Clinical Review ABC of burns

Burns reconstruction

BMJ 2004; 329 doi: (Published 29 July 2004) Cite this as: BMJ 2004;329:274
  1. Juan P Barret


    The basic concerns in burns reconstruction are for function, comfort, and appearance. Normal and hypertrophic scarring, scar contracture, loss of parts of the body, and change in colour and texture of injured skin are processes common to all seriously burnt patients and yet unique to each.

    A realistic approach is necessary to harmonise patients' expectations (which are very high) with the probable outcomes of reconstructive surgery. Burn reconstruction starts when a patient is admitted with acute burns and lasts until the patient's expectations have been reached or there is nothing else to offer. However, even when this time has come, the patient-surgeon relationship may still continue and can last a lifetime.

    Any surgeon undertaking burn reconstruction must have good understanding of wound healing and scar maturation to plan the time of reconstruction, and sound knowledge of all surgical techniques and all the aftercare required (usually in conjunction with a burn team). A strong patient-surgeon relationship is necessary in order to negotiate a master plan and agree on priorities.

    Time of reconstruction

    Definitive correction of burn scarring should generally be delayed for a year or more after scar healing. Unsightly scars mature over time, and, with the help of pressure and splints, many of them do not require surgery once the acute phase of scar maturation is over. Patience is often the best tool of a reconstructive surgeon. However, certain problems must be dealt with before scar maturation is complete. In burn reconstruction there are urgent procedures, others that are essential, and many that are desirable. It is for the last group that a good patient-surgeon relationship is necessary for negotiation on which procedures take priority.

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    Top: Burn scar contracture on the anterior axillary line. Planned Z-plasties for contracture release are shown. Middle: The scar has been incised and all flaps raised. Bottom: Closure …

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