Burns and Post Burn Deformities

Burns and Post Burn Deformities

Acute Burns

Burns are categorised into three types based on severity. First-degree burns are mild and only affect the top-most layer of the skin, i.e. the epidermis. Second-degree burns penetrate further, to the dermis. Third-degree burns affect all three layers of the skin – the epidermis, the dermis and the subcutaneous fat layer. Third degree burns usually destroy hair follicles and sweat glands too. Third-degree burns that cover more than 1% of the patient’s body are considered severe, and require hospitalisation. The management of burns depends on the

  • Percentage of burns compared to the total body surface area
  • Depth of burns
  • Cause of burns – flame burns , chemical burns etc
  • Structures involved ex: Hand , face , Chest

Deeper burns require skin grafts or flaps to replace the burnt tissue. The skin graft is taken from an uninjured part of the patient’s body. If the patient doesn’t have enough healthy skin available for a graft, skin grafts from a deceased donor or an artificial skin graft may be used temporarily to tide over the emergency situation.

Post-Burn Raw Area

Post-burn raw occurs when the deeper layers of the skin are destroyed by the burn and thus cannot regenerate. This leaves the patient’s tissue exposed and puts them at a high risk of infection. Also infection in a superficial burns can lead to skin loss requiring skin graft. The skin graft is usually taken from the thighs, the buttocks and the back or the abdomen. For aesthetically and functionally sensitive raw areas, the surgeon may be able to harvest sufficient full-thickness skin grafts from the patient, for use in reconstructive surgery. Full-thickness skin grafts are composed of the epidermis and dermis layers. In case the post-burn raw area is extensive, the surgeon may have to go for split-thickness grafts. Split-thickness skin grafts are thinner than full-thickness skin grafts and are composed of the epidermis and only a part of the dermis. In terms of aesthetic appearance, as well as functional performance of the skin (its ability to stretch etc.), full-thickness grafts are preferred, especially in important parts of the body such as the face or the hands.

Burn Scar Management

Burns on the skin cause the affected skin cells to die. The damaged skin produces collagen to heal itself. During this process, the skin thickens and becomes discoloured. This is known as scar formation. Scars caused by minor burns typically fade over time. Second and Third-Degree burns can cause permanent scarring. Burn scars are of three types – Hypertrophic, Contracture and Keloid. Hypertrophic scars are usually red or purple, and raised. The hypertrophic scar may be warm or cause an itch. Contracture scars tighten the skin and muscles around the scar, resulting in restricted movement. Keloid scars are smooth, hard, hairless bumps that occur when the body produces excess collagen during healing. Minor burn scars can be treated with silicone gel and steroid injections. Major burn scars can be treated surgically or with laser therapy. The surgical repair of burn scars is performed using skin grafts / Flaps.

Post Burn Deformities - Contractures

Contractures are formed when a burn scar matures, thickens and causes tightness in the surrounding tendons, muscles and skin. Contractures typically occur in burns on a joint. The patient can take steps during the healing process to reduce the chances of contractures. This includes using a pressure garment dressing, wearing a splint to keep the joint in a stretched position, and keeping the joint active by performing everyday activities. Contractures are treated with serial-splinting or with surgical skin grafts.

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