BURNS
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.
Can surgery treat burns?
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.
What other treatments do burn injuries require?
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.
What should I do if I sustain a burn?
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.
SCARS
Most wounds heal without too much issue. However, problems related to scars can arise in poorly opposed wounds, previously infected wounds, or deep wounds which are left to heal on their own. The formation of the scar is usually the result of ongoing inflammation, tension, and genetics. Bad scarring outcomes include hypertrophic scarring, keloid scarring, or pigmentary issues. These can cause itchiness, pain, and psychological distress. A common example of bad scarring are keloids that form at the ear lobe after ear piercing.
How can plastic surgeons help with bad scars?
From conservative to surgical options, plastic surgeons are well equipped to deal with bad scars.
Conservative management for scars includes the use of steroid injections, pressure therapy and topical scar treatment. Beyond these, advanced laser therapies can help reduce the appearance of blood vessels or pigment while resurfacing the scar.
In more severe cases or with scars that do not respond to conservative or laser treatment, surgery and/or radiotherapy can be considered. Utilizing plastic surgical techniques and meticulous suturing, the plastic surgeon can remove the scar and shift tissue from neighbouring areas to reduce the risk of recurrence.
Can bad scarring recur?
Even with the appropriate treatments, scars can be stubborn and recurrence rates may range from 10 to 50%. However, a qualified plastic surgeon can assess your scar and recommend a treatment plan to help reduce this risk greatly.
COMPLEX WOUND MANAGEMENT
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 one of our experienced plastic surgeons can help with assessment of your wound and formulating an appropriate treatment plan.
