Approximately 10 million people suffer from burns annually, with around 180,000 of them dying as a result. Burns are among the types of injuries that plastic surgeons deal with. Most burns are minor and only require first aid and dressing; however, burns that cover large areas of the body pose a significant risk and can be life-threatening, requiring careful and precise management. Even minor burns, if deep, may necessitate burn surgery.
It is essential to know how to recognize and properly treat burns, as well as to understand when to seek medical attention, which can be life-saving.
What are burns?
Burns are a type of injury that occurs when the body is exposed to something, often something hot, leading to damage to its tissues. Burns can range from minor medical issues to life-threatening emergencies, and they are very common, usually occurring accidentally. The severity of burns increases with their depth and the area of the body they cover.
The treatment of burns depends on their location on the body and their severity. Sunburns and minor burns can usually be treated with first aid, whereas deep or widespread burns, such as those caused by chemicals or electricity, require immediate medical attention. Some individuals may need treatment at specialized burn centers, with care and follow-up extending for several months.
Types of Burns
There are five types of burns classified based on their causative agent, including:
- Thermal Burns (whether hot or cold): Involve cell damage due to extreme temperatures.
- Electrical Burns: Occur when electrical energy exceeds the body’s capacity to dissipate it, as electricity generates heat and causes thermal damage.
- Friction Burns: Happen when something rubs against the body with enough force to generate heat, often causing other types of damage as well.
- Radiation Burns: Occur when various types of radiation cause cell damage, leading to the breakdown and death of these cells.
- Chemical Burns: Occur when chemicals, such as acids or bases, react with cells, leading to their destruction.
Severity of Burns
Determining the severity of burns partially depends on their depth. The old classification system based on degrees is no longer widely used; instead, experts use the following system:
- Superficial Burns (similar to first-degree): Affect only the epidermis, the outer layer of skin, and are considered simple and always self-treatable.
- Partial-Thickness Burns (similar to second-degree): These burns penetrate deeper, damaging the outer two layers of skin. They can cause blisters and changes in color or texture, beyond simple redness, and are often painful.
- Full-Thickness Burns (similar to third-degree): Penetrate all layers of skin and may reach the subcutaneous fat. These burns destroy nerve endings, so they do not cause pain.
Burns can extend deeper and damage muscles, nerves, bones, and other deep tissues. These burns are not common and are sometimes referred to as fourth-degree burns.
What is Burn Surgery?
Burn surgery is primarily divided into two main categories: acute care and reconstructive surgery.
Acute Phase of Burn Surgery
The acute phase of burn surgery begins immediately after the burn occurs, where first aid is administered and continues even after the patient arrives at the hospital. This phase involves a thorough assessment of the extent and depth of the burn, as well as an examination of any other injuries and an evaluation of the patient’s overall health. Specialists may be consulted, and if necessary, arrangements are made to transfer the patient to a specialized burn center.
After evaluation by a burn surgeon, some patients may be able to return home for outpatient treatment, while others may require hospital admission and intensive care. If surgery is not necessary, the burned skin is treated with special dressings that promote healing and help prevent infection. In cases of severe burns, surgery is typically performed to remove burned skin and tissue within the first day or two after hospital admission to avoid infection and other complications. Emergencies may also require burn surgery to relieve pressure on tissues or to assist with breathing. Burn centers have specialized rooms that allow for precise control of infection risks and temperature fluctuations.
Burn surgery includes the removal of burned skin and its replacement as part of the treatment. The burn surgery team consists of nurses, therapists, anesthesiologists, and intensive care specialists, each playing a vital role in patient care, from managing the acute injury to assisting in rehabilitation.
Most patients do not require long hospital stays, but in more severe cases, it may take weeks before the patient is in a condition to go home, even with support from assistance teams, friends, and family.
Reconstructive Phase of Burn Surgery
Reconstructive surgery can be performed months or years after the burn injury to restore vital functions of the affected organs and alleviate the disfigurement caused by scars. The success of the reconstructive phase of burn surgery depends on the extent and severity of the scars. Although burn reconstructive surgery cannot completely eliminate the effects of burns, it is a crucial step in enhancing the quality of life for the affected individual. Many scars resulting from burns can lead to skin contractures, restricting joint movement, especially in areas such as the neck, shoulders, hands, and legs.
Through burn surgery procedures, skin contractures can be released, enabling patients to regain their normal ability to move and perform daily activities. Additionally, these surgeries are used to address issues resulting from facial burns, such as eyelid, lip, or nose deformities. They may also involve reconstructing areas that have lost hair due to the injury. Thus, reconstructive surgery helps mitigate the physical and psychological impact of burns and enhances the patient’s self-confidence.
When assessing issues with the patient, the plastic surgeon often conducts an evaluation known as the “five points,” which includes:
- Problems: This includes the issues faced by patients and what each patient perceives as a personal problem, such as unsightly scars that may affect their appearance and self-esteem. Additionally, patients may experience tight scars that restrict skin movement, resulting in painful contractures. Pain and itching are also common symptoms that negatively affect daily quality of life.
- Priorities: Treatment priorities vary from patient to patient; some may focus on improving the appearance of scars, while others may consider pain relief or improved movement a higher priority. It is essential for doctors to understand these priorities to ensure optimal care is accurately provided.
- Possibilities: Various treatment options are available to patients, including burn surgery, splinting, compression garments, and psychological and cosmetic counseling. Each option has its benefits and risks, which should be thoroughly discussed with the patient to help them make the best decision for their condition.
- Patient Perceptions: Understanding the patient’s perceptions of what is possible and their awareness of potential outcomes is a crucial part of the treatment process. The patient should be informed about the likely results of each procedure, which helps them set realistic expectations and enhances their confidence in the medical team.
- Action Plan: An action plan requires a comprehensive agreement between the reconstructive and rehabilitation team and the patient. This plan should consider all aspects of treatment, from surgical procedures to ongoing post-operative care.
By evaluating each patient according to these criteria, surgeons can identify immediate treatment needs, available options, and determine how to manage them in accordance with the patient’s expectations. This comprehensive approach ensures personalized care that effectively meets the needs of each patient.
Benefits of Burn Reconstruction Surgery
Although burn reconstructive surgery cannot completely eliminate the effects of burns, it is a crucial step in enhancing the quality of life for the affected individual. These procedures aim to restore vital functions of the affected organs and alleviate the disfigurement caused by scars. Many scars resulting from burns can lead to skin contractures, restricting joint movement, especially in areas such as the neck, shoulders, hands, and legs.
Through burn surgery procedures, skin contractures can be released, allowing patients to regain their ability to move and perform daily activities normally. Additionally, these surgeries are used to address issues resulting from facial burns, such as eyelid, lip, or nose deformities, and may also involve reconstructing areas that have lost hair due to the injury. Thus, reconstructive surgery helps mitigate the physical and psychological impact of burns and enhances the patient’s self-confidence.
Techniques of Burn Surgery
Burn surgery involves a range of specialized techniques, as outlined in the following sections:
Skin Grafting in Burn Surgery
Skin grafting is a surgical procedure that replaces damaged or lost skin with healthy skin taken from another area. It is preferable to use the patient’s skin (autograft) to reduce the risk of rejection. If sufficient skin is not available, skin from a human donor (allograft) can be used as an alternative. This technique is employed to treat conditions such as burns and deep wounds.
Types of Skin Grafting in Burn Surgery
- Split-Thickness Skin Graft (STSG):
- Involves taking the upper layer of skin (epidermis) and part of the second layer (dermis).
- Used to cover large areas of damaged skin.
- Typically harvested from the thigh, buttocks, abdomen, or back.
- The donor site heals within 1-2 weeks.
- Full-Thickness Skin Graft (FTSG):
- Involves taking both the epidermis and the entire dermis.
- Used in areas requiring better cosmetic results, such as the face.
- Usually harvested from the inner thigh, arm, or clavicle area.
- The donor site is closed immediately after removal.
- Composite Grafts:
- Involve transferring skin along with other tissues, such as cartilage.
- Used to repair damage to the nose, fingertips, or ears.
Procedures for Skin Grafting in Burn Surgery
The procedure is performed in a hospital under general or local anesthesia, depending on the size of the affected area. Healthy skin is removed from the donor site using specialized tools, and techniques such as meshing may be employed to expand the skin and cover a larger area. Small openings are made in the skin to facilitate stretching and drainage. The grafted skin is then secured in place using sutures or staples and covered with appropriate dressings.
Burn Surgery Using Flaps
In flap surgery, the surgeon takes a portion of healthy tissue from a specific area of the body, such as skin, muscle, or fat, while maintaining its connection to the blood vessels that nourish it (local flap). The surgeon then carefully transfers this portion to the affected area that requires coverage or reconstruction. Sometimes, if it is not possible to keep the vessels connected to their original site, the flap is cut with its blood vessels and moved to the new site, where the blood vessels are reconnected precisely under a microscope (free flap).
After securing the flap in its new position, the tissues are stitched and firmly fixed to ensure proper placement while maintaining blood flow to keep them alive and healthy. Flap surgery is commonly used to cover:
- Deep or complex wounds
- Areas that have lost tissue due to accidents or burns
- After the removal of large tumors
- Reconstruction of difficult areas such as the face, hands, or limbs
Burn Surgery Using Tissue Expansion
The tissue expansion technique is a surgical procedure used to generate additional skin from the same body when a person needs to cover an area damaged by a wound, burn, or previous surgery. In this procedure, the surgeon implants a small balloon under healthy skin in a nearby region to the site needing reconstruction. This balloon is gradually filled with saline over weeks or months.
As the balloon increases in size, the skin above it begins to stretch and grow, allowing the body to create new skin that matches the surrounding skin in color and texture. After a period of expansion, the new skin is ready for use, and the balloon is removed.
In the next stage, the expanded skin is used to cover the damaged or missing area. This technique is beneficial because the new skin comes from the same person, reducing the risks of rejection or complications. Additionally, the appearance of the regenerated skin is very natural and closely resembles the original skin.
Other Techniques in Burn Treatment
In addition to burn surgery, several additional techniques are used in the treatment of burns, especially in severe and complex cases, including:
- Synthetic Skin: Thanks to tissue engineering techniques, materials that mimic the deep layers of skin can be manufactured and used as part of the wound healing process to stimulate the growth of natural skin.
- Splints: Used to reduce skin contractures after burns and help maintain functional movement of the affected limbs and joints.
- Steroid Injections: Administered directly into thick or swollen scar areas to help flatten them and reduce associated itching.
- Pressure Garments and Dressings: Used to apply continuous pressure on wound areas or skin grafts to limit scar formation and skin contractures.
- Silicone Gel: Applied topically to scars to help reduce their thickness and alleviate itching sensations.
- Cosmetic Makeup (Camouflage Makeup): Used to unify skin color in grafted or scarred areas and improve the overall appearance of the patient.
These methods complement burn surgery and effectively contribute to improving functional and aesthetic outcomes for burn patients.
Recovery from Burn Surgery
The treatment plan and recovery period vary significantly depending on the degree of burns the patient has suffered, their age, and overall health condition. In cases of extensive burns, the patient may need to stay in the intensive care unit for several weeks, undergoing a series of successive surgeries to treat wounds and reconstruct damaged tissues. In contrast, minor burns may heal within approximately two weeks without the need for any surgical intervention.
In cases requiring skin grafting, the wound may need dressing changes and ongoing care for up to six weeks after the procedure. In some instances, particularly in children who are still growing, additional surgeries or treatments may be necessary to improve the appearance or functional mobility of the affected area, even months or years after the initial recovery.
Once the burns have healed, the patient’s care is transferred to specialized burn teams near their residence, with regular follow-up appointments scheduled to assess the condition of the wounds and ensure they are healing as expected, guaranteeing the best possible functional and aesthetic outcomes.
Burn surgery is a vital field that requires precision and special care, playing a crucial role in improving patients’ quality of life and restoring their normal functions. Through advanced techniques and specialized care, positive outcomes can be achieved, helping to alleviate the physical and psychological effects of burns. Understanding the mechanisms of these surgeries helps raise awareness about how to manage burns and seek prompt, appropriate care.
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