How is Burn Reconstructive Surgery Done

The surgical procedure comprised of different phases, named escharotomy and fasciotomy, excision and grafting, burn wound closure and post-burn reconstruction. Clinical examination suggests the need for a required surgical procedure for burn reconstruction.

Escharotomy and fasciotomy
The escharotomy and fasciotomy are used to treat third-degree circumferential burns and high voltage burn wounds, respectively. The techniques are usually performed in the upper burned extremity on limbs, trunk or neck without damaging the critical nerves, blood vessels and veins to avoid additional complications. The techniques are used to facilitate circulation by reducing inelasticity of burnt mass tissue, termed eschar and to check the burn-induced compartment syndrome. The patient is sedated during the surgical procedure and incised down the burnt skin to the subcutaneous fat. The surgical wounds are dressed with antimicrobial medicine and lightly wrapped in a bandage.

Early Excision and Grafting (EEG)
In deep burns, scar formation is one of the important complications, difficult to manage. The early excision and grafting (EEG) are one of the most appealing methods rather than the constructive approach used for the tissue granulation formation. In second and third degree of burns, the burned wound is simultaneously excised and autografted for rapid closure within three weeks. However, there is no clear consensus found for an optimal period of the EEG.

Wound Closure
Early excision and autografting are most useful techniques for definitive wound closure. Excision has been primarily used to accelerate speedy wound closure as well as to minimise infection. Whereas autografting is preferably used for immediate coverage of wounds, However, restricted donor sites and specialised technical skills required to excise special areas, i.e. face or perineum are some limitations in skin grafting. Variety of products are also used for temporary wound closure to lessen the evaporative loss, and ameliorate metabolic stress and pain as well as to avoid infection.

Post Burn Reconstruction
Since many surgical procedures involved in burn reconstructive surgery, post-surgical care has immense importance in the successful recovery of burn wounds. Contractures, chronic ulcers, hypertrophied scars and unfavourable scars are some post-burn deformities. The post-surgery instructions and dressing requirements vary by type, depth, and degree of burn wounds. For instance, scar revisions, or Z-plasty may need only soft and light dressing after surgery whereas skin grafting needs bolster dressing to keep skin intact without any movement for at least one week.