Burns & Plastic Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Classify burns based on depth and surface area.

2. Describe the pathophysiology of burn injuries.

3. Understand fluid resuscitation protocols for burn patients.

4. Identify key surgical interventions including grafts and flaps.

5. Recognize burn complications and their management.

 Key Glossary Terms

1. Burn

• Definition: Injury to skin or deeper tissues caused by heat, chemicals, electricity, or radiation.

• Clinical Relevance: Severity depends on depth, total body surface area (TBSA), and patient comorbidities.

2. Burn Depth Classification

3. Total Body Surface Area (TBSA)

• Rule of Nines: Adult: Head 9%, Each arm 9%, Each leg 18%, Anterior trunk 18%, Posterior trunk 18%, Perineum 1%.

• Lund-Browder Chart: More accurate for children.

4. Burn Shock & Fluid Resuscitation

• Definition: Hypovolemic shock due to fluid loss from damaged capillaries.

• Parkland Formula (Adult):

  • 4 mL × %TBSA × weight (kg) of Ringer’s Lactate in first 24 hrs

  • Half in first 8 hrs, remainder over next 16 hrs

• Monitoring: Urine output 0.5–1 mL/kg/hr (adults), vital signs, hematocrit

5. Burn Wound Care

• Debridement: Removal of necrotic tissue

• Dressing:

  • Silver sulfadiazine cream – antimicrobial for partial-thickness burns

  • Hydrocolloid dressings – promote moist healing

• Infection Prevention: Burns are prone to infection; strict asepsis is critical

6. Skin Grafts

• Definition: Transfer of skin to cover a burn or defect.

• Types:

  • Split-thickness graft: Epidermis + part dermis (common, donor site heals)

  • Full-thickness graft: Epidermis + dermis (more durable, limited donor sites)

• Clinical Relevance: Used for deep partial-thickness or full-thickness burns

7. Flaps

• Definition: Tissue moved from one site to another with its blood supply intact.

• Types:

  • Local flap: Adjacent tissue moved

  • Free flap: Tissue transferred microsurgically from distant site

• Clinical Relevance: Used when grafts are insufficient or for complex reconstructions

8. Complications of Burns

• Immediate: Hypovolemic shock, inhalation injury, electrolyte imbalance

• Early: Infection, sepsis, compartment syndrome

• Late: Contractures, hypertrophic scars, keloids, pigmentation changes

9. Plastic Surgery Principles

• Reconstruction: Restore form and function (e.g., burn contracture release)

• Aesthetic considerations: Minimize scarring, preserve mobility

• Microsurgery: Free flaps for complex tissue defects

10. Burn Mnemonics

• BURNS:

  • Bleeding/fluid loss

  • Ulceration/infection risk

  • Reconstructive needs

  • Nutrition & pain management

  • Scars & contractures

Tables

Table 1: Fluid Resuscitation in Burns (Parkland Formula)

Table 2: Burn Complications