Burn Care and Reconstructive Surgery

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Excerpt

Two recent articles have provided timely illustrations of the potential for reconstructive surgery to contribute important strategies in burn care.
As'adi et al1 reported a series of lower extremity high-voltage electrical injuries treated with variations of the distally based sural flap. These patients had a 96% rate of successful closures.
Cauley et al2 described application of a modified advancement rotation flap (the “STARplasty”) for the release of late burn scar contractures in the axilla. In this series, 14 of 16 flaps were healed with functional improvement at 30 days after surgery.
The first report describes flap procedures applied to acute burns. Such operations can provide necessary coverage for critical defects involving joints, vessels, nerves, and skeletal injuries. Burn excision and flap coverage can also decrease skin grafting requirements.3,4
The second article is an example of secondary reconstruction to address complications of the initial burn injuries and treatments. Such procedures can be enormously important to the ultimate functional and social recovery of a burn patient. Secondary burn reconstructions can inspire the use of procedures engaging the entire range of plastic surgery, including skin grafts, local flaps, more complicated anatomic flaps, microsurgery, and transplantation, as well as strategic amputation and nerve decompression.5–7 The incidence of secondary burn reconstruction can be substantial. In the last 3 years of our practice, we performed 3513 burn surgeries; 790 (22%) were secondary procedures, including 260 flap cases.5
The coordination of acute burn care with primary and secondary reconstructive procedures offers potential for efficient, comprehensive management of major burns, making both life-saving procedures and reconstructive procedures immediate, albeit situationally prioritized strategies. As such, burns can be considered a variant of complex wounds, treated with initial, injury-specific management and subsequent treatment of wounds, defects, and deformities.8
Such a scheme offers the plastic surgeon great opportunities in burn care. This journal is most interested in considering articles that explore those opportunities.
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