Burn surgery: the discipline that straddles life-saving and reconstruction

Burn surgery is a complex sub-speciality and an important area of specialisation within plastic and reconstructive surgery; it deals with the treatment of patients with the most severe burns. Its principles and techniques form the basis for many advanced procedures in reconstructive surgery.

This glossary entry explains what burn surgery involves and why its significance extends far beyond the A&E department into the fields of aesthetic and reconstructive surgery.

What is burn surgery? A definition

Burn surgery is a sub-speciality of plastic and reconstructive surgery that specialises in the entire treatment pathway for burn injuries. This encompasses acute intensive care to save lives, the surgical treatment of wounds, and the long-term functional and aesthetic reconstruction of the resulting scars and defects.

Treatment takes place in specialist burns centres and requires close collaboration between a multidisciplinary team comprising surgeons, anaesthetists, intensive care specialists, nurses and physiotherapists.

The two main phases of treatment

The work of a burns surgeon can be divided into two basic phases:

1. Phase 1: Acute care – the fight for survival

   In the initial phase following a severe burn, the priority is to stabilise the patient and save their life.

   • Intensive care: Firstly, the life-threatening consequences of the burn, such as fluid loss, hypothermia and the risk of infection, must be managed.
   • Debridement / Necrosectomy: The surgeon removes dead tissue (necrosis) by debridement to prevent infection and promote wound healing.
   • Skin graft: The resulting open wounds must be covered as quickly as possible with the patient’s own skin (usually split-thickness skin from the thigh, buttocks or side of the torso) or a temporary skin substitute, in order to restore the skin’s vital barrier function.
2. Phase 2: Reconstruction – Restoring form and function

   Once survival has been ensured and the wounds have healed, the recovery phase – which often lasts for years – begins. The aim is to restore the patient’s quality of life as fully as possible.

   • Treatment of scar contractures: Burn scars tend to shrink and harden. This can lead to severe restrictions in movement, particularly in the joints. Through complex techniques such as the Z-Plastic These scar bands are released and lengthened.
   • Cosmetic scar correction: To improve the appearance of large or raised scars, techniques such as W-Plastik, dermabrasion or laser treatments are used.
   • Tissue expansion: In order to „grow“ missing, scar-free skin tissue, so-called expanders (a type of balloon) can be implanted beneath healthy neighbouring skin and gradually inflated over a period of weeks. The skin stretched in this way can then be used to cover scarred areas.

The close link to cosmetic surgery

At first glance, emergency medicine in the field of burns surgery and elective cosmetic surgery seem worlds apart. But on closer inspection, it becomes clear that: Burn surgery is the ultimate training ground for plastic surgery.

A surgeon who has learnt how to reconstruct a face destroyed by fire possesses invaluable knowledge and technical skill.

These fundamental skills form the very foundation required for excellent and safe outcomes in demanding aesthetic surgery, particularly in complex revision procedures.

Risks and safeguards for complex procedures

Reconstructive surgery following burns is a complex procedure which, like all surgical procedures, carries risks. However, complications can also arise during planned cosmetic procedures, requiring extensive follow-up treatment.

For cosmetic procedures, a Consequential Costs Insurance provide financial security in the event that complications arise and follow-up treatment is required. In the field of burns surgery, treatment is usually carried out on medical grounds.

Frequently Asked Questions (FAQ) on burn surgery