Reconstructive Burn Surgery
Reconstructive burn surgery aims to enhance the function and aesthetics of burn scars. The treatment approach involves various techniques, including both non-operative and operative methods, to modify scar tissue.
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Plastic Surgeon discusses reconstructive burn surgery.
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Pediatric Plastic Surgeon, discusses Three Phases of Wound Healing
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Pediatric Plastic Surgeon, discusses Wound Healing and Scars
What is Reconstructive Burn Surgery
Burns can cause damage to the skin and underlying tissues, and the healing process can lead to the formation of scar tissue. The severity of the burn and the depth of tissue involvement can influence the extent and appearance of the resulting scars.
Scars from burns can be particularly challenging because they can be raised, thickened, discolored, or have an irregular texture. Additionally, burns on visible areas of the body, such as the face, hands, or neck, can have a significant impact on a person's self-esteem and quality of life.
Various approaches are used to manage and improve the appearance of burn scars. Here are some common treatment options:
Pressure Garments: Wearing pressure garments over the healed burn area can help flatten and soften the scars by applying constant pressure.
Silicone Gel Sheets: These sheets are applied over the scarred area to improve the appearance of the scars. They can help reduce redness, flatten the scar, and make it less noticeable.
Scar Massage: Gentle massaging of the scar tissue can help break down scar tissue and improve its appearance.
Corticosteroid Injections: Injections of corticosteroids into hypertrophic (thickened) scars can help reduce their size and improve their appearance.
Laser Therapy: Different types of laser treatments can be used to improve the color, texture, and flexibility of burn scars.
Surgical Interventions: In some cases, surgical techniques such as scar revision or skin grafting may be considered to improve the appearance of burn scars. These procedures aim to remove or modify the scar tissue and replace it with healthy skin.
It's important to note that while these treatments can help improve the appearance of burn scars, they may not completely eliminate them. The effectiveness of each approach can vary depending on the individual and the characteristics of the scar. Consulting with a dermatologist, plastic surgeon, or a specialist in burn care can provide personalized recommendations based on the specific situation.
I understand that scars in certain areas of the body, such as the neck, across the elbow joint, or in the area of the fingers, can have negative effects on a patient's activity and mobility. Scars that are thick and shortened can restrict movement and make it difficult for individuals to extend their arms or use their hands comfortably.
In addition to the physical discomfort and limitations, patients may also feel self-conscious about how the scars look. It's important to note that the appearance of scars can vary depending on various factors, including the individual's healing process and the type of injury or surgery that caused the scars.
If scars are causing significant functional impairment or psychological distress, it is advisable for individuals to consult with a healthcare professional, such as a dermatologist or a plastic surgeon. These specialists can assess the specific situation and provide appropriate recommendations and treatment options.
Treatment for scars may include topical treatments, such as silicone gel sheets or creams, which can help soften and flatten the scar tissue. Other interventions, such as scar massage, pressure garments, or silicone-based scar sheets, may also be recommended to improve scar appearance and flexibility. In some cases, more advanced treatments like laser therapy, steroid injections, or surgical scar revision may be necessary.
It's important to remember that every scar is unique, and treatment options may vary depending on individual circumstances. Consulting with a healthcare professional will allow for a personalized evaluation and appropriate management plan tailored to the patient's needs.
Therefore, there are a number of different operations that have been designed to release the scar contractures and to allow the patients to feel more comfortable, to be more active, and to be able to function again more normally. There are different techniques, and there are different procedures and the timing of them is quite varied as well.
Sometimes the scars are released and they are re-skin grafted and subsequent to the grafting, one of the important things is to maintain of the release is the appropriate occupational therapy and physiotherapy. So most of these treatments are not just about the surgery, it is about the after care that the patients receive and these are usually a sub specialized areas of care where the therapist will see and meet with the patients every week or two for up to a year. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.
Once the surgery to release the burn scares has been completed and the wounds have healed, the patients – there are different procedures that can be used. Some involve skin grafting with split thickness grafts or full thickness grafts and that is the type of skin that you apply to the defect. Sometimes it can be a flap. Sometimes muscles are transferred into the area where these reconstructive operations are quite complex. Therefore, this will allow for example, a patient with a neck contracture to be able to move their neck more comfortably and a contracture of their arm or elbow, the same is true.
Sometimes additional layers of pressure are applied under the [inaudible] which include sheets of silicon gel that again put pressure on the scar and allow them to be softer and again improve the color of the scar. What technique is used depends on the age of the patient, the location of the scar and the depth of the scar.
In some circumstances, the patients will have a particular prosthesis placed which is called a tissue expander. It is put underneath their normal skin. It is stretched and in the process of doing that, the skin is stretched and that is then the harvested and used in another area of their body in that there is now some excess skin.
If patients have burned scars and wish to have an opinion as to whether or not they can be improved, then they should ask their family physician for a referral to a plastic surgeon who specializes in the area of burn scar reconstruction.
Non-operative treatments for burn scars may include:
Compression therapy: The use of pressure garments or dressings to apply constant pressure on the scar, which helps flatten and soften the tissue.
Scar massage: Regular massaging of the scarred area to improve blood circulation, promote tissue remodeling, and reduce scar tightness.
Silicone gel sheets or creams: Application of silicone-based products on the scar to help hydrate the skin and minimize scar thickness and color.
Topical medications: The use of specialized creams, ointments, or gels containing ingredients like corticosteroids or vitamin E to reduce inflammation, itching, or redness associated with scars.
Laser therapy: Laser treatments can help improve the texture, color, and pliability of burn scars by stimulating collagen remodeling and reducing excessive scar tissue.
Operative treatments for burn scars may include:
Scar excision: Surgically removing the scar tissue and closing the wound with sutures or a skin graft. Skin grafts involve taking healthy skin from one area of the body (donor site) and placing it over the excised area.
Z-plasty or W-plasty: These are techniques used to reposition or redirect the scar to follow natural skin tension lines, resulting in a more inconspicuous scar.
Tissue expansion: Involves the placement of a balloon-like device (tissue expander) beneath the skin near the scar. Over time, the expander is gradually filled with saline, stretching the healthy skin and creating a larger area of skin that can be used to cover the scar during a subsequent surgical procedure.
Skin grafting: Taking healthy skin from a donor site (autograft) or a deceased donor (allograft) and transplanting it onto the scarred area to promote healing and improve function and appearance.
Flap surgery: Involves transferring healthy tissue, including skin, fat, and sometimes muscle, from a nearby area to cover the scarred site. Flap surgeries are often used for larger burn scars that require more extensive reconstruction.
The relationship between a burn patient and a reconstructive burn surgeon typically spans several years due to the nature of scar management and multiple treatment stages involved in achieving optimal results. Regular follow-up visits, scar assessments, and adjustments to the treatment plan may be necessary to ensure ongoing progress and patient satisfaction.