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Burn Reconstruction

Canadian Burn Foundation

Burns are devastating injuries that have the potential to kill, maim, and cause great pain. Plastic surgeons are the primary care giving physicians for these injuries in Canada.

Inhalation injuries are the main cause of death in the burn injury. These usually occur when the patients are burned inside an enclosed space such as a burning home where a large amount of smoke is inhaled. Even with the best of care, the injury to the lungs is sometimes too great for the victim to survive.

The most common cause of burn injury in Canada is hot water from the tap. Many Canadians do not realize that their hot water taps should not be set higher than 120 F (49 C) to avoid burns. These burns tend to happen most commonly in young children and the elderly who have a hard time getting out of hot water in a bathtub quickly.

First and superficial second degree burns are partial thickness burns which may heal without skin grafting as there is still healthy skin at the bottom of the burn to heal the skin from the bottom up. Full thickness or 3rd degree burns and deep 2nd degree burns most often require surgery in the form of skin graft to restore skin coverage.

Patients who burn large parts of their body will often need more than one trip to the operating room for the plastic surgeon to remove the nonviable skin and replace it with skin grafts.

When people are burned across joints, the burns may heal by tightening the skin and restricting joint movement. This is called joint contracture. Joint contracture occurs quite frequently in poorer countries where skin grafting is not available. The girl in the photo above had a joint contracture of her neck and was not able to move her head side to side or up and down and was also unable to pull up her lower lip to close her mouth and smile. She was skin -grafted by Canadian plastic surgeons on a volunteer surgery mission and is seen one week later with fresh skin grafts able to move her head and close her mouth. Plastic surgeons are often called upon to provide reconstruction after burn injuries even when skin grafting is available and performed. Combinations of skin flaps and grafts are used to provide additional skin when it is required.

There are dedicated burn units with specialized nurses and plastic surgeons across Canada where this work is carried out.