BURNS
Injuries caused by Burns are more common than we realize. The importance of the plastic surgeon in their treatment is so significant that it is considered their area of expertise. It can destroy anything from the skin to deeper tissues, such as bones and organs.
Depending on the injuries, the plastic surgeon has a series of techniques of reconstructive and aesthetic surgery. He acts both in the acute phase (when the injury occurred) and in the eventual sequels (sometimes years later).
WHAT IT IS AND HOW IT IS DONE
The treatment for patients who have just suffered Burns can demand quite long periods of time and involve several surgeries. It depends on the degree and must be analyzed case by case. It can start with just a dressing, a simple removal of devitalized tissue, up to the use of flaps and skin grafts.
Similarly, eventual sequelae are treated using a large arsenal of plastic surgery resources. Considering the diversity and complexity of these sequelae, their location and characteristics, several surgical techniques – reparative and aesthetic – and materials are currently available.
We are especially important in this situation when we can contribute to plastic surgery by performing grafts using, for example, thin slices of the patient’s own healthy skin applied over the affected area. Another technique we can use is flaps, transferring parts of skin and tissue irrigated by arteries to the affected region.
In all cases, the injured person should be referred as urgently as possible to the nearest emergency room or hospital.
Immediately after the injury, immediately remove rings, bracelets, watches, glasses, contact lenses, necklaces, belts, shoes, and clothing before the affected area begins to swell.
In the case of Burns of thermal or chemical cause, first aid should be to cool and/or rinse the burned area with plenty of running water and then cover it with a clean cloth. If the cause is electrical, do not touch the victim and hurry to turn off the electric current.
DEGREE
As to depth, Burns can be classified as follows:
1st degree
It affects only the epidermis (superficial layer of the skin).
Redness without blisters and slight local swelling.
The pain is present.
2nd degree
It affects the epidermis and part of the dermis (2nd layer of the skin).
Bubbles are present.
The pain is sharp.
3rd degree
It affects all layers of the skin, muscles, and bones.
Necrosis of the skin (death of the tissue) occurs, which appears whitish or dark in color.
Pain is absent, due to the depth of the burn, which injures all the nerve endings responsible for conducting pain sensation.
CAUSE
The causative agents of Burns are classified as follows:
Physical
Thermal: directly through fire or a hot source such as liquid, fat, oil, iron or steam.
Electric: low voltage currents (such as a household appliance) or high voltage currents (street wire) or even lightning during a storm.
Radiant: sunlight or nuclear sources.
Chemical
Substances for industrial or domestic use, such as solvents, caustic soda, bleaches, or any acid or alkali.
Biological
Living things, such as jellyfish, tortoises or nettles.
WHAT NOT TO DO
Regardless of the agent, what not to do:
DO NOT apply toothpaste, ointment, egg white, butter, cooking oil, or any other ingredient to the injury.
DO NOT use ice, as it may aggravate the burn.
DO NOT remove sticky tissue. If so, carefully cut and remove any loose tissues.
DO NOT burst any liquid bubbles.
INDICATION
Burns affect children and adults and can be life-threatening. The resulting scars can mark them forever. Their severity is determined by depth, extension and the affected area. Those that affect the hands, feet, face, perineum, neck, and eyes, whatever the depth and extent, require hospital treatment.
Surgical treatment is indicated to prevent a series of problems both in the acute phase and in the eventual sequels. Thus, the cases that require surgical intervention have the objective of promoting the best possible healing. It is to prevent, for example, the skin from becoming retracted and having difficulty in stretching or moving freely the elbow, knees, armpits, and neck.
Aesthetically, the surgeries are indicated for correction in the light or dark tone of the skin, correct deformations in structures such as the ears, nose, and eyes.
When necessary, we work in cooperation with other professionals (physical therapists, nurses, nutritionists, psychologists, occupational therapists, social workers, and speech therapists) who can contribute to the integral and multidisciplinary care.
From the multidisciplinary team’s point of view, the goal is to reduce treatment time, facilitate recovery, and, most of the time, contribute to the patient’s reinsertion.
From the plastic surgery point of view, our main focus from the acute phase is to restore and/or preserve function while promoting the aesthetic improvement of scars, retractions, or other consequences caused by Burns.
PRE AND POSTOPERATIVE
What will determine the pre and postoperative actions is the extent of the injury caused by the Burns.
We follow your case and pass on all the information and recommendations from medications, dressings, release to return to routine and even exercises.
If the plastic surgery is to correct sequelae, it is very important to consult the SCHEDULED THE SURGERY? page that has a series of questions for us to talk about in the consultations, help with your doubts and where you find recommendations for the day of the procedure.