The basic concerns in burns reconstruction are for function, comfort, and appearance. Normal and hypertrophic scarring, scar contracture, loss of parts of the body, and change in colour and texture of injured skin are processes common to all seriously burnt patients and yet unique to each.
A realistic approach is necessary to harmonise patients’ expectations (which are very high) with the probable outcomes of reconstructive surgery. Burn reconstruction starts when a patient is admitted with acute burns and lasts until the patient’s expectations have been reached or there is nothing else to offer. However, even when this time has come, the patient-surgeon relationship may still continue and can last a lifetime.
Any surgeon undertaking burn reconstruction must have good understanding of wound healing and scar maturation to plan the time of reconstruction, and sound knowledge of all surgical techniques and all the aftercare required (usually in conjunction with a burn team). A strong patient-surgeon relationship is necessary in order to negotiate a master plan and agree on priorities
Burns Reconstruction Procedures
Waiting for scar maturation is inappropriate when it is certain that an operation is needed to correct a deformity or if vital structures are exposed or can be severely damaged. Urgent procedures should be restricted to those needed to correct function for injuries that are not suitable for other treatments. Examples include an eyelid release to protect an exposed cornea, correction of distracted or entrapped neurovascular bundles, severe fourth degree contractures, and severe microstomia.
Although they are not urgent since no important structure or the patient’s overall health is challenged, essential procedures may, if performed early, improve the patient’s final appearance and rehabilitation. Such procedures include operations for all burn scar contractures that do not respond to rehabilitation, and hypertrophic scarring and contractures that prevent a patient from eating, bathing, moving, or performing everyday activities.
Desirable reconstructive procedures
Most of the problems that patients may present fall in this category. These are often aesthetic problems and scars contractures that, although not prominent, produce great discomfort. For all desirable procedures, it is good practice to wait until all red and immature scars have disappeared before starting any kind of surgery. An early operation is often unnecessary in these