Burn Reconstruction: 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 as the Trauma Burn Center here at the University of Michigan. Many smaller burns can be treated with outpatient options. Some patients may need reconstructive burn surgery after the initial burn wounds have healed. This type of care is usually provided by a plastic surgeon. Citation: https://www.uofmhealth.org/conditions-treatments/surgery/plastic/burn-reconstructive
What Is Burn Reconstruction?
There are two main goals of reconstructive burn surgery:
- improve function of scarred tissue
- improve the looks and aesthetics of burn scars
Patients may seek out information about surgery for one or both of the above reasons. Aside from the most obvious aesthetic concerns involved with burn scarring, extensive scar tissue can impede the normal movement of the limbs, neck, shoulders, hands, etc. A surgeon cannot eradicate a patient’s burn scars totally but can increase basic functions of the burned body parts by loosening tight skin and make injuries less noticeable.
The process involves altering scar tissue, with non-invasive and/or operative treatments.
Non-operative therapies might include:
- scar massage
- pressure garments
- topical remedies
Surgical possibilities are scar release procedures where tight scar tissue is released, and the uncovered areas are closed. We will discuss those in more detail later.
Scar tissue treatments often take several months, and fresh scar contractures can appear later. This is especially true in younger patients. Their growing bodies and skin will change often. Therefore, a plastic surgeon and burn reconstruction patient will develop a longstanding relationship.
Successful burn reconstruction surgery basics:
- Solid patient-surgeon rapport is essential for a trusting relationship to evolve.
- Emotional care and reassurance from the medical staff should be offered freely and openly. Patients need reminders and support.
- Goals, priorities and expectations need to be clear for all parties so that no one has unrealistic hopes for the results.
- Multiple, simultaneous procedures can decrease the amount of time patients spend on the table as well as recovering
Summary: Burn reconstruction is an option for burn victims looking for better range of motion of the scarred areas or who want to improve the appearance of scarring.
Why Should Patients Wait One Year?
Scars will mature over time and many do not require surgery. Waiting a year will allow the skin to heal and give the doctor a better idea of which scars are permanent and need to be surgically improved.
Waiting for scar maturation is not always possible or recommended. This may be the case when vital structures are vulnerable. Urgent procedures might include:
- an eyelid release to shield a bare cornea
- modification of distracted or entrapped neurovascular bundles
- surgery fourth degree contractures
- procedures to correct microstomia (the mouth is too small and impedes eating and nutrition)
Summary: Generally, a year waiting period after the initial burn is recommended but there are severe situations which may make this impossible.
What Are The Types of Burn Reconstruction?
There are 3 types of procedures to consider:
- Urgent procedures: Waiting for scar maturation isn’t appropriate because vital structures are bare and/or can be severely injured. (like discussed in the last section)
- Essential procedures: The patient’s overall health is not in danger, but essential procedures may improve the patient’s final appearance and restoration. Such procedures might include operations for hypertrophic scarring and contractures that prevent a patient from eating, bathing, and performing other daily tasks and activities.
- Desirable reconstructive procedures: This is the most common. These procedures are to correct aesthetic problems. In this case, it is recommended that the surgeon wait for all immature scars to disappear.
Summary: There are 3 basic types of reconstruction surgery and each has special considerations for both patient and doctor.
What Are The Burn Reconstruction Techniques?
The techniques used will depend a great deal on how much skin is left to be used. In the past, surgeons relied on incisional or excisional releases of scars and skin autografting. However, presently, the first approach that is recommended is the use of local or regional flaps. Such procedures provide new and vascularized tissue to the burnt areas. These flaps give the best functional and superficial results and they can grow with a child as they mature.
A deficiency of usable tissue will create special challenges. Without deficiency of tissue, surgeons will perform excision and primary closure or Z-plasty. With deficiency of tissue, the doctor may utilize simple reconstruction, skin graft, dermal templates and skin grafts, transposition flaps (Z-plasty with modifications), reconstruction of skin and underlying tissues, axial and random flaps, myocutaneous flaps, tissue expansion, free flaps, or prefabricated flaps.
While your doctor will go over your procedural options with you, here is some basic procedural vocabulary:
- Z-plasty involves the transposition of two triangular flaps in order to reorient or elongate a scar.
- Skin grafting involves moving healthy skin to a new area of the body – almost like a donor organ.
- A myocutaneous flap is a compound flap of skin and muscle.
- Tissue expansion is a technique by which a balloon is inserted under the skin and slowly filled causing the skin around it to grow and expand.
- Prefabricated flaps are prepared before transfer. Additional specialized tissues are attached to the raw side of the flap.
Summary: There are many burn reconstruction techniques and which a doctor chooses to use is dependent on a wide array of factors.
Should I Consider Burn Reconstruction Surgery?
This is a question that only you and a qualified medical professional can answer. Dr. Khan provides free in-office consultations in which he will answer any and all questions that you may have. While you chat about your needs, be sure to express concerns and goals. Our responsibility at each of our offices is to make our patients feel comfortable and safe. Call Dr. Khan to discuss your burn reconstruction surgery options and goals today: 734-419-1615
26850 Providence Pkwy Ste 125
Novi, MI 48374