Burn Reconstruction - Benefits, Surgical Management, and Post-Operative Care

What Is Burn Reconstruction of the Face, Scalp, and Neck?

The wounds caused by burns cause not only the disfigurement of the face, scalp, and neck but also limit mobility and functional activities, causing emotional and mental trauma to the patient. Reconstruction of burn injuries is essential to achieve the aesthetic appearance and restore the functional aspects. Plastic surgeons play a crucial role in the rehabilitation of the form and function of the face.

Burn reconstruction surgery usually falls into two categories. These include:

1. Acute Burn Reconstruction: This is done immediately after the burns to restore the normal function of the face, like eating, eye closure, and lip closure. Trauma surgeons do this type of reconstruction.

2. Reconstructive Surgery: This is done after the recovery of initial wounds to reconstruct the appearance and function of the damaged areas. Plastic surgeons do this type of burn reconstruction.

What Are the Potential Benefits of Burn Reconstruction of the Face, Scalp, and Neck?

Reconstruction of the face, scalp, and neck is considered under the following conditions.

• Limited movement of eyes, lips, and mouth due to skin scarring.

• Presence of large and abnormally thick scars.

• Decreased range of motion of neck due to tissue contraction.

• Emotional and psychological trauma caused due to disfigurement of the face.

What Are the Options for Reconstructive Burn Treatment?

For surgical procedures, the presurgical evaluation is done. Before the surgery, the surgeon will evaluate the medical history, the patient's primary complaints, and the physical examination and then plan the surgery. This presurgical evaluation will help the surgeon prioritize functional reconstruction followed by aesthetic possibilities.

Different procedures are involved in reconstructing the face, scalp, and neck. The options for reconstructive burn treatment are as follows:

Skin Grafts: In this procedure, the skin is pulled out from one area of the body and transplanted onto a burnt area. Two types of grafts are preferred:

• Split thickness graft involves removing a few layers of the skin's dermis.

• Full-thickness graft that involves the removal of the entire dermis.

A particular instrument called a dermatome removes the skin from the donor area during this procedure.

• The donor area is usually skin covered with clothing, like the buttock's inner thigh.

• After the transplant of the graft to the wound area, stitches and bandages are placed to secure it.

• The donor site is covered with dressing and bandages to prevent infection.

• The recovery time for the split-thickness flap is usually a few weeks, and the prognosis is good, whereas it may take months for a full-thickness flap.

• Skin grafts are preferred when there is an extensive skin reconstruction, like burns, skin loss due to cancer and infection, in case of extensive trauma, and breast and nose reconstruction.

Microsurgery:

• This surgery is indicated in cases where there is loss of lip, ear, toe, and nose.

• This procedure allows for the reattachment of blood vessels, nerves, and arteries and helps rejuvenate and repair the structure.

• In this procedure, the surgeon uses a microscope to reattach blood vessels to aid in the reconstruction procedure.

• Microsurgery is often used in other surgeries like free flap surgery to help the surgeon achieve desired results.

Free Flap Procedure:

• In this procedure, not only the skin but also the muscle, bone, and blood supply are taken from the donor area and placed at the surgical site.

• This procedure is usually performed in cases of breast reconstruction or head and neck cancer involving extensive tissue remodeling.

• The healing is slow and may take from a few weeks to months.

• Frequent dressing may be required to prevent infection.

• This form of surgery usually involves the use of microsurgery.

Tissue Expansion:

• This procedure involves the expansion of skin, that is, the growth of extra skin, which helps the reconstruction procedure.

• In this procedure, a small instrument named a balloon expander is placed under the skin, and over time, the balloon is filled with saline to expand the skin. This expansion is similar to pregnancy, where the skin on the belly stretches and grows.

• Once the skin is stretched to the desired amount, the balloon is removed, and the skin is used to reconstruct a particular area.

• The advantage of this procedure is that skin color and texture with a minimal amount of scarring.

• This procedure is generally performed for breast enlargement procedures.

• The major drawback is the presence of a balloon expander. This procedure may be beneficial in the case of breast reconstruction procedures, but in scalp repair, this may be uncomfortable for the patient.

Tissue Engineering:

• This procedure is the latest development in plastic surgery.

• In this procedure, new synthetic material is placed inside the tissue, which helps in the new tissue growth.

• Still, research is going on on this procedure.

Physical Therapy:

• Physical therapy and rehabilitation play an important role in the treatment process. It helps in improving the strength, mobility, and function of disabled parts after burn injuries and reconstructive surgeries.

Psychological Support:

Psychological and emotional support is also an important part of burn treatment. Several support groups help individuals with emotional challenges associated with burn injuries and their treatment.

What Happens After Bone Reconstruction Surgery?

• After surgery, patients may feel tired, numb, and tingling at the surgical site.

• Once the healing progresses, evident changes are seen in the area's skin color, tissues, and sensations.

• Increased blood supply will help in more excellent recovery with minimal scarring.

• The patient should take care to avoid injury to the surgical site.

• Physiotherapy is required to increase muscle activity.

• Follow the medications prescribed by the doctor.

The patient may notice a significant improvement in functional and aesthetic appearance to a great extent.

What Are the Risk Factors Associated With the Surgery?

If the following symptoms prevail, then contact the surgeon immediately,

• Infection at the surgical site.

• Blisters or itchiness on the incision site

• Continuous fever

• A sudden increase in pain

• Nausea and vomiting.

• Rashes or white patches on skin and tongue.

• Increase in secretions near the surgical site.

• Frequent urination with blood or foul smell.

• Persistent cough.

Conclusion:

Burn reconstruction of the face, scalp, and neck improves the patient's function, aesthetics, and comfort. Look plays an essential part in defining a person's identity. So surgeons should take proper care in reducing the scars and establishing the form and function of the tissue to lead an everyday life.