What is Reconstructive Surgery for Burns?

Reconstructive surgery for burns is a type of plastic and reparative surgery that focuses on improving the function and appearance of the skin and tissues damaged by burns. This type of surgery is essential to help patients regain mobility, reduce pain, prevent additional complications, and improve aesthetics after suffering burns.

Reconstructive surgery for burns allows patients to repair potential damage and limitations, as severe burns can affect muscles, tendons, and joints, limiting movement and functionality. Reconstructive surgery aims to release contractures (scar tissue that restricts movement), improve flexibility, and restore function in the affected areas.

This type of surgery also has an aesthetic component. It aims to reduce the appearance of scars and deformities caused by burns, which can enhance the patient’s self-esteem and quality of life.

Plastic surgery also helps prevent additional complications, such as burn scars that can lead to problems like infections, ulcers, or the development of tumors in rare cases. Surgery can help minimize these risks.

If you want to learn more about this topic and delve into procedures in this field, you can visit: What is plastic surgery?.

Burn Reconstruction: Available Options and Procedures

Burn reconstruction is an important process to restore lost or diminished functions and the appearance of the affected skin. There are various options and procedures available depending on the severity of the burn and the patient’s needs. At Hospital del Guadalentín, we care about your health and can advise you on the different steps, procedures, and treatments for burns:

1. Wound care:
   • Cleaning and debridement: It is essential to keep the wound clean and remove dead tissue to prevent infections.
   • Application of dressings: Special dressings are used to protect the wound and promote healing.
2. Grafting surgery:
   • Skin grafts: Skin is taken from another part of the body (autograft) or from a donor (allograft) to cover the affected area.
   • Partial or full-thickness skin grafts: Depending on the depth of the burn, partial skin (epidermis and part of the dermis) or full-thickness skin (all layers of the skin) can be used.
3. Reconstructive plastic surgery:
   • Flap placement: Skin flaps that remain connected to their blood supply are used to cover large or complex areas.
   • Shaping procedures: These can be performed to improve the aesthetic appearance and functionality of the reconstructed skin.
4. Additional therapies:
   • Physical and occupational therapy: To help restore mobility and function in the affected areas.
   • Psychological therapy: May be necessary to address the emotional impact of burns.
5. Aesthetic treatments:
   • Laser and light therapy: To improve the texture and colour of the skin.
   • Microdermabrasion and chemical peels: To smooth the skin and reduce scars.
6. Scar management:
   • Silicone sheets and gels: To help soften and flatten scars.
   • Steroid injections: To reduce inflammation and the size of hypertrophic or keloid scars.

When is Reconstructive Surgery for Burns Performed?

People who undergo reconstructive surgery are those who have suffered some type of burn; the most impactful and affecting burns on the body are as follows:

• Second-degree burns: Affect the outer layer and the underlying layer of the skin. They are also called partial-thickness burns. This type of burn affects both the epidermis and the dermis, the second layer of skin. They usually cause swelling, making the skin look red, white, or blotchy. Blisters may form, and the pain can be intense. Deep second-degree burns can leave scars.
• Third-degree burns: Affect the deep layers of the skin. They are also called full-thickness burns. This burn reaches the fat layer beneath the skin. The burned areas may appear black, brown, or white. The skin may have a leathery appearance. Third-degree burns can destroy nerves, causing numbness in the skin.

How Long Does It Take for Skin to Regenerate After a Burn?

First-degree burns are the mildest, taking about 3 to 6 days to heal; the superficial layer of skin that forms over the burn may peel off within one or two days. Second-degree burns can be very painful and often take several weeks to heal.

Third-degree burns are the most severe and almost always need to be treated with skin grafts, so tissue regeneration can take months, even more than a year, depending on the severity and involvement of the layers.

How to Remove Scars from Second-Degree Burns?

Removing second-degree burn scars can be a process that requires time and care. Here are some options you might consider:

1. Skin care: Keep the area moisturized with creams or ointments recommended by a doctor. This can help improve the appearance of the scar.
2. Sun protection: Use sunscreen on the affected area to prevent the scar from darkening due to sun exposure.
3. Massages: Gently massaging the scar with specific creams can help soften it and improve its appearance.
4. Medical treatments: Consult a dermatologist at Hospital del Guadalentín about options such as laser, microdermabrasion, or steroid injections that can be effective in reducing the visibility of scars.
5. Specific products: There are silicone gels and patches that can help flatten and soften scars.

How to Treat and Remove Scars from Third-Degree Burns?

Third-degree burn scars can be more complex to treat due to the depth and severity of the injury. Here are some options you might consider:

1. Medical consultation: It is essential to speak with a dermatologist or plastic surgeon. At Hospital del Guadalentín, we will evaluate the condition of the scar and recommend the most appropriate treatment.
2. Wound care: Ensure you follow your doctor’s instructions for wound care and healing. Keeping the area clean and protected is crucial.
3. Physical therapy: In some cases, physical therapy can help improve mobility and the appearance of the scar.
4. Medical treatments: There are options for surgical and aesthetic treatments such as laser therapy, microdermabrasion, or even skin grafts that may be necessary to treat more severe scars.
5. Topical products: Some silicone gels and creams can help soften and flatten scars, although their effectiveness may vary.
6. Surgical interventions: In more severe cases, surgery may be necessary to improve the appearance of the scar. For these types of consultations, schedule an appointment with a specialist at Hospital del Guadalentín.

What Reconstruction Techniques Are Recommended for Third-Degree Burns?

Plastic reconstruction techniques to treat burns depend on the severity and extent of the injury as well as the location of the burn. Here are some of the most common techniques we recommend:

1. Skin grafts: This is one of the most common techniques. It involves taking skin from another part of the body (donor) and transplanting it to the affected area. It can be a partial or full-thickness skin graft depending on the depth of the burn.
2. Skin flaps: In this procedure, a skin area that remains connected to its blood supply is used to cover the burned area. This is useful for areas where more skin is needed or where the donor skin is not viable.
3. Tissue expansion: This technique involves placing a device called a tissue expander under the healthy skin near the burned area. Over time, the expander is filled with fluid, stretching the skin and creating enough skin to cover the affected area.
4. Reconstructive surgery: In more severe cases, more complex surgery may be necessary to restore function and appearance to the affected area. This may include correcting contractures (when the skin tightens and limits movement).
5. Laser therapy: Although not a surgical technique per se, lasers can beused to improve the appearance of scars after the wound has healed.
6. Scar treatments: After reconstruction, additional treatments such as steroid injections or laser therapy can be used to improve the appearance of scars.

At Hospital del Guadalentín, a plastic surgeon specializing in burns can evaluate each case to determine the best treatment option. Recovery and final results may vary depending on the technique used and the body’s response to the treatment.

How Is a Skin Graft Performed?

A skin graft is a reconstruction technique performed in the operating room by a surgeon specially trained in burn treatment. It is a procedure that involves placing skin over a wound that will not heal on its own. The graft is usually the patient’s own skin, but sometimes skin from a skin bank is used.

Most people who undergo a skin graft have a partial-thickness skin graft. This takes skin from the two upper layers of the donor site (the epidermis) and the layer below the epidermis (the dermis). This surgery is usually done under general anesthesia so the patient won’t feel anything and will be asleep and pain-free.

The donor area can be any part of the body. Most of the time, it is an area hidden by clothing, such as the buttocks or the inner thigh.

Once the partial-thickness graft is performed, that piece of skin is held in place with a thick bandage covering it, with staples or minimal sutures. The donor area is covered with a sterile dressing for a period of 3 to 5 days.

A full-thickness skin graft is a more complex surgical procedure as it requires deeper layers to be extracted and implanted. Common donor sites for these grafts include the chest wall, neck, back, or abdominal wall.

Skin Flaps

A skin flap is a way to repair a skin wound that, due to its size or surface characteristics, cannot be closed directly by bringing its edges together.

The skin flap is usually designed with skin close to the wound so that it maintains blood flow, can be positioned over the wound, and it is possible to close the secondary wound from where it was taken.

The advantages of this type of repair are that the skin retains its appearance by being from the same area and preserves blood supply, achieving a more aesthetic result compared to a skin graft. However, it should be added that the most important aspect is the functional result, i.e., preserving the function of organs such as the eyes, nose, etc.

Types of skin flaps:

• Local skin flap: The skin used is very close to the wound and usually requires a single intervention.
• Regional skin flap: The skin used is not close to the wound but comes from the same area of the body. For example, a wound on the tip of the nose can be repaired with a skin flap taken from the forehead. This type of flap may require more than one intervention.
• Free skin flap: The skin used is taken from a region distant from the wound, and it is necessary to repair the blood vessels with microsurgery to preserve its blood supply.

Healing and Aesthetic Procedures

Healing and aesthetic procedures after suffering burns are very varied and different, always depending on the state and evolution of the tissues after burn reconstruction. Some of them are:

• Z-plasty and other scar correction procedures: Surgical procedures that reposition scars to make them less visible and improve mobility.
• Reconstruction with tissue expanders: Inflatable devices placed under the skin near the scar area. They are gradually inflated to stretch the skin, which helps generate additional skin for reconstruction.
• Micropigmentation: Also known as permanent makeup, it is used to improve the appearance of discoloured or uneven areas after a burn.
• Tissue engineering and bioartificial skin: In some cases, artificial skin matrices or lab-grown skin are used to cover large, deep wounds.
• Growth factors and cell therapy: New therapies using growth factors or stem cells to promote skin regeneration.

Postoperative Care for Plastic Surgery Patients

Patients who undergo plastic reconstruction surgery for burns need to maintain postoperative care, such as:

• Keep the large, bulky dressing, which will be changed three to five days after the operation.
• Remain in bed during this time, minimizing any movement around the graft area. This allows the graft to “take” (adhere) to the clean burn wound.
• The medical specialist will decide on the treatment and start caring for the intervened area. The nurse will remove the dressing, staples, and splints. The graft will be washed and examined for signs of infection. Subsequently, dressings and splints will be reapplied and changed daily until a positive outcome is seen from the intervention.
• It is recommended to avoid strenuous or physical activities, as well as lying on the wound until it is completely healed.
• In case of pain, it is suggested to take paracetamol and avoid taking aspirin as it may increase the risk of bleeding unless prescribed for another condition.

Which Doctor Treats Burns?

The plastic and reconstructive surgeon is the main specialist in managing moderate to severe burns (second and third degree). Plastic surgeons are trained to perform skin grafts, tissue reconstruction, and procedures to minimize scars.

The plastic surgery specialists at Hospital del Guadalentín perform treatments such as skin grafts, reconstruction of damaged areas, scar correction, and other aesthetic and functional procedures.

Each patient may require a personalized approach depending on the severity of the burns and the affected areas. When addressing burn treatment, it is important to work together with a multidisciplinary team like that of Hospital del Guadalentín, which includes plastic surgeons, dermatologists, physical therapists, and psychologists to achieve the best possible outcome in healing and aesthetics after burns.