Definition and Overview
Burn surgery is a term used for a variety of procedures that are carried out to treat burn injuries and prevent further complications.
Burns typically affect an individual’s skin and/or other tissues due to injuries caused by extreme heat and cold, friction, exposure to certain chemicals, radiation, and electricity. A majority of burn injuries are caused by extreme heat from fire, as well as hot liquids and solids.
There are four different kinds of burn injuries, namely:
- First-degree burns - Affect only the superficial layers of the skin and typically appear red without blisters and pain. This type of burns disappears after three days.
- Second-degree burns - Affect some of the layers underneath the skin and typically have blisters that are quite painful
- Third-degree burns – Affect all layers of the skin, and while the patient may not feel any pain with the injury, the burnt area will feel stiff and healing will not start on its own.
- Fourth-degree burns - Involve deep tissue injury, with the burn injury extending to the muscle, tendons, or the bones
While first-degree burns are relatively easy to manage and treat at home, more serious burn injuries require special medical attention. In some cases, surgical intervention may be required to prevent complications such as infections, unsightly scarring, nerve damage, or death of the affected tissues.
Who Should Undergo and Expected Results
Patients suffering from third and fourth-degree burns are ideal candidates for burn surgery. These conditions require surgical treatments, such as skin grafting, especially when the injury involves areas that need to be closed. The type of burn surgery performed on a patient typically depends on the severity and location of the injury. For example, an escharotomy is required for circumferential burns in the limbs, where the underlying tissues are released to prevent constriction and impaired circulation. Meanwhile, a fasciotomy is performed to relieve pressure or tension if the burn injury affects tissues and muscles underneath the skin.
While it is impossible to restore the original appearance of the affected body part prior to the burn injury, burn surgery can cover and protect exposed areas. The procedure works very well with children and younger patients, as they typically heal better over time compared to older patients.
After the surgical procedure, the patient may have thick, wide, or discoloured scars, as well as hair loss and limited motion in affected areas such as the fingers, toes, legs, hands, shoulder, or neck. These issues can be addressed and improved with other treatments, including further surgery.
How is the Procedure Performed?
Burn surgery typically involves skin grafts, where healthy skin tissues are removed from one area of the body and transplanted into the area affected by burn injuries.
There are two basic types of skin graft procedures, namely:
- Split-thickness graft, which involves the use of a few layers of the outer skin; and
- Full-thickness graft, which involves all layers of the patient’s skin
In both types of burn surgery, the patient will have noticeable and permanent scarring in the area where the skin is grafted. During this procedure, the surgeon uses a dermatome, a special instrument used for cutting skin and underlying tissues, to harvest skin from typically clothing-hidden areas, such as the inner thigh or the buttocks.
Once the skin and underlying tissues are successfully removed, the graft will be placed on the affected area. The skin and tissues will be held in place with sterile dressing, as well as a couple of small stitches. The donor area will also be covered with sterile dressing to prevent the onset of infection. Patients who have undergone a split-thickness graft usually recover faster than full-thickness graft patients.
Microsurgery can also be performed on patients who have lost fingers, toes, ears, or lips to burn injuries. The surgeon will use a special surgical microscope to reconstruct the affected areas. The surgeon will sew blood vessels, arteries, and nerves together to restore not only the detached body part, but also its functions.
Possible Risks and Complications
Like any other surgical procedure, there are certain risks and complications that come with burn surgery. Infection is a common complication since the burned area and the donor site (if a skin graft is performed) is vulnerable to bacteria when they remain open.
Patients with the following symptoms after burn surgery should immediately return to the doctor for the treatment or management of infections:
- Blisters or white pimple-like growths around the incision lines
- Presence of bloody or yellow-tinged fluid from the incision line
- Pain, redness, swelling, or tenderness at the graft site
Kraft R, Herndon DN, Al-Mousawi AM, Williams FN, Finnerty CC, Jeschke MG. Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study. Lancet. 2012 Mar 17. 379(9820):1013-21.
Jeschke MG, Finnerty CC, Kulp GA, Przkora R, Micak RP, Herndon DN. Combination of recombinant human growth hormone and propanol decreases hypermetabolism and inflammation in severely burned children.Pediatr Crit Care Med. Mar 2008. 9:209-216