Philippine Burn Recovery Reconstruction Procedure

What is Burn Recovery Reconstruction?

Burns are one of the most excruciating and nasty injuries that a person can receive. The scars left behind by burns are often permanent. Because of their nature, any victim would seek redemption from the pain and humiliation of carrying burn scars. What if there was a way to give their old, happier lives back? Burn Recovery Reconstruction can open that door for them.

The procedure involves three stages: recovery, reconstruction, and rehabilitation. “Recovery” not only deals with physical trauma, but the emotional part as well. “Reconstruction” is the part where the patient’s tissues are rebuilt to restore both their form and function. “Rehabilitation” is the final step and it readies the patient to regain stability and re-enter society as a renewed person.

How is Burn Recovery Reconstruction Peformed?

Burn Recovery Reconstruction can be executed in several ways, such as incisional release and grafting, excisional release and grafting, Z-plasty, and random flaps.

Incisional/Excisional Release and Grafting

Most burn reconstructive surgeries can use incisional, excisional, or combined release to close the acquired wound with split-thickness autograft. Tension is applied on the contracture and the release performed acutely. Adjacent regions of the hypertrophic scars can be excised provided that donor sites have sufficient material to close the wound. Full-thickness skin grafts usually contract less than thin split-thickness grafts. Which to use depends on the situation. Unfortunatley, the site where full-thickness graft is derived is usually limited compared to the other kind. In patients with limited site availability, thin split-thickness grafts can be used on acellular allogenic dermis to increase achievable results.

Z-plasty

While technically simple, carefully planned and performed Z-plasties become exceptional reconstructive mechanisms.

Basic steps:

• Define any line of tension that needs modification
• Plan the central limb of the Z-plasty on the lines
• Design the lateral lines (if possible) so that they don’t align with natural skin lines after transposition
• Make the angle between the central and lateral lines of the Z-plasty to be less than 90 degrees, with lateral limbs curved and shorter than the central limb

Within these rules, an infinite variety of Z-flaps can be created by tweaking the basic concept based on blood supply of flaps and local tissue elasticity. The technique is more limited by the surgeon’s imagination than anything else.

Tissue Expanders and Flaps

Local flaps, tissue expanders, and free flaps, while very limited, play an important part in burn reconstruction. Thin random flaps can be harvested from the chest wall, but more from the groin area. Tissue expanders are helpful when applied on the head and neck, but mostly to correct burn-related alopecia. Free flaps are similar to tissue expanders and are used on difficult wounds, like those received from high-voltage injuries.

Risks of Burn Recovery Reconstruction

Every surgery, no matter how advanced, has a compromise, and it comes in form of complications. The differences in the body of each person affect the ability to heal and produce unexpected results. Common complications seen in Burn Recovery Reconstruction are excessive bleeding, infection, healing difficulties, significant bruising, and issues associated with anesthesia and the surgery itself.

Who Can be Considered for Burn Recovery Reconstruction?

Burn victims who have acquired burn scars, have realistic expectations, and know the limitations of the procedure

Facts on Burn Recovery Reconstruction

• Healing can take around 2 years for patients with burns on at least 30% of their total body surface
• Late application of Burn Recovery Reconstruction may lead to lesser surgeries and more successful attempts, where some injuries have most likely healed and no longer need surgical intervention
• Some burn scars can’t be removed, even with Burn Recovery Reconstruction
• Recovery from emotional and mental damage is the key to full burn injury restoration

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