Trends in Burn Reconstruction-Our Experience With Early Reconstruction

Abstract

Aim: Historically, burn reconstruction has taken place after maturation of the burn scar. Usually this means delay until two years post burn injury. However, the recent trend is to commence reconstructive surgery early (within two years of burn injury), once stable wound coverage has been achieved. We present our experience with early burn reconstruction, and the operative methods we use. Materials and Methods: From 2002 to 2004, 828 patients underwent a total of 3045 burn reconstructive procedures at our institute. 68.3% of these patients were within one year of burn injury. 47.5% of procedures consisted of head and neck surgeries, 36.1% were hand reconstructive procedures, and the remainder were divided between trunk, lower extremities, perineum and genitalia. We used a variety of techniques including skin grafting, local flaps and tissue expansion. Discussion: Traditionally, the burn scar was left to mature fully before consideration for operative reconstruction was undertaken. However, early surgical intervention to release contractures and reconstruct deformities is increasingly becoming accepted. Advantages of early reconstruction include earlier recovery of function/range of movement and earlier reconstruction of cosmetically distressing deformities. Disadvantages of early surgical intervention include operating on scars that are not fully mature, which can be technically more demanding, and postoperatively more detailed wound care may be required. Conclusion: Early burn reconstruction can provide good functional and cosmetic outcomes. Although, it may be technically more demanding due to the immature wound, and require detailed wound care, earlier functional recovery and aesthetic improvement can be provided to the burn patient.