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Semin Plast Surg 2010; 24(3): 262-280
DOI: 10.1055/s-0030-1263068
© Thieme Medical Publishers

Burns: Treatment and Outcomes

Andrew Burd1
  • 1Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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Publication History

Publication Date:
20 August 2010 (online)

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ABSTRACT

Burns can cause extensive and devastating injuries of the head and neck. Prevention of the initial injury must always be a priority, but once an injury has occurred, then prevention of progression of the damage together with survival of the patient must be the immediate goals. The acute care will have a major influence on the subsequent scarring, reconstructive need, and long-term outcome. In the majority of cases, the reconstruction will involve restoration of form and function to the soft tissues, and the methods used will depend very much on the extent of scarring locally and elsewhere in the body. In nearly all cases, a significant improvement in functional and aesthetic outcomes can be achieved, which, in conjunction with intensive psychosocial rehabilitation, can lead to high-quality patient outcomes. With the prospect of facial transplantation being a clinical reality, the reconstructive spectrum has opened up even further, and, with appropriate reconstruction and support, no patient should be left economically deprived or socially isolated after a burn injury.

KEYWORDS

Acute care - reconstruction - rehabilitation

REFERENCES

  • 1 Kennedy C TC, Burd D AR, Creamer D. Mechanical and thermal injury. In: Champion RH, Burton JL, Burns DA, Breathnach SM Textbook of Dermatology. 8th ed. Oxford, UK; Blackwell Science 2004: 1-28
    PubMedSearch in Google Scholar
  • 2 Burd A. Burn dressings. In: Wnek GE, Bowlin GL Encyclopedia of Biomaterials and Biomedical Engineering. New York, NY; Marcel Dekker 2004
    PubMedSearch in Google Scholar
  • 3 Burd A, Chiu T. Allogenic skin in the treatment of burns.  Clin Dermatol. 2005;  23 376-387
    CrossrefPubMedSearch in Google Scholar
  • 4 Sheridan R. Acute management of acute facial burns in children. In: Grisolia GA, Corsi A, Landi L Current Concepts in Pediatric Burn Care. Naples, Italy; Giuseppe de Nicola Editore 1999: 7-17
    PubMedSearch in Google Scholar
  • 5 Burd A, Zeng A. Changing perspectives in paediatric burns care.  Hong Kong J Paediatr. 2003;  8 272-282
    PubMedSearch in Google Scholar
  • 6 Klein M B, Engrav L H, Holmes J H et al.. Management of facial burns with a collagen/glycosaminoglycan skin substitute—prospective experience with 12 consecutive patients with large, deep facial burns.  Burns. 2005;  31 257-261
    CrossrefPubMedSearch in Google Scholar
  • 7 Lille S T, Engrav L H, Caps M T, Orcutt J C, Mann R. Full-thickness grafting of acute eyelid burns should not be considered taboo.  Plast Reconstr Surg. 1999;  104 637-645
    CrossrefPubMedSearch in Google Scholar
  • 8 Thai K N, Billmire D A, Yakuboff K P. Total eyelid reconstruction with free dorsalis pedis flap after deep facial burn.  Plast Reconstr Surg. 1999;  104 1048-1051
    CrossrefPubMedSearch in Google Scholar
  • 9 Watanabe T, Furuta S, Hataya Y, Yuzuriha S, Otsuka Y. Reconstruction of the eyelids and nose after a burn injury using a radial forearm flap.  Burns. 1997;  23 360-365
    CrossrefPubMedSearch in Google Scholar
  • 10 Fan J. A new technique of scarless expanded forehead flap for reconstructive surgery.  Plast Reconstr Surg. 2000;  106 777-785
    CrossrefPubMedSearch in Google Scholar
  • 11 Hassanpour S E, Davami B. Reconstruction of nose and lips with tubed cervical flap in electrical injury: a case report.  Burns. 2005;  31 510-513
    CrossrefPubMedSearch in Google Scholar
  • 12 Evans D M. Facial reconstruction after a burn injury using two circumferential radial forearm flaps, and a dorsalis pedis flap for the nose.  Br J Plast Surg. 1995;  48 471-476
    CrossrefPubMedSearch in Google Scholar
  • 13 El-Khatib H A, Al-Basti H B, Al-Ghoul A, Al-Gaber H, Al-Hetmi T. Subtotal reconstruction of the burned auricle.  Burns. 2005;  31 230-235
    CrossrefPubMedSearch in Google Scholar
  • 14 Bhandari P S. Total ear reconstruction in postburn deformity.  Clin Plast Surg. 2002;  29 213-220, vi
    CrossrefPubMedSearch in Google Scholar
  • 15 Akin S. Burned ear reconstruction using a prefabricated free radial forearm flap.  J Reconstr Microsurg. 2001;  17 233-236
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Takushima A, Harii K, Asato H. Expanded latissimus dorsi free flap for the treatment of extensive post-burn neck contracture.  J Reconstr Microsurg. 2002;  18 373-377
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Prakash P J, Gupta A K. The subscapular approach in head and neck reconstruction with the pedicled latissimus dorsi myocutaneous flap.  Br J Plast Surg. 2001;  54 680-683
    CrossrefPubMedSearch in Google Scholar
  • 18 Yang J Y, Tsai F C, Chana J S, Chuang S S, Chang S Y, Huang W C. Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures.  Plast Reconstr Surg. 2002;  110 39-46
    CrossrefPubMedSearch in Google Scholar
  • 19 Chin T, Ogawa R, Murakami M, Hyakusoku H. An anatomical study and clinical cases of ‘super-thin flaps’ with transverse cervical perforator.  Br J Plast Surg. 2005;  58 550-555
    CrossrefPubMedSearch in Google Scholar
  • 20 Di Benedetto G, Aquinati A, Pierangeli M, Scalise A, Bertani A. From the “charretera” to the supraclavicular fascial island flap: revisitation and further evolution of a controversial flap.  Plast Reconstr Surg. 2005;  115 70-76
    PubMedSearch in Google Scholar
  • 21 Lopez C E, Ferro A. Primary reconstruction of anterior neck burns with free flaps.  Br J Plast Surg. 2005;  58 102-105
    CrossrefPubMedSearch in Google Scholar
  • 22 Das-Gupta R, Bang C. Anterolateral thigh perforator flap from previously burned skin for secondary reconstruction of neck with post burn sequelae, new limits explored.  Plast Reconstr Surg. 2006;  59 628-630
    PubMedSearch in Google Scholar
  • 23 Tsai F C, Yang J Y, Mardini S, Chuang S S, Wei F C. Free split-cutaneous perforator flaps procured using a three-dimensional harvest technique for the reconstruction of postburn contracture defects.  Plast Reconstr Surg. 2004;  113 185-193 discussion 194-195
    CrossrefPubMedSearch in Google Scholar
  • 24 Lin J Y, Tsai F C, Yang J Y, Chuang S S. Double free flaps for reconstruction of postburn anterior cervical contractures—use of perforator flaps from the lateral circumflex femoral system.  Burns. 2003;  29 622-625
    CrossrefPubMedSearch in Google Scholar
  • 25 Ninkovic M, Moser-Rumer A, Ninkovic M, Spanio S, Rainer C, Gurunluoglu R. Anterior neck reconstruction with pre-expanded free groin and scapular flaps.  Plast Reconstr Surg. 2004;  113 61-68
    CrossrefPubMedSearch in Google Scholar
  • 26 Tsai F C. A new method: perforator-based tissue expansion for a preexpanded free cutaneous perforator flap.  Burns. 2003;  29 845-848
    CrossrefPubMedSearch in Google Scholar
  • 27 Motamed S, Kalantar Hormozi A J, Marzban S. Expanded occipito-cervico-pectoral flap for reconstruction of burned cervical contracture.  Burns. 2003;  29 842-844
    CrossrefPubMedSearch in Google Scholar
  • 28 Burd A, Pang P C, Ying S Y, Ayyappan T. Microsurgical reconstruction in children's burns.  J Plast Reconstr Aesthet Surg. 2006;  59 679-692
    CrossrefPubMedSearch in Google Scholar
  • 29 Hunt J A, Moisidis E, Haertsch P. Initial experience of Integra in the treatment of post-burn anterior cervical neck contracture.  Br J Plast Surg. 2000;  53 652-658
    CrossrefPubMedSearch in Google Scholar
  • 30 Chen T M, Wang H J, Chou T D. Correction of retrusive chin in the reconstruction of face and neck burns using sliding genioplasty.  Burns. 2005;  31 918-920
    CrossrefPubMedSearch in Google Scholar
  • 31 Onah I I. A classification system for postburn mentosternal contractures.  Arch Surg. 2005;  140 671-675
    CrossrefPubMedSearch in Google Scholar
  • 32 Tolleth H. Parameters of Caucasian attractiveness. In: Matory WE Ethnic Considerations in Facial Aesthetic Surgery. New York, NY; Lippincott-Raven 1998: 39-60
    PubMedSearch in Google Scholar
  • 33 Bauer B S, Vicari F A, Richard M E, Schwed R. Expanded full-thickness skin grafts in children: case selection, planning, and management.  Plast Reconstr Surg. 1993;  92 59-69
    CrossrefPubMedSearch in Google Scholar
  • 34 Neale H W, Kurtzman L C, Goh K B, Billmire D A, Yakuboff K P, Warden G. Tissue expanders in the lower face and anterior neck in pediatric burn patients: limitations and pitfalls.  Plast Reconstr Surg. 1993;  91 624-631
    CrossrefPubMedSearch in Google Scholar
  • 35 Hudson D A, Quarmby C, Ndobe E. A suture suspension technique to prevent ectropion after flap transposition from the neck to the face.  Plast Reconstr Surg. 2001;  108 1692-1695
    CrossrefPubMedSearch in Google Scholar
  • 36 Pallua N, von Heimburg D. Pre-expanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery.  Plast Reconstr Surg. 2005;  115 1837-1844 discussion 1845-1847
    CrossrefPubMedSearch in Google Scholar
  • 37 Pribaz J J, Maitz P K, Fine N A. Flap prefabrication using the “vascular crane” principle: an experimental study and clinical application.  Br J Plast Surg. 1994;  47 250-256
    CrossrefPubMedSearch in Google Scholar
  • 38 Khouri R K, Ozbek M R, Hruza G J, Young V L. Facial reconstruction with prefabricated induced expanded (PIE) supraclavicular skin flaps.  Plast Reconstr Surg. 1995;  95 1007-1015 discussion 1016-1017
    CrossrefPubMedSearch in Google Scholar
  • 39 Jia C, Chen B, Su Y. Pre-fabricated lined axial flaps for reconstruction of extensive post-burn facial and forehead full-thickness composite defects.  Burns. 2002;  28 688-690
    CrossrefPubMedSearch in Google Scholar
  • 40 Ninkovic M, Hubli E, Anderl H. Facial reconstruction using a retroauricular-temporal free flap.  Plast Reconstr Surg. 1998;  102 1147-1150
    CrossrefPubMedSearch in Google Scholar
  • 41 Angrigiani C, Grilli D, Karanas Y L, Longaker M T, Sharma S. The dorsal scapular island flap: an alternative for head, neck, and chest reconstruction.  Plast Reconstr Surg. 2003;  111 67-78
    CrossrefPubMedSearch in Google Scholar
  • 42 McCauley R L. Correction of burn alopecia. In: Herndon DN Total Burn Care. Philadelphia, PA; WB Saunders 1996: 449-502
    PubMedSearch in Google Scholar
  • 43 Hudson D A, Grob M. Optimising results with tissue expansion: 10 simple rules for successful tissue expander insertion.  Burns. 2005;  31 1-4
    CrossrefPubMedSearch in Google Scholar
  • 44 Rivera R, LoGiudice J, Gosain A K. Tissue expansion in pediatric patients.  Clin Plast Surg. 2005;  32 35-44, viii
    CrossrefPubMedSearch in Google Scholar
  • 45 Kuckelkorn R, Schrage N, Redbrake C, Kottek A, Reim M. Autologous transplantation of nasal mucosa after severe chemical and thermal eye burns.  Acta Ophthalmol Scand. 1996;  74 442-448
    CrossrefPubMedSearch in Google Scholar
  • 46 Jiaqi C, Zheng W, Jianjun G. Eyelid reconstruction with acellular human dermal allograft after chemical and thermal burns.  Burns. 2006;  32 208-211
    CrossrefPubMedSearch in Google Scholar
  • 47 Nagasao T, Nakajima T, Shimazaki J, Akabane N, Tsubota K. Preliminary repair of eyelids for the treatment of opaque corneas caused by burns.  Scand J Plast Reconstr Surg Hand Surg. 2005;  39 227-233
    CrossrefPubMedSearch in Google Scholar
  • 48 Achauer B M, Adair S R. Acute and reconstructive management of the burned eyelid.  Clin Plast Surg. 2000;  27 87-96, vi
    PubMedSearch in Google Scholar
  • 49 Achauer B M. Lip and mouth reconstruction. In: Burn Reconstruction. New York, NY; Thieme Medical Publishers 1991: 64-78
    PubMedSearch in Google Scholar
  • 50 Hashem F K, Al Khayal Z. Oral burn contractures in children.  Ann Plast Surg. 2003;  51 468-471
    CrossrefPubMedSearch in Google Scholar
  • 51 Daya M, Mahomva O, Madaree A. Multistaged reconstruction of the oral commissures and upper and lower lip with an island submental flap and a nasolabial flap.  Plast Reconstr Surg. 2001;  108 968-971
    CrossrefPubMedSearch in Google Scholar
  • 52 Rudkin G H, Carlsen B T, Miller T A. Nasolabial flap reconstruction of large defects of the lower lip.  Plast Reconstr Surg. 2003;  111 810-817
    CrossrefPubMedSearch in Google Scholar
  • 53 Hafezi F, Naghibzadeh B, Nouhi A. Facial reconstruction using the visor scalp flap.  Burns. 2002;  28 679-683
    CrossrefPubMedSearch in Google Scholar
  • 54 Demir Z, Kurtay A, Sahin U, Velidedeoğlu H, Celebioğlu S. Hair-bearing submental artery island flap for reconstruction of mustache and beard.  Plast Reconstr Surg. 2003;  112 423-429
    CrossrefPubMedSearch in Google Scholar
  • 55 Conley J, Norris J E. Reconstruction of half of the face.  Arch Otolaryngol. 1985;  111 142-145
    PubMedSearch in Google Scholar
  • 56 Angrigiani C, Grilli D. Total face reconstruction with one free flap.  Plast Reconstr Surg. 1997;  99 1566-1575
    CrossrefPubMedSearch in Google Scholar
  • 57 Ho W S, Chan H H, Ying S Y, Chan P C, Burd A, King W W. Prospective study on the treatment of postburn hyperpigmentation by intense pulsed light.  Lasers Surg Med. 2003;  32 42-45
    CrossrefPubMedSearch in Google Scholar

Andrew BurdM.D. F.R.C.S. 

Professor and Chief, Division of Plastic, Reconstructive and Aesthetic Surgery

Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong

Email: andrewburd@surgery.cuhk.edu.hk