Burns are a common everyday problem. Most of us have experienced burns to a small degree that they do not cause major issue. However, when burns cover a larger area of the body or are more than just skin-deep, they can lead to dehydration, infection, prolonged healing, and bad scarring, leading to functional problems in the future. This is particularly pertinent in burns covering > 15% of the body surface area or involving sensitive areas such as the groin and hands. Also, where burns have been caused by more than fire and scalding, such as in electrical or chemical burns, specialist treatment must be sought to treat or rule out any untoward sequelae such as heart or electrolyte issues.

 

Surgery for burns encompasses both the acute and chronic problems caused by burns. If the burn is deep and extensive, early surgery to clean the burns and apply specialized dressings (e.g., BiobraneTM) or skin grafts can help to hasten healing and reduce scarring. If burns get infected, surgery, along with antibiotic therapy, may be needed to clean the wounds to allow for unimpeded healing. Finally, once the burns have healed, they may cause cosmetic or functional issues, such as facial scarring or scar contractures in the joints. Plastic surgery can improve both appearance and function for all sorts of burns injuries.

While most small and shallow burns can be managed with dressings, deeper and larger burns may require surgery, as well as other treatments including antibiotic treatment, intensive care management, multi-disciplinary therapist management, and post-healing scar therapy.

If you sustain a burn which is larger than the size of your palm, and where there is blistering and skin loss, do seek medical advice. In instances where you may have inhaled fire-related smoke, sustained electrical or chemical burns, when you think you have been burned more deeply over a large surface area, or when your wounds are infected, seek treatment as soon as possible. GP clinics, polyclinics and emergency departments will be able to refer you to recommended plastic surgical services.

Complex wounds refer to wounds that cannot simply be closed, those involving multiple tissue layers, or chronic non-healing wounds. Quite often, patients with complex wounds have multiple medical problems such as diabetes and peripheral vascular disease, which can further complicate the wound healing process. Complex wounds require multi-modality treatment, which the plastic surgeon is adept at coordinating and managing.

The treatment plan for complex wounds can include modern dressing materials including negative pressure wound therapy, revascularization with the aid of an interventional vascular specialist, and long-term antibiotic therapy for chronic wound infections. Ultimately, surgery for these wounds would often require advanced reconstructive techniques, ranging from grafts to flaps and even reconstructive microsurgery. The ultimate goal is to return the best quality of life possible to the patient in the shortest space of time.

For more information on specific areas of reconstruction, do refer to the different reconstructive surgery subheadings. A consultation with our experienced plastic surgeon Dr Adrian can help with assessment of your wound and formulating an appropriate treatment plan.