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Principles of burn reconstruction: Extremities and regional nodal basins

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

INTRODUCTION

The goals of reconstructive surgery for the burn patient are first to restore function, then to restore esthetic appearances. Following resuscitation and stabilization, management of the burn wounds becomes the next priority. The later effects of burns, which are related to loss of normal tissue and scarring, include limitation of movement, pain, disfigurement, and social embarrassment [1].

The principles of burn reconstruction of the upper and lower extremities, including the axilla and inguinal lymph node basins, are reviewed here. Emergency management of the burn patient, local treatment, and the general principles of reconstruction are discussed elsewhere. (See "Emergency care of moderate and severe thermal burns in adults" and "Emergency care of moderate and severe thermal burns in children" and "Local treatment of burns: Topical antimicrobial agents and dressings" and "Principles of burn reconstruction: Overview of surgical procedures".)

INITIAL MANAGEMENT

Following resuscitation and stabilization, acute management of burns to the extremities is focused on acute compartment syndrome assessment and the need to perform an escharotomy or fasciotomy (picture 1). (See "Emergency care of moderate and severe thermal burns in adults", section on 'Escharotomy' and "Primary operative management of hand burns", section on 'Neurovascular compromise'.)

Extremity and nodal basin burns are cleansed and debrided of devitalized tissue, then covered with topical agents and dressings. (See "Local treatment of burns: Topical antimicrobial agents and dressings".) Excision and skin grafting procedures are performed early, generally within five days of the burn injury if possible, to reduce the presence of necrotic and infected tissue and to attenuate the hypermetabolic response. (See "Hypermetabolic response to severe burn injury", section on 'Early excision and grafting' and "Principles of burn reconstruction: Overview of surgical procedures", section on 'Split thickness skin grafts'.)

UPPER EXTREMITY RECONSTRUCTION

The primary goal of reconstruction of the upper extremity is to restore function. Burns to the upper extremity cause deformities and limit function, thus affecting all activities of daily living. Numerous methods have been described to release dynamic (early phase) and static (late phase) complex scar contracture [2]. Scars cause tendon adhesions, contractures, deep adipose tissue stiffness, and limitation of major joint range of motion [3].

                            

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Literature review current through: Nov 2016. | This topic last updated: Sun Mar 16 00:00:00 GMT 2014.
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