Surgery for burns after-effects

Burn surgery is an extremely broad field of plastic surgery that tends to respond to the extreme variety of injuries induced by burns.

The principles of burns surgery

Burns, whatever their cause (flames, boiling water, acid, etc.) always lead to a more or less extensive destruction of the skin's cellular layers.
If the skin's natural regenerative capacities are affected, we speak of a deep burn which systematically leads to after-effects.
Indeed, the body will react to the destruction of the skin tissue by creating retractile scars that will try to fill this "lack of skin".
Burn repair surgery therefore aims to provide good quality skin.
For this, several methods are available.

Skin grafting:

It can be full thickness (total skin graft) or partial (thin skin graft). This technique is particularly useful on the face and hand to restore small anatomical areas (nose, eyelids, finger...).


Vascularized skin is cut away from the burned area and transposed over the burn scar to release the retraction flaps.
This technique is limited by the amount of skin available on the donor site of the flap

Skin expansion:

In order to avoid the problem of the donor site, a silicone balloon is placed under the skin. It will be progressively filled with saline by means of a valve located at a distance. This will distend the skin which will be used either as a flap or as a donor area for a skin graft.
This technique has revolutionized the treatment of burns.

Artificial dermis:

When very large areas are to be treated, artificial dermis (Integra®) can be used to replace the subcutaneous tissue. A first operation puts it in place on the scarred area, then a second one 21 days later, covers this dermis with an ultra-thin skin graft.
This technique is limited by its cost, and by its sometimes disappointing aesthetic results.

Once the lack of skin has been treated, the trophic and aesthetic qualities of the reconstructed tissue must be improved.
For this, 2 surgical techniques are useful:

  • Injection of purified fat: it improves the trophicity of skin grafts and scarred areas
  • Dermabrasion: it allows to treat the differences in color and pigmentation between normal and burned skin

In Practice

Surgery for the after-effects of burns should only be considered, with some exceptions (eyelid burns, hand burns), after the initial treatment, which most often includes thin or total skin grafts.
Physiotherapy and pressure therapy are essential in order to soften the scarred areas.
Only once the scar is stabilized can surgery be considered.
Surgery is most often performed under general anesthesia in a conventional hospital setting.
Post-operative care can be lengthy and requires the greatest compliance on the part of the patient.

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Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France

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