When considering the topic of reconstructive burn surgery, which of the following statements do you consider to represent the greatest consensus view?
Reconstructive burn surgery should begin in the acute burn phase. If there is a functional problem, early intervention is appropriate. Children do pose special problems because of the additional dimension of growth. In these circumstances flaps are usually better than grafts and there is certainly no need to wait until growth stops. Burn reconstruction is aimed at both function and form, and deals with far more than contractures and mobility. We must always be thinking of the reconstructive outcome when we are dealing with acute burns. Appropriately treated, no further reconstruction may be needed despite extensive, deep burns.
Systemic effects of a major burn include:
When considering burn reconstruction of the head and neck where the eyes, nose, mouth, ears and scalp are all significantly involved what would be the usual order for priority of reconstruction?
Eyes, mouth, scalp, nose, ears. Prioritizing is very important in reconstructive burns surgery and the concept of a ‘shopping list’ of problems is well established. In terms of anatomy, it is possible to look at problems objectively or, in terms of the patient’s perception of disability and deformity, it is possible to look at problems subjectively. In this question, we are focusing on the head and neck with involvement of a number of anatomical features. When we consider prioritizing the reconstructive strategy we have to look at the seriousness of the consequence(s) of the scarring and in this context the loss of vision must be considered the number one complication to avoid. The second complication of greatest significance would be loss of oral continence if there is lip ectropion or poor feeding and vocalisation if there is microstomia. There will always be debate about the priority of the other features but a general consensus would agree with eyes first, mouth second.
Regarding Integra®, which of the following statements is true?
Integra® is a bilaminar biodegradable tissue engineered dermal matrix generation template. Integra® does not inherently contract. It is physically inert, but placed in a flexor recipient site without postoperative rehabilitation and the newly generated auto-collagenous dermal matrix will contract. Of note, Integra® contains chondroitin-6-sulphate, does not cause infection but can become infected, and does not act as a template for skin regeneration.
1. Young RC, Burd A. Paediatric upper limb contracture release following burn injury. Burns 2004; 30(7): 723-8.
There are few published series of microsurgical reconstruction in post-burn paediatric patients. What is the principal reason for this?
Where the technical skills and resources exist there are relatively few patients who can benefit from the surgery. Sadly, in much of the developing world where the need for resources and expertise is much greater, many such children struggle to survive.
1. Burd A, Pang PCW, Ying SY, Ayyappan T. Microsurgical reconstruction in children’s burns. J Plast Reconstr Aesthet Surg 2006; 59: 679-92.
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