The patient's chief complaint or complaints need to be carefully evaluated. This will help to determine the techniques available for burn reconstruction. When planning surgery for a burnt patient, a surgeon must consider what is the patient's primary complaint, what tissues are left, what parts are missing, and what sort of donor sites are available. Even though burnt tissue generally has a high tendency to congestion, ischaemia, and necrosis, it can be used as a reliable flap if extreme care is taken while raising the flap and the injured skin is left attached to the underlying tissues. Such flaps can be raised either with normal skin or with burn scar. These provide new and vascularised tissue to the area, they grow in children, and they give the best functional and cosmetic results. Nowadays, however, the first approach that should be considered is use of local or regional flaps. ![]() For many years, burn reconstructive surgery comprised incisional or excisional releases of scars and skin autografting. Patients' feelings and impressions must be addressed continuously, and any trouble, minor disappointment, or depression detected early and treated as needed.īurn reconstructive surgery has advanced in recent decades, though not as dramatically as in other areas of plastic surgery. In the case of a small child, this may take more than 18 years. A burn reconstruction project commonly requires more than 10 operations and many clinic visits over a long period before a final assessment is made. A reconstructive surgeon needs to know a patient's fears and feelings as the reconstructive plan goes on. Photographic workup is extremely important to assist in definitive preoperative planning and for documentation. ![]() We have to remember, though, that the patient will also evaluate the surgeon's attitude and conduct.Īlthough deformities or chief complaints will often be apparent and ready for surgery, it is preferable to have further visits before surgery, to allow new queries to be addressed and unhurried preparation for surgery. The patient presents a set of problems, and the reconstructive surgeon has to evaluate these and the patient's motivation for surgery and psychological status. The initial meeting is one of the most important events. ![]() These techniques allow the transplantation of any tissue (skin, fascia, fat, functional muscle, and bone) in the same patient In this case skin from the thigh was transplanted to the ankle with microsurgical vascular anastomosis. Bottom: The scars were excised and the defect reconstructed with a free vascularised perforator based skin flap. Top: Unstable burn scars with chronic open wounds on medial malleolus. A strong patient-surgeon relationship is necessary in order to negotiate a master plan and agree on priorities. However, even when this time has come, the patient-surgeon relationship may still continue and can last a lifetime.Īny 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). 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. 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.Ī realistic approach is necessary to harmonise patients' expectations (which are very high) with the probable outcomes of reconstructive surgery. The basic concerns in burns reconstruction are for function, comfort, and appearance.
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