Burn Surgery | Specialists and Information

Burn surgery focuses on the human body’s largest organ: the skin. This specialty is complex because burns can disfigure people. They heal only slowly.

The burn surgeon’s task is to preserve the patient’s life and ensure a good quality of life. In addition to burns, they also treat scalds and chemical burns.

In cases of acute burns, maintaining vital functions is the top priority. If large areas of skin are affected, the patient receives intensive care.

Burn on the hand @ Africa Studio /AdobeStock

Doctors classify burns according to their severity, which is determined by the percentage of the body’s surface area affected and the depth of the burn.

Using the Rule of Nines, doctors divide the body’s surface area into sections, each covering approximately 9% of the total body surface area.

This allows for a rough estimate of the burned body surface area:

• The upper and lower extremities, as well as the head and neck, each account for 9% of the body surface area.
• The entire trunk accounts for 36% of the body surface area (upper and lower back, abdomen, and chest area, each accounting for about 9%).
• The genital area or the palm of the hand accounts for 1% of the body surface area.

The degree of a burn is a measure of its depth:

1. In first-degree burns, the skin is slightly reddened (as with a sunburn), swollen, and painful.
2. In second-degree burns, blisters form, and severe pain occurs.
3. In third-degree burns, the patient no longer feels pain because the nerve endings have also been burned.
4. In fourth-degree burns, the tissue is charred, sometimes down to the bone. There is no pain.

First-degree burns usually heal completely on their own and do not require any special treatment.

Second-degree burns require medical attention. However, they also have a very good prognosis for healing. 

Here, medical professionals distinguish between:

• Second-degree A burns 
• Second-degree B burns 

Second-degree B burns are more severe than second-degree A burns.

Third- and fourth-degree burns are severe and, depending on the extent of the burned body surface area, can even be fatal.

In cases of these severe burns, prompt treatment at a specialized burn center is always required.

Germany now has a dense, excellent network of specialized hospitals for severe and critical burn injuries.

According to the 2018 guidelines, every burn patient should have access to a specialized center for severe burn injuries.

However, this is medically essential for the following burns:

• All burns covering more than 20% of the body surface area
• All third- and fourth-degree burns
• All burns to the hands, face, or genitals
• Burns caused by chemicals and electricity (including lightning strikes) as well as inhalation injuries (resulting from inhaling hot air)

Burn patients who require psychological, psychiatric, or physical care should also receive treatment at a center for severe burn injuries.

Clinics for plastic, reconstructive, and burn surgery are well-equipped. They are high-quality facilities that meet specific quality criteria regarding space, equipment, and staffing.

The attending physicians at a center for severe burn injuries are typically board-certified specialists in plastic and aesthetic surgery.

Plastic and aesthetic surgeons must complete at least 4 years of their 6-year residency in plastic and aesthetic surgery, including at least 6 months in an intensive care unit.

During this time, resident physicians must demonstrate that they have completed treatment for at least 50 burn cases.

In some cases, burn surgeons also have in-depth knowledge in the field of hand surgery. Many plastic and aesthetic surgeons in Germany hold a subspecialty certification in hand surgery. To obtain this, they must complete an additional 3-year training period in the field of hand surgery.

Minor burn on the arm @ Lidia /AdobeStock

Providing adequate care for patients with severe burn injuries is complex and possible only through the collaboration of various medical specialties.

The various medical specialties are:

• Plastic surgery
• Intensive care medicine
• Emergency Medicine
• Infectious Diseases
• Internal Medicine
• Family physicians and
• Psychologists

The duties of a burn surgeon include, for example:

• Preventing compartment syndrome (reduced tissue perfusion due to a closed tissue compartment) by incising superficial layers of burned skin or muscle fascia (“muscle sheath”)
• Removal of necrotic or burned tissue
• Wound coverage using various tissues or materials, skin grafts
• Scar treatment
• Surgical correction of limited joint mobility caused by scarring
• Treatment of severe burns

The goals of scar treatment are to reduce size, extent, and volume @ yta /AdobeStock

Burns are usually medical emergencies. Due to the severity of the injury, the patient’s circulation is also unstable.

First, doctors must cool the wounds, stabilize circulation, and relieve pain. At the same time, however, they must also ensure that the severely injured body does not become hypothermic and lose too much fluid.

In patients with stable circulation, doctors remove dead and charred tissue after manually cleaning the burn wounds in a sterile bath.

Patients receive intensive care and close monitoring to prevent complications associated with burn injuries. These can include life-threatening infections and pneumonia.

In addition to wound care, most burn victims require skin grafts. Often, doctors can take unburned skin from healthy areas of the body and graft it onto the burned areas.

Various techniques are available for this purpose (such as split-thickness skin grafts) to treat even extensive burns with the patient’s own skin.

If there is not enough healthy skin available from the patient’s own body, experts can now grow artificial skin outside the body (keratinocyte transplantation).

Donor skin or animal skin is also used temporarily until the patient’s own skin has regenerated sufficiently.

In addition to acute wound care, psychological support is necessary.

If children do not receive proper treatment, serious long-term consequences can result.

This can lead, for example, to:

• Neurological damage
• Respiratory problems
• Circulatory disorders in the hands, arms, and legs
• Fluid retention
• Increased susceptibility to infections or
• Pain in the area of the burned joints

The psychological consequences should not be underestimated either. As a precaution, you should keep all medical records related to your treatment in case you need to file a claim for damages as an adult. This generally applies to all medical records.