ACUTE BURNS AND BURNS REVISION SURGERY
Acute burns and Burns revision surgery
(secondary surgery for scars and contractions)
There are two main categories of burn surgery: acute and reconstructive. Acute burn care occurs immediately after the injury.
Large burns, or burns of critical body areas, should be treated at a verified burn centre. Many smaller burns can be treated with outpatient options. Some patients may need reconstructive burn surgery after the initial burn wounds have healed. The goals of reconstructive burn surgery are to improve both the function and the cosmetic appearance of burn scars. This involves altering scar tissue, with both non-operative and operative treatment. 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.
Surgery will not be able to remove a patient’s burn scars entirely, but it will help improve basic functions and make scars less noticeable. Scarring can limit the normal motion of the neck, shoulder, hands, or legs. Often surgery to help release this contracture can help a patient regain range of motion. Facial scarring that leads to problems with the eyelids, lips, nose, or hair loss can also be helped with reconstructive burn surgery. Scars that are abnormally thick, wide, or discoloured might also be improved by a variety of operative and non-operative methods.
Non-operative therapies might involve scar massage, application of pressure garments, or other topical therapies. Surgical options consist mainly of scar release procedures. The tight scar tissue is released and the open area closed. There are a variety of ways to close these wounds depending on a patient’s needs. Skin grafts, skin rearrangement (sometimes called Z-plasty), and more complex skin donor flaps could be used, depending on the location of the scar and a patient’s personal goals. Most minor procedures are performed as outpatient surgery, but the larger grafts and flaps would likely require an inpatient stay. Tissue expansion can also be used as an alternative to skin grafting. Excellent results are commonly attained when performing tissue expansion to regions of the face, neck, arms, hands, and legs.
Following post-surgery instructions are important to heal and obtain the best possible outcome, both in terms of function and physical appearance. You will have follow up appointments so Dr. med. Strouthou 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 5-7 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, Dr. med. Strouthou may place you in a larger dressing that incorporates a plaster splint for support after surgery. In general, follow-up visits are scheduled within two weeks of surgery, and there may be stitches 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.