Burn surgery is a vast and specialized area of plastic surgery that addresses the wide range of injuries caused by burns. Each case is unique and requires a tailored approach depending on the severity, depth, and location of the burn.
Principles of Burn Surgery
Burns—whether caused by flames, boiling water, chemicals, or other sources—lead to varying degrees of skin layer destruction.
When the skin’s natural regenerative ability is compromised, the result is a deep burn, which almost always causes long-term after-effects.
In response to the damaged skin, the body forms retractile scars to compensate for the loss of tissue. These scars often tighten and distort the surrounding skin.
The goal of burn reconstruction surgery is to restore healthy, functional, and aesthetically acceptable skin. Several surgical techniques may be used, depending on the situation:
Skin Grafting
Skin grafts can be:
- Full-thickness grafts (total skin)
- Split-thickness grafts (thin skin layers)
These are commonly used to restore delicate or visible areas like the face, eyelids, nose, and fingers.
Flap Surgery
In this technique, healthy, vascularized skin from another part of the body is repositioned over the burn area.
This method helps release scar tension and improve mobility, but it is limited by the availability of donor skin.
Tissue Expansion
To reduce the need for distant donor sites, a silicone balloon (tissue expander) is placed under healthy skin.
It is gradually filled with saline via a small valve, stretching the skin over time.
This expanded skin can then be used as a flap or graft donor.
This technique has revolutionized burn care, especially in complex reconstructions.
Artificial Dermis (Integra®)
For extensive burns, an artificial dermis can temporarily replace the missing subcutaneous tissue.
- Stage 1: The artificial dermis is applied to the scarred area.
- Stage 2 (21 days later): A thin skin graft is placed over the new dermal layer.
Although effective, this method is expensive and the cosmetic results may vary.
Enhancing Skin Quality After Reconstruction
Once skin coverage has been restored, additional techniques may be needed to improve the texture, function, and appearance of the reconstructed skin:
- Fat Grafting (Lipofilling): Improves skin quality and suppleness in grafted or scarred areas
- Dermabrasion: Helps correct color and pigment irregularities between normal and grafted skin
In Practice
Burn reconstruction surgery should only be considered after the initial treatment phase is complete, except in specific urgent cases (e.g. eyelid or hand burns).
Initial treatments typically include split-thickness or full-thickness skin grafts, followed by months of healing.
During this phase:
- Physical therapy and pressure garments are crucial to reduce scar tightness and improve mobility
- Surgery can only proceed once scars have fully stabilized
Surgical Setting
- Procedures are typically performed under general anesthesia
- Takes place in a conventional hospital environment
Post-operative care is often lengthy and requires strong commitment and follow-up by the patient