Overview of surgical procedures used in the management of burn injuries
- Jorge Leon-Villapalos, MD, FRCS
Jorge Leon-Villapalos, MD, FRCS
- Consultant in Plastic Surgery and Burns
- Chelsea and Westminster Hospital, London, UK
- Peter Dziewulski, MD, FRCS
Peter Dziewulski, MD, FRCS
- Consultant in Plastic Surgery and Burns
- St. Andrews Centre for Plastic Surgery and Burns, Essex, UK
- Section Editors
- Marc G Jeschke, MD, PhD
Marc G Jeschke, MD, PhD
- Section Editor — Burn Surgery
- Director Ross Tilley Burn Centre
- Sunnybrook Health Sciences Centre
- Professor, Department of Surgery and Plastic Surgery
- University of Toronto
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
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".)
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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL PRINCIPLES
- BURN WOUND EXCISION
- BURN WOUND COVERAGE
- Coverage of skin defects
- Coverage of soft tissue defects and deep structures
- BURN SCAR REVISION AND TIMING
- DIRECT WOUND CLOSURE
- SKIN GRAFTING
- Split-thickness autografting
- Use of allografts
- Full-thickness autografting
- Use of skin substitutes
- TISSUE EXPANSION
- FLAP RECONSTRUCTION
- SUMMARY AND RECOMMENDATIONS