SURGERY FOR THE ACUTE BURN WOUND

Shah Fahad
B.S Emergency Care (KMU)
Certificate in Respiratory Therapy (RMI)
Demonstrator institute of paramedical Sciences-KMU

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 Which burn wound needs surgery?
• Any deep partial-thickness & full-thickness burns, except those that
are < 4 cm2, need surgery.

• Burn of indeterminate depth?

• Reassess after 48 hours, because burns that initially appear
superficial may well deepen over that time.

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 Surgical treatment of deep burns
• Deep dermal burns need tangential shaving & split-skin grafting
• All full-thickness burns need surgery
• You must be ready for significant blood loss
• Topical adrenaline reduces bleeding
• All burnt tissue needs to be excised
• Pass large bore cannula
• Monitor B.P regularly

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• If a large excision is considered, then an arterial line (to monitor
B.P) & CVP monitor are needed
• Measure & control acid–base balance, clotting time & Hb level.
• Avoid hypothermia
• To control blood loss during excision use: subcutaneous injection of
a dilute solution of adrenaline 1:1 000 000 or 1:500 000 & tourniquet

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• In deep dermal burns, the top layer of dead dermis is shaved off
until punctate bleeding is observed & the dermis can be seen to
be free of any small thrombosed vessels
• Full-thickness burns require full-thickness excision of the skin
• In certain circumstances, it is appropriate to go down to the
fascia but, in most cases, the burn excision is down to viable fat.
• Wherever possible, a skin graft should be applied immediately.

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• Postoperative management of these patients obviously
requires careful evaluation of fluid balance and levels of
haemoglobin.
• The outer dressings will quickly be soaked through with serum
and will need to be changed on a regular basis to reduce the
bacterial load within the dressing.
• Physiotherapy and splints are important in maintaining range of
movement and reducing joint contracture.

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• Elevation of the appropriate limbs is important.
• The hand must be splinted in a position of function after grafting,
although the graft needs to be applied in the position of maximal
stretch.
• Knees are best splinted in extension, axillae in abduction.
• Supervised movement by the physiotherapists, usually under direct
vision of any affected joints, should begin after about 5 days.

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Delayed reconstruction of burns- Summary
• Eyelids must be treated before exposure keratitis arises
• Transposition flaps and “Z”plasties with or without tissue expansion
are useful
• Full-thickness grafts & free flaps may be needed for large or difficult
areas
• Hypertrophy is treated with pressure garments
• Itch should be treated pharmacologically

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 Burn’s alopecia?
• Burn alopecia is best treated with tissue expansion of the
unburned hair-bearing skin.
• Tissue expansion is also a useful technique for isolated burns &
other areas with adjacent normal skin.

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 Burn’s hypertrophy?
• Hypertrophy of many scars will respond to pressure garments.
• These need to be worn for a period of 6–18 months.
• Where it is difficult to apply pressure with pressure garments, or
with smaller areas of hypertrophy, silicone patches will speed scar
maturation, as will intralesional injection of steroid.
• Itching: treat it with pharmacological agents

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REFERENCES

• “Baily & Love short practice of surgery “

• Chapter 30 “ Burns”
• Thank you

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