Reconstructive Burn surgery in Pakistan

Reconstructive Burn Surgery is one of the neglected parts of plastic surgery. Patient with acute burn suffers a lot due to psychological problem, social problems and financial problems and family support issues.

Dr Abdul Malik is doing this Reconstructive Burn Surgery in Multan at Medicare Hospital Multan (0345-4492128).

Reasons of Burns

Burn can be due to different reasons;

1- Scald Burn means Burn with hot water, hot oil, hot milk or any other liquid: Children and kids usually suffer more with this type of burn and is usually superficial to deep. There is more pain and itching due to damage to nerves.

2- Chemical burns like an Acid burn or Alkali burn: This kind of burn is a social dilemma and people to take revenge for any issue they spill away acid on faces and so many females are suffering due to this problem.

3- Flame burn or Contact burn: The patient can get burned by heat or flame or by contact with flame. Usually, this burn occurs in labourers, household workers, housewives and epileptic patients. The patient usually suffers deep to full-thickness burn and a large percentage of body surface area is involved.

4- Electrical burn: this burn usually occurs in rainy areas when roofs or floors are wet and in people who work on high voltage wires of WAPDA. There is usually an entry wound and exit wound. These burns are deep to full thickness and may cause damage to kidneys and can involve the heart that can cause heart failure or sudden cardiac arrest due to arrhythmia.

5- Inhalational burn: These burns usually occur in the winter season when there is the use of gas at home and use of heaters and shortage of gas may occur and which leave a problem that people forget to turn off heater or geezer. This may involve the face neck chest and can cause problems in breathing and lungs issues.

6- Frostbite burn: This burn occurs when there is exposure to extreme cold like in glaciers or Siachen areas.

Classification of Burn Depths

There are different categories of burn depth according to the involvement of skin layers

1- superficial burn is when sunburn type occurs, there is only redness or erythema and no blisters and usually heals in about 3-7 days

2- partial-thickness burn; it is further divided into superficial partial-thickness burn in which blister develops and involves the epidermis and papillary dermis of the skin. It is painful as nerve damage occurs in this. This takes about 7-14 days to heal.

Deep partial-thickness burn is usually deep and dry white and may have blister and pain is less as nerve damage is more and it can heal in 21 days but some time does not heal

3-full thickness burn. It usually involves both layers of skin and burn can go deeper than skin. It is dry, leathery with thick Eschar tissue. It usually does not heal and need surgery.

Percentage of Burn

Rule of nine is used to calculate the percentage of burn as fluid management of patient depends on the percentage of burn

Head is 9 %

Arms 9 per cent

Front and back of chest 18 %

Front and back of abdomen 18%

Thighs and legs each side 18 %

Perineum 1 %

Initial management

Initial management when a burn occurs even at home is to wash the burnt area with the normal temperature running tap water for 10-15 minutes. Remove the clothes. Bring the patient out of the burning place.

Shift the patient to a nearby hospital. pain killers are given to the patient. Intravenous fluid is given to the patient and the wound is washed and clean of dirty tissue then topical antibiotics are applied (silver sulphadiazine). Then a dressing is done. Then after initial management patient is shifted to a burn unit or to the plastic surgeon to deal with the burn patient.

Plastic Surgeon Dr Abdul Malik himself assesses the patient about the percentage of burn, depth of burn, any associated injury and manage the patient with fluid, pain killers, antibiotics, dressing of patient after wound wash and if needed surgery of patient is planned to remove the dead tissue.

About Burn Surgery

Burn surgery is a complicated surgery. It needs passion and a good deal of business and along with surgery need a good diet of patient and family and social and psychological support. The patient may need multiple surgeries and the cost burden is also more and more. The patient may be depressed due to the involvement of the face which masks his or her facial features.

The patient may develop complications of burns which may need surgeries later on; Like for the release of contracture of fingers hands elbows or legs and feet. The patient may need surgery of the face, ectropion surgery, neck contracture release and many other procedures to improve function and aesthetics.

Complications of Burns

Burn can have a wide range of complications that include:

1-airway problems

2-breathing problems

3- vascularity problem

4- fluid and electrolyte imbalance

5- acute kidney failure

6- infection and sepsis

7- Development of contractures

8- hypertrophic scars and keloids

9- cataracts and seizure with electrical injury

10-limbs amputation if proper management is not done

Cost

The Cost of Burn Surgery in Pakistan is variable and depends on which kind of dressing is done as different specialized burn dressings are available which are very good for healing burns like AquacellAG, Deuderm, Keltostate and others. It also depends on which kind of surgery is done and how many surgeries are needed.

It is in the range of 50,000 to 5,00,000 Pkr.