Burns and Post Burn Deformities

Post-burn raw area results from infection of a superficial burn or an acute third-degree burn. This 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. The skin graft is usually taken from the thighs, the buttocks and the back or the abdomen. For relatively small raw areas, approximately within 10cm in size, 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.

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.

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.