Burn surgery focuses on the largest human organ: the skin. The specialty is complicated because burns can disfigure people. They are slow to heal.
The task of the burns surgeon is to preserve the life of the affected person and create quality of life. In addition to burns, they also treat scalds and chemical burns.
In the case of fresh burns, the priority is to preserve vital functions. If larger areas of skin are affected, the patient receives intensive medical treatment.
Burn on the hand @ Africa Studio /AdobeStock
Doctors classify burns according to their severity, which can be determined based on the burnt body surface and the depth of the burn.
Using the rule of nines, doctors divide the surface of the body into areas that each cover around 9% of the total body surface.
This gives a rough estimate of the body surface area burned:
- The upper and lower extremities as well as the head and neck each cover 9% of the body surface.
- The entire torso covers 36% of the body surface (upper and lower back, abdomen and chest each cover around 9%).
- The genitals or the palm of the hand cover 1% of the body surface area
The degree of burn is a measure of the depth of the burn:
- In first-degree burns, the skin is slightly reddened (like a sunburn), swollen and painful.
- In the case of second-degree burns, blisters form and severe pain occurs.
- With third-degree burns, the patient no longer feels any pain as the nerve endings are also burned.
- In fourth-degree burns, the tissue is charred, sometimes down to the bone. There is no pain.
Grade 1 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 chance of healing.
Here doctors differentiate between
- Grade 2A burns
- Grade 2B burns
2B burns are more serious than 2A burns.
Third and fourth degree burns are severe and can also lead to death, depending on the extent of the burnt body surface.
In the case of these severe burns, rapid assistance is always required at a specialist burn center.
In Germany today, there is a dense, excellent network of specialist clinics for severe and very severe burn injuries.
According to the 2018 guidelines, every burn patient should have access to a specialized center for severe burns.
For medical reasons, however, this is mandatory for the following burns
- All burns over 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) and inhalation trauma (after inhaling hot air)
Burn victims who require psychological, psychiatric or physical care should also receive treatment at a severe burn center.
Plastic, reconstructive and burn surgery clinics are well equipped. They are high-quality facilities that meet certain quality criteria in terms of space, equipment and personnel.
The head physicians of a burn center are usually specialists in plastic and aesthetic surgery.
Plastic and aesthetic surgeons must complete at least 4 years of the 6-year training period in plastic and aesthetic surgery. At least 6 months in an intensive care unit.
During this time, residents must provide evidence of at least 50 completed burn treatments.
In some cases, burn surgeons also have in-depth knowledge in the field of hand surgery. Many plastic and aesthetic surgeons in Germany have an additional qualification in hand surgery. For this, they require a further 3-year training period in the field of hand surgery.
Slight burn on the arm @ Lidia /AdobeStock
The adequate treatment of patients with severe burn injuries is complex and only possible with the cooperation of various specialist disciplines.
The different specialist disciplines are
- Plastic surgery
- Intensive care medicine
- Emergency physicians
- Infectiology
- Internal medicine
- General practitioners and
- psychologists
The activities of a burns surgeon include, for example
- Prevention of compartment syndrome (reduced tissue perfusion due to a closed tissue space) by cutting through superficial, burnt skin layers or muscle fascia ("muscle skin")
- Removal of dead or burnt tissue
- Wound covering with various tissues or materials, skin grafts
- Scar treatment
- Surgical correction of limited joint mobility due to scarring changes
- Treatment of severe burn wounds
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The aims of scar treatment are to reduce the size, extent and volume @ yta /AdobeStock
Burns are usually emergencies. Due to the severity of the injury, the patient's circulation is also unstable.
First of all, doctors must cool the wounds, stabilize the circulation and stop the pain. At the same time, however, they must also ensure that the severely injured body does not cool down and lose too much fluid.
For patients with stable circulation, doctors remove dead and burnt tissue after manually cleaning the burn wounds in a sterile bath.
Patients receive intensive medical care and close monitoring to prevent complications from the burns. These can include life-threatening infections and pneumonia.
Most burn victims require skin grafts in addition to treatment of their wounds . Doctors can often take unburnt skin from healthy areas of the body and use it on the burnt areas.
Various techniques are available for this (e.g. split-thickness skin transplants) to treat even extensive burns with the patient's own skin.
If there is not enough healthy skin available, 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 grown sufficiently.
In addition to the acute treatment of wounds, psychological help is necessary.
If children do not receive professional treatment, serious long-term consequences can occur.
This leads, for example, to
- Neurological damage
- Respiratory defects
- Circulatory disorders in the hands, arms and legs
- Water retention
- Increased infections or
- Pain in the area of the burn-injured joints
The psychological consequences should not be underestimated either. As a precautionary measure, you should keep all documents relating to medical treatment for claims for compensation in adulthood. This generally applies to all medical records.
