A burn is an injury to the skin caused by its exposure to extreme heat like steam, chemicals or fire. Burns can be minor, which heal without the need for treatment, severe, requiring hospitalisation, and some that can be life-threatening. Based on the severity, burns are classified into first-degree burns (affect the outer layer of skin), second-degree (involve the first two layers of skin), and third-degree burns (damage the deeper layers of the skin and tissues - fat, muscle and bone).
Normally, burns heal and new skin grows to replace the damaged skin. However, when a large amount of tissue is damaged (second or third degree burns), the surrounding normal skin pulls together in an attempt to cover and heal the affected region. This tightening of the skin is called a contracture. Contractures are the most common post burn deformity, and when formed across or close to muscles, tendons, ligaments and joints, can cause stiffness and restrict the motion and function around the injured area.
Post burn deformities most often require plastic or reconstructive surgery for treatment. The surgical treatment options may include:
- Scar release surgery: This procedure is performed for large burns, to reduce scar contracture and improve mobility. During the surgery, your doctor will cut away the scar tissue to release the tightness of the skin between the muscles and joints. This reopens the burned area, so your doctor will further perform a skin graft or flap surgery.
- Skin grafting: This procedure involves removing and transferring healthy skin from a donor site to the burned area to restore the function of the affected part. Once the healthy skin is transferred, the burned area and donor site are covered with a bandage. There are two types of skin grafts depending on the amount of donor tissue transplanted:
- Split-thickness skin graft: only the outer most layers of the skin are harvested
- Full-thickness skin graft: all the layers of the skin are harvested
- Flap surgery: This procedure is similar to skin grafting but involves the transfer of the underlying fat, blood vessels and muscle tissue, along with the skin from the donor site to the affected area. It restores the function of the affected area that has lost blood vessels, skin, fat, muscle or bone.
- Free flap/microsurgery: The procedure is similar to a flap surgery, except that the healthy flap of tissue that is transferred is detached from its original blood supply and reattached to a new blood supply at the burn site using microsurgery (delicate surgery performed under a microscope, using fine sutures).
- Z-Plasty: This method is generally used to treat small burns. In this procedure, small triangle shaped flaps of skin are cut around the scar, repositioned (rotated) and sutured, to cover the scar and relieve the contracture tension. This results in a Z-shaped scar pattern that is less noticeable as it aligns with the natural skin folds.
- Tissue expansion: This procedure promotes the growth of extra skin by stretching the surrounding tissue. An inflatable balloon called a tissue expander is surgically inserted under the skin close to the burn site and is slowly filled with saline solution. The expansion of the balloon stretches the skin, enabling extra skin growth. The tissue expander is removed once enough extra skin has grown. This newly grown skin is used to replace the damaged skin.
Other treatment options for managing post-burn deformities include:
- Wearing a cast or a splint at the affected area to stretch the tissue and improve function
- Steroid injections and silicone gel to reduce thick scars and treat itchiness
- Pressure garments and dressings to reduce scarring and contracture by applying pressure to the burn wounds
- Physical therapy to improve range of motion and strengthen the affected region
Treatment of burn deformities is provided through multiple surgeries spaced across a period of many years. Reconstructive surgery for post burn deformities aims at restoring the function and aesthetic appearances of the affected region.