Plastic surgery to treat burns
What is burn surgery?
There are two main categories of burn surgery: acute and reconstructive. Acute burn care occurs immediately after the injury. It is delivered by a team of trauma surgeons (General Surgeons) that specialize in acute burn care. Complex burns often require consultation with plastic surgeons, who assist with the inpatient and outpatient management of these cases. Large burns, or burns of critical body areas, should be treated at a verified burn center, such as the Trauma Burn Center here at the University of Michigan. Many smaller burns can be treated with outpatient options. Some patients may need reconstructive burn surgery after the initial burn wounds have healed. This type of care is usually provided by a plastic surgeon. The goals of reconstructive burn surgery are to improve both the function and the cosmetic appearance of burn scars. This involves altering scar tissue, with both non-operative and operative treatment. The relationship between the burn patient and the reconstructive burn surgeon often lasts many years. Treatments for scar tissue often take several months to be effective, and new scar contractures can appear long after these injuries, especially in young patients who are still growing.
What are the benefits of reconstructive burn surgery?
Surgery will not be able to remove a patient’s burn scars entirely, but it will help improve basic functions and make scars less noticeable. Scarring can limit the normal motion of the neck, shoulder, hands, or legs. Often surgery to help release this contracture can help a patient regain range of motion. Facial scarring that leads to problems with the eyelids, lips, nose, or hair loss can also be helped with reconstructive burn surgery. Scars that are abnormally thick, wide, or discolored might also be improved by a variety of operative and non-operative methods.
What are the options for reconstructive burn treatment?
Non-operative therapies might involve scar massage, application of pressure garments, or other topical therapies. Occupational therapist at the University of Michigan can help fit patients with pressure garments. The team includes specialty hand therapists who help with rehabilitation of hand burns and scars. Surgical options consist mainly of scar release procedures. The tight scar tissue is released and the open area closed by a plastic surgeon. There are a variety of ways to close these wounds depending on a patient’s needs. Skin grafts, skin rearrangement (sometimes called Z-plasty), and more complex skin donor flaps could be used, depending on the location of the scar and a patient’s personal goals. Most minor procedures are performed as outpatient surgery, but the larger grafts and flaps would likely require an inpatient stay. Tissue expansion can also be used as an alternative to skin grafting. Excellent results are commonly attained when performing tissue expansion to regions of the face, neck, arms, hands, and legs.
If you need reconstructive burn treatment
The first step is to schedule a personal consultation with a plastic surgeon. Communication is crucial in reaching your goals. You will have the opportunity to explain the results you'd like to see from therapy. Together, you and your surgeon will reach an understanding about what you can expect from procedures and the long-term benefits you will experience. Every patient is different, and your surgeon will choose the surgical technique and treatment plan that is right for you. During the initial consultation, you should expect:
- To provide a complete medical history, including information about previous surgical procedures; past and present medical conditions; and any medications or herbal supplements you are taking.
- Your surgeon to conduct a complete physical examination.
- To discuss possible risks and complications of the procedure.
If you choose to have surgery at U of M, you will be given a pre-operative information packet that explains everything you should do and know before your surgery date. Your procedure will take place at the University of Michigan Hospital which provides state-of-the-art surgical suites and recovery areas. The majority of these procedures are completed on an outpatient basis. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on preoperative skin cleansing, eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.
Following post-surgery instructions are important to heal and obtain the best possible outcome, both in terms of function and physical appearance. You will have follow up appointments so your surgeon can assess your long-term results and answer any questions or concerns you may have. Since a variety of procedures can be performed, your individual postoperative instructions may vary. In general, skin grafts require kind of "bolster" dressing to keep them in place for 3-5 days without any movement of the skin graft. The bolster helps the skin graft "stick" to the wound and begin to heal. Smaller operations (scar revisions, Z-plasties) might require only a small, soft dressing afterwards. After scar releases on the hand, your surgeon may place you in a larger dressing that incorporates a plaster splint for support after surgery. In general, follow-up visits are scheduled within two weeks of surgery, and there may be stitches to remove at that time. Additional physical therapy or occupational therapy may be required in the weeks and months following surgery to ensure a complete recovery of function. This may involve splints or casts, as well as exercises you perform at your treatment visits and on your own at home. Your surgeon and therapists will work together to develop the plan that is best for you.