Plastic Surgery in Burns Reconstruction

The IncisionNo Comments

Issue 7 – Volume 3 – April 2017

by Nicholas Mattock

Few surgical disciplines suffer the burden of patient experience to the same degree as plastic surgery in burns reconstruction. Beyond the immediate and potentially life-threatening implications of burn injury, focus must turn towards functional and aesthetic outcomes – largely the domain of the plastic and reconstructive surgeon. As an exclusively acute presentation, and with a considerable proportion of these individuals being children or young adults, it is evident that appropriate surgical management of severe burns is crucial to long-term functional and psychosocial wellbeing.

The plastic surgeon’s role in burns reconstruction can be approached from the perspective of timing, with procedures stratified as urgent, early, or late. Urgent procedures are performed to preserve vital functions as part of the patient’s acute care; conversely, early procedures facilitate improved rehabilitation and aim to improve non-vital function. Late procedures are performed following scar maturation, and are largely focused on aesthetic repair of non-functional area, such as the passive surface of the trunk or limbs. UpToDate has an excellent summary of plastics in the context of burns reconstruction for those wanting more information.

Perhaps most exciting is the role of cellular and materials engineering in burns reconstruction. Conventional plastics techniques are typically supplemented with synthetic skin substitutes (buzzword: ‘dermal regeneration templates’) that facilitate primary coverage of defects and provide a template for regeneration. Importantly, such materials are designed to encourage the production of dermal tissue, as opposed to scar tissue, as a means of reducing the scar load for the patient.

Professor Fiona Wood, ubiquitous among the Australian medical fraternity and hauling a list of postnomials and awards longer than her scalpel, has kindly articulated her experience of the patient with burns for Incision. As the current director of the Burns Service of Western Australia, Prof Wood occupies a unique crossroads between the surgical management of burns and novel technical innovations derived from basic science in cellular repair and regeneration.


Thanks for your time Dr Wood. Can you give us a brief overview of where you feel the plastic surgeon fits in treating a patient with burns?

Reconstruction needs to be considered from the time of injury with good pre-hospital care, first aid, resuscitation, and wound care, all focused on reducing the extent of the injury. The plastic surgeon is pivotal in leading the acute care including surgical intervention, with the aim to reduce the time to healing.

As a plastic and reconstructive surgeon, I have treated burn-injured patients my entire career with a clear understanding that every intervention from the point of injury will influence the scar worn for life. It is clear that regeneration, as opposed to repair by scarring, would be preferable but not technically possible as the injuries often overwhelm the capacity for regeneration. The plastic surgical techniques for wound closure are used both in the acute phase and long term to optimise the outcome post injury.

How has plastic surgery for burn reconstruction changed throughout your career?

With an aggressive approach to rapid wound closure, including cell-based therapies, the need for reconstruction post-healing has reduced in the last 30 years. Also, the technology has advanced in the last three decades with the use of tissue engineering in the form of dermal scaffolds and cell-based therapies. Laser techniques have improved as an adjunct scar management strategy. 

In your opinion, what is the most technically challenging aspect of burn reconstruction from a plastic surgeon's perspective?

The challenge remains the safe removal of the toxic load of the burnt tissue and the repair of extensive burns surface area. The burn drives an aggressive scar response which needs to be addressed and is an area of intense research. We now know that surviving a burn has an impact for life - understanding the mechanisms driving the aggressive inflammatory response offers an exciting opportunity to develop innovative therapies.

Finally, I would like to reiterate the point made by Prof Wood that ‘every intervention from the point of injury influences the scar worn for life’. This statement should form the cornerstone of every medical practitioner’s approach to the patient with burns, regardless of role or seniority. Whether pre-hospital, emergency, surgical, or rehabilitative, every individual involved in caring for the patient with severe burns will shape the long-term physical and psychological impact of a burn injury.

Thanks must go to Professor Fiona Wood for kindly giving up her time to answer questions regarding her experience of the patient with burns and the role of the plastic and reconstructive surgeon.


Nicholas Mattock is a 2nd Year Medical Student studying at UWA

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