Reconstructive Burn Surgery
What is Burn Surgery?
There are two main categories of burn surgery: acute and reconstructive. Acute burn care occurs immediately after the injury. It is delivered by a team of Trauma Surgeons (General Surgeons) that specialize in acute burn care. Complex burns often require consultation with Plastic Surgeons, who assist with the inpatient and outpatient management of these cases. Large burns, or burns of critical body areas, should be treated at a verified Burn Center, such at the Trauma Burn Center here at the University of Michigan. Smaller burns may be managed as an outpatient.
Reconstructive burn surgery may be required after the initial burn wounds have healed. This kind of care us usually provided by a Plastic Surgeon. The goals of reconstructive burn surgery are to improve both the function and the cosmetic appearance of burn scars. This involves the modification or alteration of the scar tissue, by both non-operative and operative means. The relationship between the burn patient and the reconstructive burn surgeon often lasts many years. Treatments for scar tissue often take several months to be effective, and new scar contractures can appear long after these injuries, especially in young patients who are still growing.
Who is a Good Candidate for Reconstructive Burn Surgery?
The ideal candidate for this surgery realizes that surgery cannot remove their burn scars entirely, but may be able to help improve basic functions or make scars less noticeable. If contracture from scarring is limiting the normal motion of the neck, shoulder, hands, or legs, release of scar contractures may be of benefit. Facial scarring that leads to problems with the eyelids, lips, nose, or hair loss can also be addressed. Scars that are abnormally thick, wide, or discolored might also be improved by a variety of operative and non-operative methods.
How is the Procedure Performed?
Non-operative therapies might involve scar massage, application of pressure garments, or other topical therapies. The fitting of pressure garments is usually coordinated with an Occupational Therapist. Within the O.T. department, there are also hand therapists to assist with rehabilitation of hand burns and scars.
Operative therapy consists mainly of scar release procedures. Once a tight scar is released, the opening in the skin must be repaired-the Plastic Surgeon uses a variety of techniques to close these wounds. Skin grafts, skin rearrangement ("Z-plasty"), and more complex flaps could be required, depending on the location of the scar and the desired outcome. Most minor procedures are performed as outpatient surgery, but the larger grafts and flaps will likely require an inpatient stay.
List of Physicians Who Perform Reconstructive Burn Surgery
Planning for Your Surgery
The first step is to schedule a personal consultation with your plastic surgeon. Communication is crucial in reaching your goals. You will have the opportunity to express your goals and the results you'd like to achieve. Together, you and your surgeon will reach an understanding about what you can expect from this procedure and the long-term benefits you will experience. Every patient is different, and your surgeon will choose the surgical technique and treatment plan that is right for you. During the initial consultation, you should expect:
- To provide a complete medical history, including information about previous surgical procedures; past and present medical conditions; and any medications or herbal supplements you are taking.
- Your surgeon to conduct a complete physical examination.
- To discuss possible risks and complications of the procedure.
Preparing for Your Surgery
You will be given a pre-operative information packet that explains everything you should do and know before your surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on preoperative skin cleansing, eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.
Where Your Surgery Will be Performed
Your procedure will take place at the University of Michigan Hospitals which provides state-of-the-art surgical suites and recovery areas. The majority of these procedures are completed on an outpatient basis.
Types of Anesthesia
You'll remain comfortable throughout the entire procedure. In most cases, general anesthetic is used so that you will sleep throughout the procedure; although local anesthesia with intravenous sedation is also an option for some patients.
After Your Surgery
It is very important that you follow your surgeon's instructions in order to promote healing and obtain the best possible outcome-both in terms of function and physical appearance. Also, it is important that you attend all follow-up appointments as scheduled so that your surgeon can assess your long-term results and answer any questions or concerns you may have.
Since a variety of procedures can be performed, your individual postoperative instructions may vary. In general, skin grafts require kind of "bolster" dressing to keep them in place for 3-5 days without any movement of the skin graft. The bolster helps the skin graft "stick" to the wound and begin to heal. Smaller operations (scar revisions, Z-plasties) might require only a small, soft dressing afterwards. After scar releases on the hand, your surgeon may place you in a larger dressing that incorporates a plaster splint for support after surgery. In general, follow-up visits are scheduled within 2 weeks of surgery, and there may be sutures to remove at that time.
Additional physical therapy or occupational therapy may be required in the weeks and months following surgery to ensure a complete recovery of function. This may involve splints or casts, as well as exercises you perform at your treatment visits and on your own at home. Your surgeon and your therapist(s) will work together to develop the plan that is best for you.