Secondary Burn Reconstruction

The scarring that results from a person being burned can have long lasting life changing effects. Not only in regards to and appearance and confidence, but also with quality of life, as scars may also reduce a person’s mobility (constricting the skin between their joints and muscles).

Burns can heal slowly, and often there is a wait period before secondary burn reconstruction can take place. Once the initial burn has healed to a point that secondary burn reconstruction can occur, Dr. Tahernia, a plastic and reconstructive surgeon with extensive experience in treating patients with burn scarring, utilizes the latest in surgical techniques to reconstruct burn scarring (various sizes and locations). His utilization of these expert techniques and his outstanding patient outcomes have attracted patients from all over the globe. He is dedicated to helping those whose lives have been impacted by burns. Call us today 310-614-9701.

Contractures

Burns that involve damage to the dermis rarely heal without formation of a scar. Scar tissue is usually more fibrous than normal tissue, and has less functional quality. Sometimes the scarred skin extends beyond the three-dimensional boundary of the original tissue resulting in a raised or hypertrophic scar. Hypertrophic scarring can lead to wound contracture if the scar affects a joint as the skin over the joint is firmer and less extensible, which limits movement of the joint.

Restrictive contractures due to burn injuries can result in long term aesthetic and physical consequences, such as restricting range of motion (ROM) of the effected joint. Skin contractures can also result in pain and significant disruption in both social and professional life.

Surgical techniques

Scar Release Surgery

Scar release surgery can be performed to reduce skin constriction and improve mobility. The procedure involves cutting out scar tissue to release the skin tightness between the joints and muscles. Because removing the scar tissue takes away skin, a skin graft or flap surgery is necessary to replace the skin removed.

• Skin graft: This procedure involves covering the burn using healthy skin taken from another location on the patient’s body, usually the buttocks or inner thigh. Once the graft is in place, it begins to form new blood vessels. Though burn scars will be less visible after a skin graft, new scars will often take their place.
• Flap surgery: Flap surgery involves transplanting a flap of the patient’s skin and connective tissue from another location on the patient’s onto the area after the removal of the scar tissue. Flap surgery generally produces less new scarring than skin grafting.

If not enough healthy skin is available for a flap or skin graft, a surgeon may be able to place tissue expanders under the skin. As these small balloons slowly inflate, they stretch the skin until enough donor tissue is available.

• Tissue Expansion: Tissue expansion is a relatively straightforward procedure that enables the body to “grow” extra skin for use in reconstructing almost any part of the body. A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow.

Z-Plasty

Z-plasty is a procedure that can camouflage scar tissue and improve flexibility. The surgeon performing the procedure makes a Z-shaped incision in the burn scar, creating two triangle-shaped flap, then he rotates the flaps and sews them into place. This releases skin contracture and conceals scar tissue as it now conforms to the natural creases of the skin.

Non-Operative Burn Treatment

Splinting

Splints are a highly effective method of helping manage burn contractures and can be an integral part of secondary burn rehabilitation. As scars not only contract, but also take the shortest route possible, they often cause webbing across natural concavities and joints for example to the neck, knee and axilla; splints appear to help remodel scar tissue and maintain the anatomical contours. Splinting applies controlled gentle forces to soft tissues for sufficient lengths of time to induce tissue remodeling. Splints can be made of various different materials. The ideal material is low temperature thermoplastic as it is lightweight, easily mouldable and remouldable and conforms extremely well to contours.

Skin Resurfacing Procedures

In some cases, burn scars may be reduced with in-office skin resurfacing procedures. Dermabrasion targets burn scars by surgically scraping the top layer of skin. Laser resurfacing is a similar treatment performed with a medical laser.

Pressure Garments

Pressure garments for burn healing improve scar appearance, decrease itching, and protect the skin from injury. Some burn survivors also feel that the pressure garments look better than the scars themselves. Bandages or custom garments will increase pressure on the scar and can improve healing. These inserts can be made from a variety of substances, ranging from soft foam to a rubber consistency.

Burns Categorized

Minor burns are:

• First degree burns anywhere on the body
• Second degree burns less than 2-3 inches wide

Major burns include:

• Third-degree burns
• Second-degree burns more than 2-3 inches wide
• Second-degree burns on the hands, feet, face, groin, buttocks, or a major joint