initial stages may be complicated by infections or delayed healing, making late surgical interventions more challenging.
Severe Systemic Conditions: Patients with severe comorbidities or systemic conditions that would increase surgical risk or impair recovery.
Infection: Active infection at the burn site that would complicate surgical intervention.
Poor Prognosis: Patients who are unlikely to benefit from surgery due to extensive underlying injuries or poor overall health.
When is This Surgery Recommended?
Severe Burns: When the burn is extensive and involves critical areas such as the face, hands, or joints, requiring advanced surgical intervention.
Functional Impairment: Burns that cause significant functional disabilities needing reconstruction to restore mobility and function.
Aesthetic Concerns: Burns that result in significant cosmetic deformities requiring surgical reconstruction for improved appearance.
Contractures: Burns that lead to skin tightening and contractures impairing movement, requiring surgical correction.
Preoperative Management
Surgical Technique
Wound Management
Postoperative Care
Complications
Outcomes and Prognosis
Psychological Support
Multidisciplinary Collaboration
Advances in Surgery
About The Treatment
Burn injuries can be very devastating, affecting not only the skin but also the underlying tissues, muscles, and bones. Burn injury may be caused due to Flames (heat), Scalds (moist heat), Steam, Frost bite (Cold), Electrical injury, Chemicals and Radiation.
Burn injury can lead to mortality or permanent scarring and on many occasions functional disabilities in survivors. Effective management and reconstruction are crucial for the physical and psychological recovery of burn patients.
Here’s why plastic surgeons are essential in burn management :
Primary treatment is very important for burns. Mortality and morbidity both can be improved by efficient primary treatment. The treatment of burns and post-burn reconstruction involves a comprehensive approach by plastic surgeons, focusing on both acute care and long-term rehabilitation |
There are many factors which affect the end result of a Burn injury. These are the depth of the burn, the percentage of body area affected, special areas affected like face, hands etc, the cause of burn like flame/ scald/ electric shock etc. |
Burns First Aid
As First Aid, whenever a person gets burnt, the most important and simplest step towards reducing the depth of Burn is to pour water over the burnt area for at least 20 -30 minutes.
This will reduce the temperature of the skin and help reduce the depth of the burns and consequently the resultant scarring.
Do not use ice / ice packs as it causes further injury to skin. In cold places make sure that the patient does not go into hypothermia (body becoming too cold).
To stop the burning process / extinguish the flames, pour water or pat the flames off to extinguish the flames. Do not let the victim run around at it fuels the flames of a loose flowing dress. Always remove the smoldering clothes else they will continue to cause more burning of skin. Make sure you remove all rings, watches, jewellery, belts etc. which retain heat and continue the burning process of skin as also have a tourniquet effect and cause reduced blood flow in the limbs / fingers. Even in cases of scalds, remove the soaked clothing, or it will act as a continuous source of heat. Remember to wrap the burnt area / victim with a clean sheet while transporting to the hospital.
Acute Burn Treatment
Initial Assessment and Stabilization
Primary Survey:
Address life-threatening conditions (airway, breathing, circulation).
Secondary Survey:
Detailed assessment of the burn extent, depth, and associated injuries.
Fluid Resuscitation:
Administration of IV fluids based on burn size and patient’s needs (e.g., Parkland formula).
Wound Care
Cleansing:
Gentle cleaning of the wound to remove debris and dead tissue.
Debridement:
Removal of necrotic tissue to prevent infection and promote healing.
Dressings:
Application of appropriate dressings to keep the wound moist and protected (e.g., silver sulfadiazine, hydrocolloid dressings).
Pain Management
Use of analgesics and sedatives to manage pain and anxiety.
Infection Control
Prophylactic antibiotics may be administered.
Strict aseptic techniques during wound care.
Nutritional Support
High-calorie, high-protein diet to meet the increased metabolic demands of healing.
Surgical Interventions
Escharotomy/Fasciotomy
Performed to relieve pressure and restore circulation in cases of circumferential burns.
Skin Grafting
Autografts:
Transplantation of the patient's own skin from an unburned area.
Allografts/Xenografts:
Temporary coverings using donor or animal skin.
Flap Surgery
Use of local or distant flaps to cover large defects, providing both coverage and blood supply.
Post-Burn Reconstruction
Scar Management
Pressure Garments:
Worn to reduce hypertrophic scarring.
Silicone Gel Sheets:
Used to soften and flatten scars.
Steroid Injections:
Administered to reduce inflammation and scar formation.
Surgical Reconstruction
Z-Plasty:
A surgical technique to release contractures and improve function.
Tissue Expansion:
Gradual stretching of the skin to provide additional tissue for reconstruction.
Free Tissue Transfer:
Transplantation of tissue along with its blood supply from one part of the body to another.
Laser Therapy
Used to improve the appearance of scars and treat hyperpigmentation or hypopigmentation.
Rehabilitation
Physical Therapy:
To maintain and improve range of motion and strength.
Occupational Therapy:
To assist in regaining daily living skills.
Psychological Support:
Counselling and support groups to address emotional and psychological aspects of recovery.
Long-Term Follow-Up
Monitoring:
Regular follow-up to monitor healing, detect complications, and assess the need for further interventions.
Revisions:
Additional surgeries may be required to optimize function and appearance.
Special Considerations
A small burn in an important special area like the face, hands, fingers, feet, perineum (private parts), eyes, ears etc needs special attention as deformities in these areas will affect the survivors life to a large extent. Such burns must be treated by expert plastic surgeons.
Pediatric Burns:
Require specialized care considering the growth and development of the child.
Facial Burns:
Need meticulous reconstruction to preserve or restore aesthetic and functional outcomes.
Hand Burns:
Critical to address promptly to preserve function and dexterity.