Burns Surgery

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

1. Rinse the burn area with cool running water for 10-15 minutes.
2. Remove clothing around the burned area.
3. Move the patient to a safe location.
4. Administer painkillers and intravenous fluids.
5. Clean the wound, apply topical antibiotics (e.g., silver sulfadiazine), and dress the burn.
6. 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

1. Airway and breathing difficulties.
2. Vascular and electrolyte imbalances.
3. Acute kidney failure.
4. Infection and sepsis.
5. Contractures, hypertrophic scars, and keloids.
6. Cataracts and seizures (with electrical burns).
7. 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.