Burn reconstruction entails the corrective surgeries that are carried out to address different post burn deformities. There are different types of surgeries which have to be carried out by Plastic surgeons to improve post burn deformities of different areas of the body.
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 discolored might also be improved by a variety of operative and non-operative methods.
Burn injuries constrict and deform the face, distorting its features, proportions and expression. Burns also alter the surface of the facial mask by causing scars and altering texture and pigmentation. The changes to the surface of the skin are deforming but are much less important to facial appearance than are the changes in proportion, features, and expression. The removal of scars should not be the primary goal of facial burn reconstruction. A normal looking face with scars is always better looking than an even slightly grotesque looking face with fewer scars. Mature scars that result from burn injury will often be less conspicuous than surgically created scars or surgically transferred flaps or grafts. The subtle and gradual transition between unburned skin and burn scar is an excellent example of nature’s camouflage and can render scarring remarkably inconspicuous. The principal goal of facial burn reconstruction should be the restoration of a pleasing and tension-free facial appearance with appropriate animation and expression. If this goal is kept in mind and pursued with persistence and determination, the amount of improvement that can result after severe facial burn injury can be remarkable. Ignoring this basic principle can result in iatrogenic catastrophes during reconstructive surgery of the head and neck following burn injury.
Successful reconstruction of burn deformities of the head and neck requires a well-functioning and extensive team. Major burn deformities in this area can be intimidating and overwhelming. Experience and a specialized infrastructure are required to take care of these patients comfortably and successfully. Familiarity with their unique problems and a firm commitment to correcting their challenging deformities is required from all members of the reconstructive team. The care of a patient from the onset of a major burn involving the head and neck to a successful reconstructive outcome requires skill, patience, determination, and enthusiasm from all who are involved.
Skin grafts are most useful for wounds that are wide and difficult to close. A skin graft is a patch of healthy skin that is taken from one part of the body, also called the “donor site”, used to cover another area where the skin is damaged. There are three types of skin grafts including a split-thickness skin graft, a full thickness skin graft, and a composite skin graft.
A split-thickness skin graft, commonly used to treat burn wounds, uses the layers of skin closest to the surface. If possible, the surgeon will choose a less noticeable donor site.
A full-thickness skin graft may be used to treat a burn wound that is deep and large or to cover jointed areas where skin elasticity is needed. A small scar usually results from a direct wound closure at the donor site.
A composite skin graft is used when a wound needs underlying support. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A scar will remain at the site where the graft was taken but will fade with time.
Flap surgery involves the creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
One type of flap surgery involves tissue that remains attached to its original site, retaining its blood supply. The flap consists of skin, fat, and muscle. Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks.
The tissue is transplanted to the area by reconnecting the blood vessels. This procedure requires experience with microvascular surgery.
Flap surgery is more complex than skin expansion. Scars will be present at both the tissue site and on the reconstructed region.
Microvascular surgery involves the transfer of skin, muscle or bone with the artery and vein to a site needing reconstruction. This type of surgery is used to reattach fingers, hands, arms, and other amputated parts to the body by reconnecting the small blood vessels and restoring the circulation. Microvascular surgery also can be used in reconstructive surgery or soft tissue defects created by trauma or tumor surgery.
Tissue expansion is a fairly common procedure that enables the body to “grow” extra skin for use in reconstructing almost any part of the body. The procedure involves a silicone balloon expander which is inserted under the skin near the area to be repaired. Gradually, the area is filled with saline solution over time, enabling the skin to stretch and grow. Most commonly used for breast reconstruction, this procedure is also used to repair skin damaged by birth defects, accidents or surgery.
Prof. Dr. Nauman Ahmad Gill as a Life member of Pakistan Association of Plastic Surgeons (PAPS) and enjoys a good repute among his peers and junior colleagues. He has been an office bearer of the Association in the year 2016 to 2018 and is currently selected as Assistant Secretary of the Society.