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Principles of burn reconstruction: Extremities and regional nodal basins

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


The goals of reconstructive surgery for the burn patient are first to restore function and then to restore aesthetic 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 "Topical agents and dressings for local burn wound care" and "Overview of surgical procedures used in the management of burn injuries".)


Following resuscitation and stabilization, initial management of burns to the extremities focuses on ensuring the neurovascular integrity of the limb. The presence of circumferential burns, deep-patterned burns, and, potentially, acute compartment syndrome should be assessed and escharotomy (picture 1) and/or fasciotomy (figure 1) performed in a timely fashion, as needed. (See "Emergency care of moderate and severe thermal burns in adults", section on 'Escharotomy' and "Lower extremity fasciotomy techniques".)

Extremity and nodal basin burns are cleansed and debrided of devitalized tissue, then covered with topical antimicrobials and dressings. (See "Overview of the management of the severely burned patient", section on 'Burn wound management' and "Topical agents and dressings for local burn wound care".)

For deep burns, 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, avoid conversion of a zone of stasis to zone of necrosis, and attenuate the hypermetabolic response to the burn injury. (See "Hypermetabolic response to severe burn injury", section on 'Glycemic control' and "Overview of surgical procedures used in the management of burn injuries", section on 'Split-thickness autografting'.)

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Literature review current through: Nov 2017. | This topic last updated: Jul 10, 2017.
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