Presented at the Burn Unit of Dhaka Medical College Hospital in June, 2007.

1. Surgery on Burn Patients
Dr. Iftekhar Ibne Mannan
HMO, DMCH

2. Topics of discussion
 Principles
of burn surgery
 Reconstructive ladder
 Z-plasty
 W-plasty

3. Principles of burn care
 Preservationof life
 Prevention and control of infection
 Conservation of all viable tissue
 Maintenance of function
 Timely closure of the burn wound

4. Burn Surgery
 Escharotomy and Fasciotomy
 Excision and Grafting
 Burn wound closure
 Post-burn reconstruction

5. Post-burn deformities
 Contractures
 Hypertrophied scars
 Chroniculcers
 Unfavourable scars

6. Methods
 Incisional release and coverage
 Excisional and coverage
 Reorientaion of scars e.g. Z-plasty, W-
plasty etc.
 Resurfacing
 Pressure garments
 Steroids
 Massage

7. Timing of Surgery
 Acute: to facilitate patient care and to
prevent acute contractures from causing
irreversible secondary damage. e.g.
eyelid contractures with exposure
keratitis etc.
 Intermediate: to manipulate scars to
make them favourable
 Late: to correct established postburn
deformities.

8. Behaviour of scars
 Scars under tension are angry and
respond with erythema, hypertrophy,
pruritus, pain and tenderness.
 Relaxed scars are happy scars and
respond by flattening, softening and
becoming pale and asymptomatic.

9. Principles of burn reconstruction
 Analyze the deformity and note distorted and
absent tissue.
 Generate a long-range plan for reconstruction
that establishes priorities and addresses both
functional and esthetic concerns.
 Delay reconstruction until the scars and grafts
have matured. Use splints and elastic garments
to minimize scar hypertrophy.
 Release extrinsic contracture before intrinsic
contracture.
 Orient scars parallel to relaxed skin tension lines.

10. Principles of burn reconstruction
 Identify and ration potential donor site skin.
 Resurface according to regional esthetic units.
If possible, adjacent units should be covered
with a single large graft to avoid seams
between territories.
 Match donor skin according to thickness, color
and texture. Thicker skin grafts produce less
postoperative contracture.
 Protect new scars and grafts from ultraviolet
radiation to decrease the chance of
hyperpigmentation.

11. Reconstructive Ladder

12. Direct tissue closure

13. Skin graft

14. Local flap

15. Blood supply of flaps

16. Z-Plasty
•Lengthens
•Reorients