Reconstructive burn surgery is a vital yet often neglected aspect of plastic surgery. Patients with acute burns face numerous challenges, including psychological, social, and financial issues, often compounded by a lack of family support.
Types of Burns
1. Scald Burns
Burns caused by hot liquids such as water, oil, or milk.
- Common in children.
- Typically ranges from superficial to deep burns.
- Causes significant pain and itching due to nerve damage.
2. Chemical Burns
Burns caused by acids or alkalis.
- Often a result of acid attacks, a major social issue, particularly affecting women.
3. Flame or Contact Burns
Burns from direct heat, flames, or contact with hot objects.
- Common among laborers, household workers, housewives, and epileptic patients.
- Usually deep or full-thickness burns affecting large areas.
4. Electrical Burns
Burns caused by exposure to high-voltage electricity.
- Common in wet conditions or among workers handling electrical wires.
- Results in entry and exit wounds, often leading to severe internal damage.
- May cause kidney damage or cardiac arrest.
5. Inhalation Burns
Burns affecting the respiratory tract due to gas heater or geyser mishaps.
- Commonly affects the face, neck, chest, and lungs.
6. Frostbite
Burn-like injuries caused by prolonged exposure to extreme cold, such as in glacier regions.
Classification of Burn Depths
1. Superficial Burns
- Resemble sunburns with redness but no blisters.
- Heal within 3-7 days.
2. Partial-Thickness Burns
- Superficial Partial-Thickness: Blisters, involves the epidermis and papillary dermis. Painful, heals in 7-14 days.
- Deep Partial-Thickness: Dry, white burns with less pain due to nerve damage. May take 21+ days to heal or require surgery.
3. Full-Thickness Burns
- Involves all skin layers and possibly deeper tissues.
- Dry, leathery with thick eschar tissue.
- Requires surgery for healing.
Percentage of Burn: Rule of Nine
This method calculates the total body surface area (TBSA) affected:
- Head: 9%
- Each arm: 9%
- Chest (front and back): 18%
- Abdomen (front and back): 18%
- Each leg: 18%
- Perineum: 1%
Initial Management of Burns
- Rinse the burn area with cool running water for 10-15 minutes.
- Remove clothing around the burned area.
- Move the patient to a safe location.
- Administer painkillers and intravenous fluids.
- Clean the wound, apply topical antibiotics (e.g., silver sulfadiazine), and dress the burn.
- Refer the patient to a burn unit or plastic surgeon for further management.
Surgery for Burns
Burn surgery is complex, requiring skilled surgeons and substantial family and psychological support.
- Patients may need multiple surgeries to address dead tissue removal, contracture release, or aesthetic restoration.
- Common procedures include finger contracture release, ectropion correction, and neck contracture release.
Complications of Burns
- Airway and breathing difficulties.
- Vascular and electrolyte imbalances.
- Acute kidney failure.
- Infection and sepsis.
- Contractures, hypertrophic scars, and keloids.
- Cataracts and seizures (with electrical burns).
- Limb amputations (if not managed properly).
Cost of Treatment
The cost depends on the type of dressing (e.g., AquacellAG, Duoderm, Keltostat) and the number of surgeries required.
- Ranges between PKR 50,000 and PKR 500,000.