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| Dr. Dawood Almahr |
Dr. Dawood Almahr says that burn plastic surgery is a set of medical and surgical procedures that are performed to treat the burn directly or to treat the effects resulting from the burns. These effects can affect the function of the organ affected by the burn, and hinder the performance of daily functions. They can also affect the aesthetic appearance of the affected area.
What is a burn? What are its types?
A burn is a severe damage to cells as a result of exposure to high temperatures that lead to their death. The nature of the substances that cause the burn varies, as there are burns caused by fire or hot water, burns caused by electricity, burns caused by chemicals, and burns can occur as a result of exposure to sunlight for long periods. The difference in the substance that causes the burn is accompanied by a difference in the degree and amount of the burn. All of these factors play an important role in determining the course of burn recovery, and whether it will recover without leaving traces or scars or whether it requires medical intervention to beautify the burns.
The complications resulting from exposure to a burn vary according to the degree of the burn and the area exposed to the burn. Burns can be classified into three main degrees:
First-degree burn: It is the mildest degree of burns, characterized by redness of the affected area, and the presence of pain, and it also recovers without leaving scars or traces.
Second-degree burn: The burn is deeper and includes more layers of skin, characterized by the presence of bubbles with redness in the affected area. In mild second-degree burns, the burn heals without leaving scars, but if it is a severe second-degree burn, it may leave some scars.
Third-degree burn: It involves all layers of the skin, the burned area is white, and in cases of charring it may be black, and some internal parts such as bones and tendons may appear. This type of burn leaves severe long-term damage.
Severe second- or third-degree burns require special medical care, in addition to the need sometimes to perform surgical intervention to directly repair the burns, and this is done by transferring a patch of skin from a healthy place to the affected place when the depth and area of the burn are large and the treatment requires transferring a patch of skin to this area because it cannot heal on its own. As for less severe burns, they are treated with medication through sterilization, frequent changes to the burn area, anti-inflammatories, painkillers, and others.
But advanced burns cases need more care than just drug treatment to reduce physical and psychological damage to the injured person, so the patient may need:
Plastic surgeries.
Physical therapy.
Rehabilitation of the injured part.
Long-term care and assistance.
What are the types of burn scars?
Scars resulting from burns are an inevitable result except for first-degree burns. Scars occur as a result of the loss of most of the layers that make up the skin, and scars can occur alone or accompanied by shrinkage and contraction in the same area, depending on the depth of the burn.
If the burn includes most of the layers of the skin up to the dermis layer while preserving all the elements in it from nerves, lymphocytes and specialized cells, a burn of this type results in compensation for the burned layers but not completely, as half the thickness of the burned layers is compensated, so a slight decrease in the affected area results in the formation of a scar.
The burn reaching a depth greater than the dermis layer and complete damage to all layers results in a complete loss of the entire thickness of the skin, and therefore there are no cells in the same burned area to compensate for the damage, so the area recovers as a result of the cells adjacent to the burn area trying to cover the affected area, resulting in a clear shrinkage and contraction in the burn area, which causes other complications.
For more: Can the effects of wounds and scars be prevented?
Types of scars include:
Hypertrophic Scar.
Keloid.
Shrinkage or contraction of the burn site is one of the most influential types of scars on the patient's quality of life, because it limits the movement of the affected part and significantly disrupts its function. In some cases, such as neck burns, shrinkage can lead to airway closure due to the compressive effect of the shrinking skin and difficulty breathing. Therefore, early surgical intervention is crucial.
Pigmentation and change in skin color.
How to prevent burn complications
First, complications must be prevented. To prevent scarring and reduce the need for surgical burn repair, the following instructions can be followed:
Medicinal treatment and good care of the burned area to prevent infection or pus accumulation in the area. Care must also be taken to protect the area recovering from the burn from exposure to sunlight until the burn is completely healed to prevent skin pigmentation.
Wearing a compression garment to reduce the possibility of hypertrophic scars, especially for deep skin burns or areas from which skin grafts have been taken to treat other areas. It is recommended to wear it for a long period of up to 24 hours, except for bathing time during the day for a period of 9-12 months.
Closing the wound resulting from the burn directly with a skin graft is the most important and effective factor in preventing or reducing the possibility of shrinkage of the burn site.
What are the methods of burn beautification?
Non-surgical beautification of burns
Topical treatments for burns
Various topical treatments are used to reduce some types of scars, such as hydroquinone to lighten dark pigmentation, and silicone gel to improve the shape, texture and sides of scars. Mitomycin cream is also used to reduce hypertrophic scars.
Intra-scar injections for burns
Many different substances can be injected into the scar area to reduce the formation of contractures and reduce hypertrophic scars, as cortisone can be injected (6 injections maximum, one injection every month); It reduces the height of hypertrophic scars and helps make them flatter, but it does not affect the width or depth of the scar.
Cryotherapy for burns
Cryotherapy can be used alone or in conjunction with cosmetic surgery, or local injections. Cryotherapy is used to treat keloids and hypertrophic scars, 80% of cases notice an improvement in the appearance of scars. However, side effects such as scars decreasing more than desired can occur in a significant number of cases.
Laser treatment for burns
Laser reduces the redness and hyperpigmentation of scars, stimulates the rebuilding and modification of collagen and improves their overall appearance. However, specific types of lasers must be used, and the doctor determines whether or not they can be used in the event of a surgical cosmetic procedure.
Surgical cosmetic surgery for burns
There are many techniques used to treat different types of scars, the type of technique varies depending on the condition of the scar, but in general it is very important to know that the cosmetic surgery for burns must be performed after the scar has matured (i.e. the burn has healed completely through the accumulation of collagen, so the scar becomes cohesive and solid and its color changes, with no blood vessels). Also, surgical intervention cannot be performed during the recovery phase because immature scars are rich in blood vessels, and surgical intervention can cause bleeding that prevents achieving the desired ideal result, and it also leads to taking an imperfect skin patch, and thus more scarring and contractions.
As a result, the appropriate time to perform cosmetic surgery for burns is 12-18 months after the burn, which is the time required for the scar to mature. In addition to the disadvantages of performing cosmetic surgery for scars before they mature, the immature scar is more responsive to physical therapy, and thus the existing contractions improve and the movement of the affected part becomes more flexible and free. Giving this period of time gives the small and light scars a chance to disappear and improve, reducing the number of areas that need cosmetic surgical intervention, and increasing the focus during the operation on the most affected areas.
It is preferable to leave the scars for a year or more to mature and cosmetic surgery can be performed on them, but in specific cases, cosmetic surgical intervention is performed within the shortest time and without waiting. These cases include:
Shrinkage in the neck with the inability to move it.
Severe shrinkage in the size of the mouth opening as a result of the burn, which interferes with the patient's nutrition and ability to maintain oral and dental hygiene.
Skin shrinkage in the hand area, specifically the back of the palm, which leads to pulling the hand and fingers backwards and damage to the tendons and muscles, which can result in chronic disability in the hand.
Shrinkage of the burn in the knee area in a way that prevents the patient from standing or walking due to the severity of skin shrinkage in that area.
Shrinkage scars adjacent to exposed areas that need to be covered with a layer or skin patch.
Burns in the eyelid, specifically the upper eyelid, with a risk of corneal ulceration, or permanent scarring in the cornea that affects vision.
Contractile scars with inflammation and suppuration, which require cleaning and drainage of pus to heal properly.
Any severe contractile scars that are not expected to heal or improve with any form of physical therapy.
Burns and their resulting complications greatly affect the patient's life, and their negative impact is reflected in his physical performance and psychological health, so burn plastic surgery provides a means to eliminate or reduce these damages, and improve the quality of life of burn patients.
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