SURGICAL PROCEDURES

Reconstructive Burn Surgery (Available Upon Request)

Overview

Burns, whether minor or severe, can leave the patient feeling disfigured and self-conscious about their appearance. Reconstructive burn surgery involves manipulating and improving scar tissue to even out the skin’s appearance. This is not only to improve aesthetics but restore functionality too.

Reconstructive burn surgery can occur directly after the burn (acute) or over some time. Several reconstructive procedures are required, especially when the burn causes extensive damage to the skin and underlying tissue. First, debridement occurs, which is the surgical removal of dead tissue. Removing necrotic tissue prevents the spread of infection.

Sometimes, the burn still needs to be given time to heal before the plastic and reconstructive surgeon can begin surgery. Dr Kleintjes usually attends to adult acute burns by performing reconstructive surgery directly after traumatic incidents at Tygerberg Hospital. In private practice, the majority of burn patients treated by Dr Kleintjes are paediatric patients.

Procedures

A team consisting of a trauma surgeon, general surgeon, and plastic and reconstructive surgeon works together to rebuild the area that sustained the most damage due to a burn. Smaller burns can be attended to in an outpatient setting. However, larger burns require specialised care in the trauma unit.

Once the burn has healed, reconstructing the area remains a priority for most patients. This is for them to regain their confidence and restore the badly burned area. Surgery aims to redevelop and improve the appearance of a burn scar.

The most common reconstructive techniques involve:

  • The use of a skin graft whereby a portion of skin elsewhere is transferred to the damaged part of the skin. There are two forms of skin grafts-the first involves removing only a few of the skin's outer layers, and the second is a thick graft whereby the entire dermis is taken out.
  • A flap is a popular procedure done on the breasts or as a post-operative surgery after treating head and neck cancer. Several biological components such as the skin, muscle and sometimes bone are taken from the donor site along with the blood supply and sent to the operative site. Afterwards, reconstruction takes place. A free flap combines microsurgery using a microscope to view the site thoroughly.
  • Tissue expansion promotes the body's natural growth of extra skin to reconstruct the damaged area. A balloon expander is placed below the skin of the operative region. Typically, saline is used to expand the balloon to dilate the skin. This allows the plastic and reconstructive surgeon to work with more skin to reconstruct the injured portion. Tissue expansion is a favourable surgery for breast reconstruction and scalp repair.

Recovery

After removing and transferring skin, it is vital to follow general wound care instructions provided by Dr Kleintjes. Be patient following cosmetic surgery to treat burns; it may take time to heal. There will be slight changes to the surgical area concerning colour, sensation and appearance. In addition, it is normal to experience a mild to moderate tingling feeling or numbness in the operative region. These strange sensations are guaranteed to subside after several months.

Wearing tight clothing can affect circulation and perfusion, which is the passing of fluid. So, until the wound has healed entirely, tight clothing should not be worn. Instead, wear loose, comfortable clothing while recovering at home.

FAQ

1Can you remove burn scars entirely?
While it is not always possible to get rid of a burn scar, surgical techniques help reduce the appearance of a scar. Ways to improve the appearance of a burn scar include topical creams and a non-surgical method such as laser therapy or surgery.
2What burn degree can receive a skin graft?
Normally, deep partial-thickness (second-degree) and full-thickness burns can be resurfaced using a skin graft. Only several of the skin's outer layers are affected. With superficial (first degree) burns, the damaged skin cells heal naturally. A skin graft for burns reduces the appearance of bad scars and enables a much faster recovery.
3How do you reconstruct a full-thickness (third-degree) burn?
A full-thickness (third-degree) burn cannot heal without surgical intervention. So, in this instance, a burn of this kind requires a skin graft. Deep full thickness (fourth-degree) burns are much more extensive, damaging the skin, muscle, fat and bone.
4How do you assess burns?
Burns can be categorised according to the depth of skin affected, age of the patient and the type of burn, whether a first, second, third or fourth-degree burn.
  • A first-degree burn is classified as a superficial burn because it is only skin deep, affecting a few outer layers. As a result, these burns do not lead to scarring or infection. At most, the skin reddens but recovers within five days.
  • A second-degree burn is a partial thickness burn that causes injury to the dermis, including the epidermis. The dermis is the skin’s second layer, making it incredibly painful when this part is affected. Also, these burns can lead to infection and scarring when not seen early enough.
  • A third-degree burn is a full-thickness burn that reaches the dermis, epidermis and underlying tissue. The affected area may change colour, turning black, white or red.
  • A fourth-degree burn destroys an expansive amount of skin, muscle, fat and even bone.

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