Moving past tragedy – Reconstructive surgery for burn victims

Summary

Burns are injuries caused by heat exposure, chemical fires, electric currents or high levels of radiation. Burn victims often suffer severe trauma and are left with scars and disfigurements even after healing. Burn victims are often subjected to pain, lack of confidence and social stigma because of these scars. Reconstructive burn surgery aims to enhance the functionality and aesthetics of the injured areas. Often, reconstructive burn surgery is performed to release contractures in scar tissue that limit movement. Reconstructive surgery offers burn victims a new lease on life, allowing them to function independently, return to employment and engage with society without stigma.

Introduction

Burn victims often endure severe trauma and are left with scars and disfigurements even after healing. Burns are injuries caused by high heat exposure, intense friction, contact with chemicals, electric currents, or radiation. Burns are categorized into degrees of severity, from First-degree (superficial) to Fourth-degree (deep tissue involvement). Acute burn surgery and reconstructive plastic surgery are the two main categories for treating burn injuries. Acute burn surgery focuses on stabilizing the patient and addressing immediate concerns, while reconstructive surgery deals with rehabilitation and aesthetic considerations after the initial healing.

What is Reconstructive burn surgery?

Reconstructive burn surgery aims to enhance both functional and aesthetic aspects of healed burns. Large burns typically leave extensive scars, which can restrict movement, particularly over joints like knees, elbows, and shoulders. This type of surgery can help release the constriction caused by scar tissue and improve range of motion. Additionally, it addresses the psychological impact of scarring by improving the aesthetics. Reconstructive surgery is often performed in stages over several months or even years, and new scar contractures may require attention later, especially in growing children.

What are the benefits of Reconstructive burn surgery?

Reconstructive burn surgery cannot completely erase scars, but it can make them less noticeable and improve the functionality of affected areas. Some key benefits include:

1. Aesthetic Improvement – Burn scars are often a constant reminder of trauma and can lead to social stigma. Reconstructive surgery helps minimize the appearance of scars, making patients feel more comfortable in social and professional settings and improving self-esteem.
2. Improved Function – Scar tissue can cause constriction, limiting movement in joints like knees, elbows, and shoulders. Reconstructive surgery helps release this constriction and may include skin grafts to restore normal function. It can also address facial scarring affecting features like the nose, lips, or eyelids.
3. Pain Relief – Scar tissue constriction can be painful. Various non-surgical techniques, including pressure garments, and surgical methods can alleviate this pain.
4. Prevention of Infections – Techniques such as wound closure with skin grafts, debridement of dead tissue, and escharotomy can help prevent infections.
5. Psychological Benefits and Better Quality of Life – By improving the physical appearance of scars and rehabilitating motor skills, patients can regain dignity and independence, significantly enhancing mental health and quality of life.

What are the options for Reconstructive burn surgery?

The choice of reconstructive technique is customized to each patient’s case by the plastic surgeon. Often, a combination of techniques will be used to achieve the desired effect. Most burn patients turn to reconstructive surgery to close large wounds and release stiffness caused by scar tissue. Depending on the location and intensity of the burn injury, the plastic surgeon may choose to use skin grafts, skin rearrangement or skin donor flaps:

Skin Grafts – Skin grafting is basically a surgical skin transplant procedure. There are many different types of skin grafts. An autograft is a skin graft taken from a healthy part of the patient’s body. An allograft is a skin graft donated by another human donor, usually a cadaver. Allografts are often used as a temporary measure to reduce the chances of infection. Skin grafts can also be split-thickness (only epidermis and partial-dermis layers) for shallower burns and full-thickness (epidermis and entire dermis) for deeper burns. In some cases, synthetic skin grafts made of bioengineered skin substitutes are also used.

Skin rearrangement (Z-plasty) – Skin rearrangement is a common technique used in scar revision surgery. To relieve constriction caused by the scar, a long incision is made along the length of the scar, followed by 2 diagonal incisions crossing this line. The length and angle of the diagonals is decided by the plastic surgeon based on the elongation needed to restore a full range of motion.

Skin donor flaps – A skin donor flap is a unit of tissue that is removed from a donor site on the patient’s body to the location of the burn injury. The donor flap retains its own blood supply. The skin donor flaps can be taken in the shape and size required for the specific burn being treated. The key difference between a skin graft and a skin flap is that the skin flap has its blood supply network intact. Skin donor flap surgeries are hence more complex, because the vascular network needs to be connected as well. Skin donor flaps are used to cover more extensive burn injuries, where muscle and bone become exposed.

Reconstructive burn surgery: FAQs

1. How do I choose the right surgeon for my reconstructive surgery? Look for a plastic surgeon with experience in burn care and review their credentials. Seek recommendations from healthcare professionals and consider surgeons at reputed hospitals.
2. What should I expect during my first consultation with a reconstructive surgeon? The surgeon will assess the extent of your injuries, discuss reconstruction options, and develop a treatment plan. This is also your opportunity to ask questions and address concerns.
3. How soon after the burn injury can reconstruction be done? Reconstruction typically occurs once the burn has healed and dead tissue has been removed. Reconstructive procedures are often long-term processes and may require follow-up surgeries.
4. Will reconstructive surgery completely restore my appearance? While reconstructive surgery can improve function and minimize scarring, it may not fully restore pre-burn appearance. Multiple procedures and physiotherapy may be necessary for optimal results.
5. Will I need physical therapy after reconstructive surgery? Yes, physical therapy is crucial for improving mobility, strength, and function. Your surgeon will recommend a physical therapist and a tailored rehabilitation plan.

Tips for Post-Surgical Care

Reconstructive burn surgery often requires ongoing care. Here are some tips:

1. Follow your doctor’s advice carefully, including attending follow-up appointments and changing dressings as directed. Proper care is essential to prevent infections.
2. Keep the injured area clean and avoid activities like swimming or sweating until cleared by your doctor. Watch for signs of infection and report them immediately.
3. Maintain a balanced diet and stay hydrated to support healing.
4. Adhere to physical therapy routines to regain functionality, strength, and independence.
5. Protect the injured area from sun exposure and follow moisturizing instructions to care for sensitive skin grafts.
6. Avoid stressful situations and strenuous activities to allow your body to recover.
7. Join a support group if you’re struggling with feelings of grief or dejection. Community support can be invaluable during recovery. Your doctor can suggest support groups and counsellors.

Whether you or a loved one are considering reconstructive surgery for burns, it’s crucial to consult with experienced professionals who can guide you through each step of the process. At Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our team of skilled reconstructive plastic surgeons is dedicated to providing compassionate care and advanced surgical solutions tailored to meet your unique needs.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801