Burns are one of the many forms of injury that plastic surgeons treat. Burns that are minor require only first aid and dressings.They leave red marks that fade away with time.However burns on a large area of the body are more serious. They can be life threatening, require intensive care and possibly several operations or procedures. In some cases the damage caused is severe and needs long term measures to overcome the deformity.
Sequelae of burns can have a major impact on a person’s appearance and functional ability even to perform routine activities. Plastic surgeons have an important role in the immediate as well as long term management of burns. They are involved in the treatment of burns patients from the moment they are admitted, through the initial critical phase till the wounds start healing and thereafter post discharge from the hospital, during rehabilitation. Sometimes prolonged therapy is needed if there is residual scarring with tightening of the skin over joints and muscles causing restriction of movement.
There are a number of advanced surgical techniques involved in the treatment of burns. The goals of treatment are to control pain, remove dead tissue, prevent infection, reduce scarring risk and regain function. Dr Amit Bhalotia has tremendous experience in managing all types and degrees of burns with good gain-to-function as well as cosmetic outcome.
Skin grafting is a procedure that involves taking a healthy patch of skin from one area of the body, known as the ‘donor site’, and using it to cover another area where skin is damaged or missing.There are two basic types of skin graft:
- Split-thickness skin graft
This uses the superficial layer of skin closest to the surface and is commonly used to treat burn wounds.
- Full-thickness skin graft
This involves use of all layers of skin from the donor area.It is more often used in reconstructive or secondary treatments than in acute burns.
Rarely, if there is insufficient undamaged skin for grafting, a sample of the patient’s skin is taken and the cells are grown in a laboratory to provide sheets of one’s own skin cells that are then placed as skin grafts.
Free Flap Surgery/ Microsurgery
Free flap surgery involves transfer of a living piece of tissue from one part of the body to another, along with the blood vessel that keeps it alive.Unlike a skin graft, flaps carry their own blood supply,tissues and skin. The procedure involves joining up blood vessels of the flap with those at the new site and is performed with use of a microscope, hence the name ‘Microsurgery’.The ability to disconnect and reattach tissue in this way means that the reach of a flap is no longer limited by a patient’s anatomy.
Flap reconstruction is a technique used to aid rehabilitation in burns victims.It can restore form and function to areas of the body that have lost skin and underlying tissues like fat, muscle and/or need skeletal support. These are not suitable for covering very large areas of damaged tissues.
Tissue expansion is a procedure that enables the body to ‘grow’ extra skin by stretching the surrounding tissue. This is similar to the way the tummy skin stretches and grows during pregnancy.
A balloon-like device made up of silicone called an expander is inserted under the skin near the area to be repaired, and is then periodically filled with saline, causing the skin to stretch and grow gradually. The time needed for tissue expansion depends on the individual case and size of the area to be repaired, but often takes several weeks.When the skin has stretched enough to cover the affected area, there will be a second procedure to remove the expander and reposition the new tissue.
Following surgery, it is important to duly follow instructions to heal well and obtain the best possible outcome, both in terms of function and physical appearance. Having follow-up appointments with the surgeon will help to monitor the wound. Additional physical therapy or occupational therapy may be required in the weeks and months following surgery to ensure a complete recovery of function.