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Burn Surgery

Burns is the damage or an injury generally caused by heat. It affects the largest organ of the body – “The skin”. It is one of the common household injuries. Burns can be minor medical problems or life-threatening emergencies. The majority of burn injuries are superficial and can be managed conservatively.

Burn injuries can occur due to

  • Flames/Fire Burns
  • Contact Burns – contact with hot Objects
  • Chemical Burns – contact with chemical agents like acid/alkali, and lye gasoline. Even concentered bathroom cleaners can cause these burns.
  • Cracker Burns – these are firecracker injuries that have both heat injury and wound due to the bursting nature of the crackers. Most commonly affects the face and hand. These types of injuries are common in children
  • Electrical Burns – caused by contact/passage of electricity through the body
  • Radiation Burns- These are burns caused by a high dose of radiation like X-rays

Burns if treated early and properly reduces the chance of infection, scarring, contractures, and deformities. These are generally managed by plastic surgeons, who have in-depth knowledge about the skin and the healing process. The presentation of a patient to the plastic surgeon can in the following scenario:

  • Acute Burns – immediately after burns
  • Post Burn Raw Area – initial treatment done elsewhere and presenting with the burn wound
  • Post-Burn Sequelae – Delayed presentation presenting with the complications of the burn injuries
    1. Unsightly scar
    2. Contractures of neck, hand & fingers
    3. Deformities

The prime parameters in the management of burn injuries are

  • The area affected by burns is represented as the percentage of the total body surface area
  • Depth of the burn injury
  • Type/ cause of Burn Injury
  • Regions involved in burns

Skin anatomy

Burn symptoms vary depending on how deep the skin damage is. Burn injuries are classified into 3 degrees based on the depth of the injury.

1st-degree burn
This superficial burn affects only the outer layer of the skin (epidermis). It causes redness and pain. This burn injury heals spontaneously. Medication usually will be required for pain.

2nd-degree burn
This type of burn affects both the epidermis and the second layer of skin (dermis). It may cause swelling and red, white, or splotchy skin. Blisters may develop, and pain can be severe. Deep second-degree burns might need surgery for skin cover. It will also cause scarring.

3rd-degree burn
This burn reaches the fat layer beneath the skin. Burned areas may be black, brown, or white. The skin may look leathery. Third-degree burns can destroy nerves, causing numbness. This will definitely require a cleaning procedure and skin cover if the defect is large.


Most minor burns can be treated at home. They usually heal within a couple of weeks.

To treat minor burns, follow these steps

  • Cool the burn
    Hold the burned area under cool (not cold) running water or apply a cool, wet compress until the pain eases. Don’t use ice. Putting ice directly on a burn will reduce blood supply and can cause further damage to the tissue. This will reduce the intensity of the burn and will not cause infection.
  • Remove rings or other tight items:Try to do this quickly and gently, before the burned area swells.
  • Don’t break blisters:
    Fluid-filled blisters protect against infection. If a blister breaks, clean the area with water. Apply an antibiotic ointment. Draining of the blisters will be done in certain cases, but needs to be done only by a specialist under aseptic precautions.
  • Apply lotion
    For superficial burns with redness of the skin, once a burn is completely cooled, apply a lotion, such as one that contains aloe vera or a moisturizer. This helps prevent drying and provides relief.
  • Pain reliever/ Analgesics:
    Paracetamol or ibuprofen can help relieve pain. don’t take these medications if you have a gastric ulcer/renal problem/allergy to these medications. Consult a doctor in such a scenario.
  • Take a tetanus shot:
    Make sure that your tetanus booster is up to date. It is recommended that people get a tetanus shot at least every 10 years. This protects the burn wound from the dreadful tetanus infection.
  • Breaking the blisters
  • Application of ink/coffee powder/tea powder/plant extracts/rice batter over the burn area. This will stain the area and will be difficult to assess the depth, also there is a high probability of infection
  • Apply cold water, especially in large burns. This will lead to hypothermia.

Consult the doctor if you experience:

  • Signs of infection, such as oozing from the wound, increased pain, redness, and swelling
  • A burn or blister that’s large or doesn’t heal in two weeks
  • New, unexplained symptoms
  • Significant scarring
  • Whether your burn was minor or serious, use sunscreen and moisturizer regularly once the wound is healed. This will prevent irritation and hyperpigmentation of the area.
  • Burns in the specific sites: that cover the hands, feet, face, groin, buttocks, a major joint, or a large area of the body
  • Deep burns, which means burns affecting all layers of the skin or even deeper tissues
  • Burns that cause the skin to look leathery
  • Burns that appear charred or have patches of black, brown, or white
  • Burns caused by chemicals or electricity
  • Difficulty breathing or burns to the airway
  • Burns happening in closed rooms associated with smoke

Take first-aid measures while waiting for emergency assistance.

People with severe burns may require treatment at specialized burn centers. They may need skin grafts to cover large wounds. And they may need emotional support and months of follow-up care, such as physical therapy.

For major burns, first aid and wound assessment are done initially. The goals of treatment are

  • Pain control – using oral/IV medications
  • Removal of dead tissue – Surgical cleaning under anaesthesia
  • Prevention of infection – Appropriate antibiotics wound dressing
  • Reduce the risk of scarring risk – early wound healing and scar care
  • Regain function – maintaining the proper position of the joints during wound healing and physiotherapy after wound healing

After you have received first aid for a major burn, your medical care may include medications and products that are intended to encourage healing.

  • Fluids to prevent dehydration:
    Burns more than 10- 15% may require intravenous fluid therapy especially when the patients are not able to take it orally or have facial burns. This maintains the blood volume and prevents dehydration and organ failure.
  • Pain and anxiety medications:
    Burns can be incredibly painful. You may need appropriate medications for pain, sleep, and anxiety medications.
  • Burn creams and ointments:
    Appropriate antibiotic/wound healing ointments are prescribed for open wounds. This helps to prevent infection and prepare the wound to close.
  • Dressings:
    We use various specialty wound dressings depending on the wound condition and prepare the wound to heal. Generally, nonadherent moist dressing added with appropriate ointments is done. Pain medications will be supplemented during dressing changes. The frequency of dressing change depends on the wound condition and as decided by the specialist.
  • Drugs that fight infection:
    In major burns, antibiotics are given to prevent and treat the infection. It will be administered orally or IV depending on the wound condition and the drug given.
  • Tetanus shot:
    It is recommended to have a tetanus injection after a burn injury.

If the burned area is large, especially if it covers any joints, you may need physical therapy exercises. These can help stretch the skin so that the joints can remain flexible. Other types of exercises can improve muscle strength and coordination. And occupational therapy may help if you have difficulty doing your normal daily activities.

You may need one or more of the following procedures:

  • Breathing assistance:
    If you’ve been burned on the face or neck, your throat may swell, and will have difficulty in breathing. If that appears likely, your doctor may insert a tube down your windpipe (trachea) to keep oxygen supplied to your lungs.
  • Feeding tube:
    Patients with burns need a lot of energy, micronutrients, and protein-rich foods for proper wound healing. People with extensive burns or who are undernourished need nutritional support. If oral intake is inadequate, then a feeding tube through your nose to your stomach to give the required calories and proteins.

  • Easing blood flow around the wound:

    If a burn scab (eschar) goes completely around a limb and finger, it can tighten and cut off the blood circulation. An eschar that goes completely around the chest can make it difficult to breathe. In such a situation, emergency escharotomy/fasciotomy will be done to release the tight scar and relieve this pressure.
  • Collagen application:
    This is a biological dressing that is applied to cover superficial burns. It is generally after 12- 24 hours after the burn injury. This is a temporary dressing that will peel off once the skin is formed underneath.
  • Skin grafts:
    A skin graft is a surgical procedure in which sections of your own healthy skin are used to cover the wound caused by deep burns. The donor area generally heals within 10-14 days. In large burns/patients in critical condition Donor skin from deceased donors can be used as a temporary solution.
  • Reconstructive procedures:
    These are plastic surgical (reconstruction) procedures that can improve the appearance of burn scars and increase the flexibility of joints affected by scarring. The different procedures are
    1. Wound debridement and skin cover
    2. Contracture release
    3. Scar reduction

Complications of deep or widespread burns can include:

  • Bacterial infection, which may lead to bloodstream infection (sepsis)
  • Fluid loss, including low blood volume (hypovolemia)
  • Dangerously low body temperature (hypothermia)
  • Breathing problems from the intake of hot air or smoke
  • Scars or ridged areas caused by an overgrowth of scar tissue (keloids)
  • Bone and joint problems, such as when scar tissue causes the shortening and tightening of skin, muscles, or tendons (contractures)

Household burns are a common reason for burns and the good news is the majority of them can be prevented if adequate caution is taken.

To reduce the risk of common household burns:

  • Never leave items cooking on the stove unattended
  • Turn pot handles toward the rear of the stove.
  • Don’t carry or hold a child while cooking at the stove.
  • Keep hot liquids out of the reach of children and pets.
  • Keep electrical appliances away from water.
  • Check the temperature of food before serving it to a child. Don’t heat a baby’s bottle in the microwave.
  • Never cook while wearing loose-fitting clothes that could catch fire over the stove.
  • If a small child is present, block his or her access to heat sources such as stoves, outdoor grills, fireplaces, and space heaters.
  • Before placing a child in a car seat, check for hot straps or buckles.
  • Unplug irons and similar devices when not in use. Store them out of reach of small children.
  • Cover unused electrical outlets with safety caps. Keep electrical cords and wires out of the way so that children can’t chew on them.
  • If you smoke, never smoke in bed
  • Be sure you have working smoke detectors on each floor of your home. Check them and change their batteries at least once a year
  • Keep a fire extinguisher on every floor of your house
  • When using chemicals, always wear protective eyewear and clothing
  • Keep chemicals, lighters, and matches out of the reach of children. Use safety latches. And don’t use lighters that look like toys.
  • Set your water heater’s thermostat to below 120 F (48.9 C) to prevent scalding. Test bath water before placing a child in it.

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