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Burn Surgery

Burn Surgery

Burn management is a complex and multifaceted process that requires a combination of immediate first aid, professional medical assessment, and a comprehensive treatment plan. From understanding burn severity to long-term rehabilitation, addressing the physical, psychological, and social aspects of burn injuries is essential for optimal outcomes. 

 

Dr Geetika Paliwal Plastic surgeon is highly skilled and experienced burn surgeon, she has experience of more than 15 years and deals in both acute burn injury and post burn deformities.

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Introduction

Burns can result from various sources, including heat, liquids, chemicals, electricity, or radiation, and their management requires a multidisciplinary approach to ensure optimal outcomes.

Causes of Burns:

  • Thermal Burns:
  • Caused by exposure to flames, hot surfaces, liquids, or steam.
  • Common scenarios include kitchen accidents, house fires, or industrial mishaps.
  • Chemical Burns:
  • Result from contact with corrosive substances such as acids or alkalis.
  • Often occur in laboratories, industrial settings, or through accidental exposure at home.
  • Electrical Burns:
  • Caused by contact with electrical currents.
  • Severity depends on the voltage, with high-voltage injuries posing significant risks.​
  • Common in workplaces, construction sites, and incidents involving faulty electrical systems.
  • Radiation Burns:
  • Result from exposure to ionizing radiation.
  • Common in medical treatments like radiation therapy or industrial accidents involving radioactive materials.

Understanding Burn Severity:

Burns are classified into different degrees based on their severity.Understanding the severity of a burn is crucial for determining the appropriate course of treatment.

Degrees of Burns:

  • First-Degree Burns:
  • Superficial burns that affect only the outer layer of the skin.
  • Symptoms include redness, pain, and minor swelling
  • Typically caused by brief exposure to low-intensity heat sources like sunburns or mild scalds.
  • Second-Degree Burns:
  • Affect both the outer layer and part of the underlying skin.
  • Characterized by blistering, more intense pain, and increased swelling.
  • Commonly caused by contact with hot liquids, flames, or prolonged exposure to the sun.
  • Third-Degree Burns:
  • Extend into the deeper layers of the skin, damaging tissue, hair follicles, and sweat glands
  • Skin may appear white, charred, or leathery.
  • Often caused by prolonged exposure to flames, hot liquids, or severe electrical injuries.
  • Fourth-Degree Burns:
  • Involve damage to muscles, tendons, and bones beneath the skin.
  • Often associated with high-voltage electrical injuries or prolonged exposure to intense heat.
  • Require immediate medical attention due to the severity and potential complications.

Percentage Burn assessment

Accurate assessment of burn percentage is crucial for determining the severity of a burn injury and guiding appropriate medical interventions. The Wallace Rule of Nines is a widely used method for estimating the extent of burn injury in adults .It is a quick and practical tool used to estimate the percentage of total body surface area (BSA) affected by burns. The body is divided into regions, each representing approximately 9% or multiples thereof. The regions include the head, chest, abdomen, upper back, lower back, each arm, each leg, and the genital area.

Another is Lund and Browder Chart which unlike the Wallace rule of Nines, it takes into consideration the age of the person, with decreasing percentage BSA for the head and increasing percentage BSA for the legs as the child ages, making it more useful in pediatric burns.

Immediate First Aid:

Prompt and proper first aid is essential for minimizing damage and preventing complications. For burns, cool running water can be applied to the affected area for at least 10 minutes to reduce pain and swelling. However, it’s crucial to avoid using ice or very cold water, as this may further damage the tissue. For more severe burns, it’s advisable to cover the area with a clean, non-stick bandage and seek medical attention promptly.

Professional Medical Assessment:

Regardless of the burn’s severity, seeking professional medical assessment is crucial. Healthcare professionals can accurately assess the extent of the burn, identify potential complications, and recommend an appropriate treatment plan.

 

In some cases, specialized burn centers may be necessary for optimal care, especially for severe burns.

 

For adults, burns involving:

  • Less than 10% TBSA may be managed as outpatient care.
  • 10-20% TBSA may require hospitalization.
  • More than 20% TBSA often necessitates specialized burn unit care.

For children, the percentages may be different due to variations in body proportions. Additionally, burns to certain areas, such as the face, hands, feet, or genitalia, may be considered more critical even if the TBSA is relatively small. Paediatric burn involving more than 10% body surface area burn requires hospitalisation.

 

It’s crucial to seek immediate medical attention for any burn injury, as burns can lead to complications such as infection, fluid loss, and shock. Always consult with healthcare professionals for accurate assessment and appropriate care.

Treatment Modalities:

Burn management involves a combination of medical interventions aimed at promoting healing and preventing infection. Topical antimicrobial agents, dressings, and surgical procedures may be employed, depending on the burn’s severity. In recent years, advanced therapies such as skin grafts, tissue engineering, and regenerative medicine have shown promise in enhancing the healing process and minimizing scarring.

Collagen dressing

Collagen dressings play a significant role in the management of burn injuries, contributing to the wound healing process and promoting tissue regeneration. Collagen is a natural protein found in the skin and connective tissues, making it an excellent choice for  superficial burn wound care. Here’s an overview of collagen dressings in burns:

  • Promoting Healing:

Collagen is a crucial component of the extracellular matrix, providing structural support for cells. When applied to burn wounds, collagen dressings create a conducive environment for cell proliferation and migration, facilitating the healing process.

  • Moist Wound Healing:

Collagen dressings help maintain a moist wound environment, which is essential for optimal healing. Moisture supports cell migration, reduces pain, and minimizes the risk of scarring. This is particularly beneficial for burn wounds, where moisture balance is critical.

  • Minimizing Scarring:

Collagen dressings have been shown to minimize scarring by promoting the formation of a more organized and functional tissue structure. This can be especially important in burn injuries, where preventing excessive scarring is a key consideration for both aesthetic and functional outcomes

  • Managing Exudate:

Collagen dressings have the ability to absorb excess exudate from burn wounds while providing a moist environment. This helps in preventing complications such as maceration and infection. Some collagen dressings also come in different formulations to address varying levels of exudate.

  • Biocompatibility:

Collagen is naturally biocompatible and well-tolerated by the body. This makes collagen dressings suitable for a wide range of patients, including those with sensitive skin. They are generally associated with minimal allergic reactions or adverse effects.

  • Facilitating Angiogenesis:

Collagen promotes angiogenesis, the formation of new blood vessels, which is crucial for supplying nutrients and oxygen to the healing tissues. This vascularization aids in the regeneration of damaged skin and accelerates the overall healing process.

  • Easy Application and Removal:

Collagen dressings are available in various forms, including sheets, gels, and powders, making them versatile and easy to apply to different types of burn wounds. Additionally, many collagen dressings are designed for painless removal, reducing discomfort for the patient.

While collagen dressings offer several advantages, it’s important to note that their use should be based on the specific characteristics of the burn injury, and healthcare professionals should determine the most appropriate treatment plan for each patient.

Early excision and grafting

Early excision and grafting are crucial components of modern burn management, aiming to improve outcomes, minimize complications, and accelerate the overall healing process. This approach involves the removal of burned tissue (excision) and the subsequent application of autografts or allografts (grafting) to promote efficient wound closure. Here are key aspects of early excision and grafting in burns:

  • Prompt Removal of Necrotic Tissue:

Early excision involves the removal of necrotic or damaged tissue from the burn site. This is done to eliminate the source of infection, reduce inflammation, and create a healthier wound bed for grafting.

The removal of non-viable tissue is crucial for preventing complications such as infection, sepsis, and systemic inflammatory response syndrome (SIRS).

  • Accelerated Wound Closure:

Early grafting allows for the prompt closure of burn wounds, promoting faster healing and reducing the risk of hypertrophic scarring.

Grafting involves the application of healthy skin to the wound site, which helps in restoring the skin barrier and supporting tissue regeneration.

  • Minimization of Infection Risk:

Timely excision and grafting significantly reduce the risk of infections associated with open wounds. The removal of dead tissue creates a cleaner wound bed, and grafting provides a protective barrier against microbial invasion.

Infections in burn wounds can have serious consequences, so minimizing this risk is crucial for successful burn care.

  • Improvement of Aesthetic and Functional Outcomes:

Early excision and grafting contribute to improved cosmetic results by minimizing scarring and preserving the functionality of the affected areas.

Grafting allows for a more organized and natural tissue structure, reducing the likelihood of contractures and deformities.

  • Pain Management:

Early closure of burn wounds through grafting can contribute to better pain management. Closed wounds are generally less painful than open wounds, providing relief to patients and improving their overall comfort during the healing process.

  • Patient-Specific Approaches:

The decision for early excision and grafting depends on various factors, including the depth and extent of the burn, the availability of donor sites, and the patient’s overall health.

In some cases, temporary coverage with allografts or synthetic dressings may precede autografting.

  • Multidisciplinary Approach:

Successful early excision and grafting involve a coordinated effort by a multidisciplinary team, including burn surgeons, anesthesiologists, nurses, and rehabilitation specialists.

Continuous monitoring and follow-up care are essential to address potential complications and ensure the long-term success of the grafts.

It’s important to note that while early excision and grafting have demonstrated significant benefits in many cases, the decision to pursue this approach should be made based on careful assessment by burn care specialists, taking into consideration the unique characteristics of each burn injury.

Long-Term Rehabilitation:

Long-term rehabilitation is a crucial aspect of burn care, aiming to maximize functional recovery, improve quality of life, and address the physical and psychological challenges that individuals with burn injuries may face. Rehabilitation typically begins during the acute phase of burn treatment and continues for an extended period, adapting to the evolving needs of the patient. Here are key components of long-term rehabilitation in burns:

  • Wound Management and Scar Care:

Long-term rehabilitation involves ongoing wound management and scar care. This may include the use of pressure garments, silicone sheets, and topical treatments to reduce scarring and improve the appearance and flexibility of the healed skin.

  • Physical Therapy:

Physical therapy plays a central role in helping burn survivors regain strength, flexibility, and mobility. Therapists work with patients to restore joint function, prevent contractures, and improve overall physical fitness.

Adaptive equipment and techniques may be introduced to facilitate daily activities and enhance independence.

  • Occupational Therapy:

Occupational therapists assist individuals in regaining skills necessary for daily living, such as dressing, grooming, and cooking. They may also provide guidance on adaptive strategies and devices to optimize independence.

  • Psychosocial Support:

Coping with the psychological impact of burn injuries is a critical aspect of long-term rehabilitation. Psychosocial support, including counseling and support groups, helps individuals and their families address emotional challenges, anxiety, depression, and potential post-traumatic stress disorder (PTSD).

  • Pain Management:

Chronic pain can be a significant issue for burn survivors. Long-term rehabilitation includes ongoing pain management strategies, such as medications, physical therapy modalities, and psychological interventions to improve pain coping mechanisms.

  • Scar Revision Surgery:

In some cases, individuals may undergo scar revision surgeries as part of long-term rehabilitation to improve function and appearance. These procedures may address contractures, hypertrophic scars, or other complications.

Preventing Burn Injuries:

While effective burn management is crucial, preventing burn injuries is equally important. Education on fire safety, proper handling of hot liquids, and electrical safety can significantly reduce the risk of burn incidents. Workplace safety measures, proper use of protective equipment, and awareness campaigns contribute to a safer environment for everyone.

POST BURN DEFORMITIES

Post-burn deformities refer to physical changes or alterations in the appearance and function of the body that persist after a burn injury has healed. These deformities can result from the scarring, tissue contractures, and other complications associated with severe burns. If a burn Managing and addressing post-burn deformities often involves a combination of surgical interventions, rehabilitation, and psychosocial support. Here are key aspects of post-burn deformities:

  • Scar Contractures:

Scar contractures are one of the most common post-burn deformities. They occur when scar tissue tightens and pulls the adjacent skin, joints, or other structures, restricting movement. Contractures can affect areas such as the neck, hands, elbows, knees, and feet.

  • Joint Dysfunction:

Burn injuries can lead to joint dysfunction due to scar tissue formation around joints. This may result in limited range of motion, stiffness, and difficulty performing daily activities. Physical therapy is often employed to improve joint mobility and functionality.

  • Hypertrophic Scarring:

Hypertrophic scars are thick, raised scars that may develop after burns. While they do not extend beyond the boundaries of the original wound, they can cause functional limitations and cosmetic concerns. Scar management techniques, including pressure garments and silicone therapy, LASERS may be used to address hypertrophic scarring.

  • Facial Deformities:

Burns affecting the face can result in facial deformities, including changes in the nose, lips, and eyelids. Surgical interventions may be employed for scar revision, tissue reconstruction, or other cosmetic procedures to restore a more natural appearance.

  • Hand Deformities:

Burns on the hands can lead to deformities that impact fine motor skills and dexterity. Hand therapy, reconstructive surgery, and the use of splints or orthoses may be part of the rehabilitation process to improve hand function.

  • Amputations:

In severe burn cases, amputations may be necessary due to irreparable damage to limbs. Prosthetics and adaptive devices can be incorporated into the rehabilitation process to enhance mobility and functionality for individuals with limb loss.

  • Psychosocial Impact:

Post-burn deformities can have a profound psychosocial impact on individuals. Body image concerns, self-esteem issues, and emotional challenges may arise. Psychosocial support, counseling, and support groups are important components of addressing these concerns.

  • Reconstructive Surgery:

Reconstructive surgery is often employed to address post-burn deformities. Procedures may include scar revision, tissue grafting, and flap surgeries to restore both form and function. Multiple surgeries may be required over time.

  • Functional Rehabilitation:

Physical and occupational therapy are integral components of managing post-burn deformities. Therapists work with individuals to improve mobility, strength, and adaptability, helping them regain independence in daily activities.

  • Long-term Monitoring:

Individuals with post-burn deformities require long-term monitoring for potential complications, such as recurrent contractures or changes in scar tissue. Regular follow-up with healthcare professionals is essential to address emerging issues promptly.

Addressing post-burn deformities requires a holistic and multidisciplinary approach, involving burn care specialists, plastic surgeons, rehabilitation therapists, and mental health professionals. The goal is to enhance both the physical and emotional well-being of individuals affected by burn injuries and their associated deformities.

Reconstructive Surgery in post burn contractures:

Reconstructive surgery aims to release tight skin and tissues, restore normal anatomical structures, and improve the function of affected areas. This type of surgery is highly individualized, with the specific approach depending on the severity and location of the contractures.

Common Reconstructive Procedures:
  • Z-Plasty and W-Plasty:

These surgical techniques involve the rearrangement of scar tissue to improve the appearance and flexibility of the affected area. Z-Plasty and W-Plasty are often utilized to release tight bands of tissue, allowing for increased range of motion.

  • Skin Grafts:

Skin grafting involves transplanting healthy skin from one part of the body (donor site) to the area affected by the burn contracture. This helps in covering the damaged tissue, promoting healing, and enhancing mobility.

  • Tissue Expansion:

Tissue expansion is a method where a balloon-like device(tissue expander) is placed under the skin near the affected area. Over time, this device is gradually filled with a saline solution, stretching the surrounding tissue and creating extra skin to cover the contracture.It gives the best cosmetic result as scarred skin is replaced by normal adjacent skin.

  • Flap Surgery:

Flap surgery involves the transfer of tissue, including skin, muscle, or a combination, from one part of the body to another. This technique is particularly useful for addressing larger or more complex contractures.

Benefits of Reconstructive Surgery:
  • Improved Functionality:

Reconstructive surgeries aim to restore normal function to the affected areas, allowing individuals to regain mobility and engage in daily activities more comfortably.

  • Enhanced Aesthetics:

Beyond functional improvements, reconstructive procedures often lead to significant improvements in the aesthetic appearance of the treated areas, contributing to increased self-esteem and confidence.

  • Reduced Pain and Discomfort:

By releasing tight bands of tissue, reconstructive surgery can alleviate pain and discomfort associated with post-burn contractures, enhancing overall well-being.

Best Results / Before & After

Burn
Post-Burn-contracture-Hand
BEST QUALITY

Our Goal is Quality Treatment with Satisfaction:

At Sukriti Clinic we believe that quality and customer satisfaction are crucial in any medical practice, including plastic and pediatric surgery clinics. We focus on providing personalized care tailored to each patient's needs. This involves clear communication, empathy, and involving patients in decision-making processes regarding their treatments. We emphasis on:

  • Safety Protocols
  • Quality of Care
  • Patient-Centered Care
  • Ethical Practices
  • Holistic Approach
  • Transparent Communication
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