Reconstructive Burn Surgery

A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation. Burns that affect only the superficial skin are known as superficial or first-degree burns. When damage penetrates into some of the underlying layers, it is a partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle or bone.

Burn Plastic Surgery Before and After

First Degree Burns

• First Aid & Treatment
• Remove patient from heat source
• Remove the burnt clothing
• Run cool water over burnt area
• Gently clean the injured area
• Gently dry
• Apply anti biotic such as Silver Sulphadiazine
• Use a sterile bandage to cover burns
• Take tetanus vaccination

Second-degree burns

• First Aid & Burn Treatment
• Clean the affected area thoroughly
• Gently dry
• Apply antibiotic cream over affected area
• Make the patient lie down
• Keep burnt body part at a raised level
• Skin graft may be required
• Physical therapy may be essential to aid mobility
• Splints may be used to rest affected joints
• Hospitalization may be required

Third-degree burns

• First Aid & Burn Treatment
• Requires immediate hospital care
• Dehydration treated through intravenous fluid supply
• Oxygen is administered
• Eschars are surgically opened
• Multiple surgeries like Skin graft or Flap surgery required
• Nutritious diet helps to heal quickly

Burn scar contracture refers to the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area and for this Burn Surgery is required.

Treatment

Burn scar contractures do not go away on their own, although may improve with the passage of time and physiotherapy and splinting. If persistent the person may need the contracture to be released or a bury surgery can be opted. Techniques may include local skin flaps (z-plasty) or skin grafting (full thickness or split thickness). There are also pharmacy and drug-store treatments that can be used to help scar maturation, especially silicone gel treatments.

FACIAL BURN PLASTIC SURGERY

Burn injuries account for over 100,000 hospital admissions per year. The most common age groups are toddlers (age 2 through 4) and adolescents (age 17 through 25). Injuries to the head and neck account for approximately 50% of all burn injuries.

Burn Surgery Patient: This patient had tissue expansion, with scalp reconstruction, as well as reconstructive surgery on her eye and cheek to create a more natural and normal appearance.  Notice the symmetry of the eyes that was created with a ptosis repair, mid face lift and lower eyelid reconstruction.

With the opening of many specialized burn centers for acute burn injuries, death rates from severe burns have dropped significantly. Survivors are often left, not only with functional impairment (e.g., drooling, neck contracture, corneal exposure, nasal airway blockage, lip incompetence), but also with a grotesque facial appearance and distortion of facial expression.

Doctor specializes is facial reconstructive surgery to not only improve the function of the face (speaking, chewing, eyelid opening and closing, and ability to move the head and neck) but also to restore the appearance to a more normal aesthetic. Skin grafts are used by conventional plastic surgeons to replace burn-damaged skin. The thin grafted skin often leaves a “patchwork,” expressionless face. The skin texture is ropey, thickened and irregular, lacking facial animation.  Doctors incorporates more advanced methods of burn reconstruction and uses facial flaps (tissue flapped or transferred from other parts of the face head and neck), skin expanders, laser technology, and custom corrective make-up matches to achieve the most complimentary surgical outcomes.

Although disfiguring burn scars cannot be “erased” in their entirety, generally significant improvement can be achieved in cosmetic appearance and functional activities of everyday life.

Treating the Burn injuries through Surgery

Burn injuries aren’t that rare to sustain. We play with fire so much in our daily life that we start underestimating its damaging potential. Then comes the time when fire wreaks havoc on us. Burn injuries, regardless of their intensity, always deserve extra care. The immediate treatment to a minor injury could be water and then a burn healing ointment. But this treatment isn’t effective when the burn injuries are severe. In such cases, depending upon the damage, doctors employ various treatment methodologies.

The most common procedure is Burn Surgery.  This procedure involves skin grafting, where skin is removed from some other area of the victim and transferred to the injury site. And in cases when skin graft is needed in large amounts then the hospitals depend on skin banks, analogical to the blood banks. These grafts cover the injured part and guard it against any infection or septic and stop fluid loss.

The next treatment type is skin substitutes. The doctors use skin substitutes which when applied at the injury site replace the damaged skin with the fresh one. These substitutes do not contain any nerves, sweat glands or hair follicles. The biggest factor of concern is to manage the pain if the burns are severe. The necessary factor to be kept in mind keeping the morphine rate in check as an over dosage could trigger other problems. Once the substitutes have done their job, the wound is treated with topical antibiotic ointments. A relatively less famous treatment is through homeopathy. Two common homeopathic treatments, Cantharis and Causticum can expedite the burn healing process.

Preparing for Your Burn Surgery

You will be given a pre-operative information packet that explains everything you should do and know before your burn surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on preoperative skin cleansing, eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

Types of Anesthesia

You’ll remain comfortable throughout the entire procedure. In most cases, general anesthetic is used so that you will sleep throughout the procedure; although local anesthesia with intravenous sedation is also an option for some patients.

After Your Surgery

It is very important that you follow your surgeon’s instructions in order to promote healing and obtain the best possible outcome-both in terms of function and physical appearance. Also, it is important that you attend all follow-up appointments as scheduled so that your surgeon can assess your long-term results and answer any questions or concerns you may have.

Since a variety of procedures can be performed, your individual postoperative instructions may vary. In general, skin grafts require kind of “bolster” dressing to keep them in place for 3-5 days without any movement of the skin graft. The bolster helps the skin graft “stick” to the wound and begin to heal. Smaller operations (scar revisions, Z-plasties) might require only a small, soft dressing afterwards. After scar releases on the hand, your surgeon may place you in a larger dressing that incorporates a plaster splint for support after surgery. In general, follow-up visits are scheduled within 2 weeks of burn surgery, and there may be sutures to remove at that time.

Additional physical therapy or occupational therapy may be required in the weeks and months following surgery to ensure a complete recovery of function. This may involve splints or casts, as well as exercises you perform at your treatment visits and on your own at home. Your surgeon and your therapist(s) will work together to develop the plan that is best for you.

 

Burn Surgery Treatment

Burn surgery service caters for both adult and paediatric patients for a broad range of conditions. We are involved in the treatment of many congenital skin lesions, together with some congenital conditions such as correction of prominent ear, skin tags and also the provider of a hypospadias service to the region. We are also involved in the correction of cleft lip and palate.

We cater for general plastic surgery conditions in adults. This includes the management of trauma, linked to our regional burns unit, for the acute effects of burns and also the reconstructive element. We are also involved in the management of trauma to the hands, including flexor tendon repair, nerve repair and the fixation of fractured bones in the fingers and distal part of the wrist. In addition, we manage soft tissue trauma such as dog bites or lacerations and are involved in the management of complex lower limb injuries in conjunction with the orthopaedic department.

We are also involved in the management of some congenital lesions such as tubular breasts, breast asymmetry. In the head and neck, we are involved to some degree in the management of skin cancers around the face, although the main intra-oral carcinoma is treated in Oxford.

Burn service

The Burns service is designated as a Burns Unit, forming part of the London and South East Burns Network; working to ensure patients who experience varying severity of burns are admitted to the most appropriate care setting. The service offers a robust multi-disciplinary team centred approach for its patients, including dedicated input from psychology, occupational therapy and physiotherapy in conjunction with experienced nurses and clinicians.

We cater for adult burns (up to 40% of total body surface area) in a dedicated burns unit and paediatric burns (up to 20% of total body surface area) on the paediatric ward.

CHALLENGES

There are several challenges related to tissue loss and scarring that must be met in order to reconstruct burns. The key to longer-term local burn care is scar management, which can be achieved through surgery and physical therapy. A balance must be attained between immobilization to allow skin grafts or tissue flaps to heal and mobilization of the burned area to restore function. Successful reconstruction needs to be complemented with the integration of the patient in the multidisciplinary team and specifically with the early intervention of the therapy and rehabilitation teams to restore the patient to society as an active and functional member.

 

 

Burn Surgery

What is Burn Surgery?

There are two main categories of burn surgery: acute and reconstructive. Acute burn care occurs immediately after the injury. It is delivered by a team of Trauma Surgeons (General Surgeons) that specialize in acute burn care. Complex burns often require consultation with Plastic Surgeons, who assist with the inpatient and outpatient management of these cases. Large burns, or burns of critical body areas, should be treated at a verified Burn Center, such at the Trauma Burn Center here at the University of Michigan. Smaller burns may be managed as an outpatient.

Reconstructive burn surgery may be required after the initial burn wounds have healed. These kind of care us usually provided by a Plastic Surgeon. The goals of reconstructive burn surgery are to improve both the function and the cosmetic appearance of burn scars. This involves the modification or alteration of the scar tissue, by both non-operative and operative means. The relationship between the burn patient and the reconstructive burn surgeon often lasts many years. Treatments for scar tissue often take several months to be effective, and new scar contractures can appear long after these injuries, especially in young patients who are still growing.

How is the Procedure Performed?

Non-operative therapies might involve scar massage, application of pressure garments, or other topical therapies. The fitting of pressure garments is usually coordinated with an Occupational Therapist. Within the O.T. department, there are also hand therapists to assist with rehabilitation of hand burns and scars.

Operative therapy consists mainly of scar release procedures. Once a tight scar is released, the opening in the skin must be repaired-the Plastic Surgeon uses a variety of techniques to close these wounds. Skin grafts, skin rearrangement (“Z-plasty”), and more complex flaps could be required, depending on the location of the scar and the desired outcome. Most minor procedures are performed as outpatient surgery, but the larger grafts and flaps will likely require an inpatient stay.