Burns surgery

A burn is a thermal injury to the skin which damages the different layers of the skin and sometimes the structures that lie beneath it. Thermal injury can occur through hot liquids (scald), fumes and gases, open flames and explosions, UV exposure (sun burn), electric current, chemicals or friction. Similar injuries are caused by exposure to extreme cold, causing frost bite.

Severe burns involving the deeper layers of the epidermis warrant urgent specialist care in a dedicated burns centre. Not only is the burn wound care of utmost importance, but also the treatment of the patient as a whole. Secondary damage to vital organs can occur with burns when circulatory instability, the bodies` natural inflammatory response or infection lead to collapse of perfusion and oxygen supply to organs like the kidney.

Our team of specialists is available 24h to be able to deal with any acute burn. In our 10 bed intensive care unit we deal with all grades of severities of burns.

Classification of burn depths:

Superficial (First Degree) Burn:

Painful reddening and swelling of the skin, superficial layers of the skin involved, heals completely.

Partial Thickness (Second Degree) Burn:

Superficial: Severe pain, blisters, reddening, deep layers still intact, heals without scaring

Deep: Severe pain, burnt blisters, paler pink to white, deeper layers and structures involved, slow healing with scars

Third degree (Full Thickness) Burn

Painless, white leathery texture, deeper structures completely destroyed (blood vessels and nerves) therefore no spontaneous healing possible.

Fourth degree Burn:

Charring, all layers of the skin and soft tissues destroyed, often muscle and bone involvement, not compatible with life.

Management of Burns

Early surgical intervention is necessary for deep partial thickness and full thickness burns where spontaneous healing can not be expected. The dead skin and tissue is excised to create a wound surface suitable for skin grafting. In most cases, this can be done at the same time. Skin grafting involves taking slices of skin from one area of the body, mostly the thighs, which are a few tenths of millimetres thick, in order to place it on the wounds left when the burn is excised. The skin is meshed to increase its surface dimensions. This way the skin can grow into the new site, and healing can occur. The donor site of the skin graft usually heals after 10 days with minimal scarring.
Sometimes primary closure of the wounds is not possible. In these cases, skin substitutes are used as a temporary measure.

If there are not enough donor sites available for taking skin, a biopsy of skin can be sent for cell culture, where new skin cells are grown. After about 10 days, the so called autologous keratinocyte-transplantation is performed to cover large wound areas.

After healing of transplanted skin has taken place, the new skin is still somewhat unstable and should not be exposed to heavy strain. During the following months and years, scarring can occur with subsequent development of contractures.  In these cases, revision procedures can alleviate the symptoms by using a variety of special plastic surgical techniques. This includes the Z-plastic, further skin grafting, local skin flap transpositions, expander techniques or cosmetic procedures.

We are happy to answer any of your questions in one of our specialist clinics.