Surgery on Burn Patients

Dr. Iftekhar Ibne MannanHMO, DMCH

Topics of discussion

Principles of burn surgeryReconstructive ladderZ-plastyW-plasty

Principles of burn care

Preservation of lifePrevention and control of infectionConservation of all viable tissueMaintenance of functionTimely closure of the burn wound

Burn Surgery

Escharotomy and FasciotomyExcision and GraftingBurn wound closurePost-burn reconstruction

Post-burn deformities

ContracturesHypertrophied scarsChronic ulcersUnfavourable scars

Methods

Incisional release and coverageExcisional and coverageReorientaion of scars e.g. Z-plasty, W-

plasty etc.ResurfacingPressure garmentsSteroidsMassage

Timing of Surgery

Acute: to facilitate patient care and to prevent acute contractures from causing irreversible secondary damage. e.g. eyelid contractures with exposure keratitis etc.

Intermediate: to manipulate scars to make them favourable

Late: to correct established postburn deformities.

Behaviour of scars

Scars under tension are angry and respond with erythema, hypertrophy, pruritus, pain and tenderness.

Relaxed scars are happy scars and respond by flattening, softening and becoming pale and asymptomatic.

Principles of burn reconstruction

Analyze the deformity and note distorted and absent tissue.

Generate a long-range plan for reconstruction that establishes priorities and addresses both functional and esthetic concerns.

Delay reconstruction until the scars and grafts have matured. Use splints and elastic garments to minimize scar hypertrophy.

Release extrinsic contracture before intrinsic contracture.

Orient scars parallel to relaxed skin tension lines.

Principles of burn reconstruction

Identify and ration potential donor site skin. Resurface according to regional esthetic units.

If possible, adjacent units should be covered with a single large graft to avoid seams between territories.

Match donor skin according to thickness, color and texture. Thicker skin grafts produce less postoperative contracture.

Protect new scars and grafts from ultraviolet radiation to decrease the chance of hyperpigmentation.

Reconstructive Ladder

Direct tissue closure

Skin graft

Local flap

Blood supply of flaps

Z-Plasty

•Lengthens

•Reorients