Burn Treatment and Post-Burn Reconstruction

A burn is not simply an injury affecting the surface of the skin. Depending on the intensity of the heat, duration of exposure, depth of injury and the area involved, damage can extend from the superficial layers of the skin to deeper tissues such as muscle and tendon.

The first aim of burn treatment is to achieve safe wound healing. In deeper burns, treatment may also involve removal of non-viable tissue, wound closure with skin grafts or other reconstructive techniques, and later treatment of burn scars, hypertrophic scars and contractures. 

What Is a Burn?

A burn is an injury to the skin and, in some cases, deeper tissues caused by heat or another source of energy.

Burns may result from:

• Hot liquids
• Flame
• Contact with hot surfaces
• Steam
• Chemicals
• Electricity
• Radiation or intense sun exposure

One of the most important factors in determining treatment is the depth of the burn.

How Is Burn Depth Assessed?

Although terms such as first-, second- and third-degree burns are still commonly used, clinical assessment focuses more on how deeply the tissue injury extends.

Superficial Burns

First-degree burns affect only the epidermis, the outermost layer of the skin.

They may cause redness, tenderness, burning and pain, but blistering is usually absent.

Many sunburns fall into this category and usually heal without permanent scarring.

Second-Degree Burns

Second-degree burns extend into the dermis and may be superficial or deep.

Superficial second-degree burns may cause blistering, a pink or red wound surface and significant pain. When enough viable dermis remains, the wound may heal without surgery.

In deeper second-degree burns, more of the structures responsible for skin regeneration have been damaged. Healing may take longer and the risk of significant scarring is higher. Some patients may require surgical treatment and skin grafting.

Full-Thickness Burns

Third-degree, or full-thickness, burns involve the entire thickness of the skin.

The wound may appear white, brown, dark, dry or leathery. Because nerve endings can also be damaged, the centre of a very deep burn may be less painful than expected. This does not mean the injury is mild.

Many full-thickness burns require surgical excision and skin grafting.

When injury extends beyond the skin into deeper tissues such as muscle, tendon or bone, more complex reconstructive treatment may be necessary. 

First Aid After a Burn

For thermal burns, once the source of heat has been removed, the affected area should ideally be cooled under cool running water for around 20 minutes as soon as possible.

Ice or very cold water should not be applied directly to the burn. Rings, watches and other items that may become tight as swelling develops should be removed early, but clothing that is stuck to the skin should not be pulled away forcibly.

Toothpaste, butter, oils or unidentified creams and substances should not be applied to a burn.

Blisters should also not be deliberately burst at home. 

Which Burns Need Medical Assessment?

Not every small superficial burn requires hospital treatment. However, some burns should be assessed promptly by a healthcare professional.

These include:

• Large burns
• Deep burns
• Burns involving the face
• Burns of the hands or feet
• Genital burns
• Burns over major joints
• Electrical burns
• Chemical burns
• Burns with suspected airway involvement

Children, older patients and people with significant medical conditions may also require earlier assessment. 

Surgical Treatment of Deep Burns

In deep burns, it is not always appropriate to wait for severely damaged tissue to heal on its own.

When necessary, non-viable tissue is removed surgically. This is known as debridement or excision.

The method used to close the resulting wound depends on its depth and on which structures are exposed underneath.

Skin Grafting for Burn Wounds

A skin graft is a thin layer of skin taken from a healthy part of the patient’s body and transferred to the burn wound. Common donor areas may include the thigh, buttock, back or another suitable site.

The graft is placed over the wound and is expected to establish a new blood supply from the underlying tissue. Skin grafting is particularly important in deep burns that are unlikely to heal adequately on their own or would otherwise take a very long time to close.

Not every deep burn can be treated with a skin graft. When tendon, bone or other important structures are exposed, local, regional or free flaps may be required. 

Burn Scars

Not every burn leaves the same type of scar.

One of the most important factors influencing scarring is the time the wound takes to heal. Superficial burns that heal quickly have a lower risk of significant permanent scarring, while deeper wounds that remain open for longer have a higher risk of hypertrophic scarring and contracture.

Depending on the patient, burn-scar treatment may include:

• Silicone-based scar products
• Pressure therapy
• Moisturising
• Sun protection
• Laser treatments
• Selected injection treatments
• Surgical scar revision

Treatment is planned according to the age, thickness, colour and location of the scar, and whether it causes functional limitation. 

What Is a Burn Contracture?

As deep burn wounds heal, scar tissue may gradually tighten and shorten.

When this tightening changes the position of an anatomical structure or restricts movement, it is known as a burn contracture.

Contractures can be particularly important around:

• The neck
• Armpit
• Elbow
• Hands and fingers
• Knee
• Mouth
• Eyelids

Mild contractures may respond to physiotherapy, splinting and scar treatment.

When a contracture is established and significantly restricts movement, surgery may be required.

After the contracted scar is released, the resulting defect may be reconstructed using Z-plasty, skin grafts, local flaps, tissue expansion or more complex reconstructive techniques.

The aim is not only to improve appearance, but also to restore lost movement and function as much as possible. 

Why Does the Location of a Burn Matter?

The anatomical location of a burn can be just as important as its size.

Neck Burns

Severe neck contractures can restrict upward head movement, reduce neck mobility and alter the contour of the lower face.

Once the scar is released, a large tissue defect may remain, so the reconstructive method needs to be planned carefully.

Hand Burns

Even relatively small hand burns can have major functional consequences.

Burns around the fingers and joints may lead to:

• Reduced movement
• Tendon adhesions
• Finger contractures
• Narrowing of the web spaces between the fingers

For this reason, hand therapy and rehabilitation are important alongside wound treatment.

Facial Burns

Facial burns can cause both aesthetic and functional problems.

Deep burns may lead to:

• Eyelid retraction
• Restricted mouth opening
• Changes in the contour of the nose or lips
• Significant hypertrophic scarring

Facial reconstruction aims to preserve natural anatomical units as much as possible while considering function and appearance together. 

Eyelid and Perioral Contractures

Deep burns around the eyes can cause scar contraction that pulls the eyelid away from the eye.

If the eye cannot close fully, the cornea may become dry and the surface of the eye can be damaged. For this reason, severe eyelid contracture is not only a cosmetic issue.

Contractures around the mouth can reduce mouth opening and interfere with eating, speech, oral hygiene and dental care.

In advanced cases, scar release and reconstructive surgery may be required. 

Reconstructive Surgery for Old Burn Scars

Burn injuries that occurred many years ago may still be suitable for reconstructive treatment.

The goal is not always to remove every scar completely. In extensive burns, this would not be a realistic promise.

Reconstructive surgery may be used to:

• Release contractures that restrict movement
• Correct scar-related distortion of facial anatomy
• Improve selected areas of broad or irregular scarring
• Reconstruct missing tissue

Some patients may require a single operation, while extensive burn sequelae may need staged reconstruction. 

Rehabilitation After Burn Injury

Burn treatment does not necessarily end when the wound has closed.

In burns involving the hands, neck or joints, long-term treatment may include:

• Physiotherapy
• Stretching exercises
• Splints
• Pressure garments
• Scar care

For some patients, burn treatment is therefore a longer process involving wound care, surgery and rehabilitation together. Yapıştırılan markdown(20261020-…

Frequently Asked Questions