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Overview of surgical procedures used in the management of burn injuries

Authors
Jorge Leon-Villapalos, MD, FRCS
Peter Dziewulski, MD, FRCS
Section Editors
Marc G Jeschke, MD, PhD
Charles E Butler, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Once the burn patient has been resuscitated and stabilized, restoring anatomy, preserving function, and rehabilitating the patient is the next priority. To accomplish this, the surgeon must evaluate the extent to which tissue is missing and identify potential donor sites or other solutions to best manage skin and soft tissue defects. The aim is to reconstruct like tissue with like tissue, restoring function first, which supersedes immediate concerns over cosmesis. Appropriate measures are taken to limit scarring in the postoperative period; however, once the patient has progressed through the acute phase of the injury, reassessment of the wounds may necessitate wound revisions to achieve an optimal cosmetic outcome.

An overview of the surgical techniques used for burn reconstruction is reviewed here. The general management of the burn patient and management of burn injuries according to depth of injury are discussed in separate topic reviews. (See "Overview of the management of the severely burned patient" and "Treatment of superficial burns requiring hospital admission".)

GENERAL PRINCIPLES

Burns are a specialized form of trauma, and, as such, they are managed according to recognized protocols of trauma resuscitation. Characteristically, these protocols assess the trauma patient through a primary survey, a secondary survey, and a process of continuous reassessment that ultimately refers the patient to a definitive treatment facility.

The primary survey addresses life-saving priorities through a structured approach that includes examining sequentially Airway, Breathing, Circulation, Disability (neurologic status), and Environment (exposure of the patient with prevention of hypothermia). This is called the ABCDE approach. The secondary survey subsequently examines the patient from head to toe, completing the trauma assessment.

There are two important priorities within the primary survey that are specific and exclusive to the burn patient. These are the assessment of the total body surface area (TBSA) or extent of the burn wound and the assessment of the depth of the burn wound. These are of paramount importance because the assessment of the TBSA determines the level of fluid resuscitation, while the assessment of the depth of the burn wound determines the need for surgical debridement, rather than a conservative approach.

                 
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Literature review current through: Nov 2017. | This topic last updated: Dec 13, 2017.
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