The Role of Plastic Surgery in Burn Management and Scar Revision

Burn injuries are among the most traumatic medical conditions, often causing severe pain, physical deformities, and long-term psychological distress. In Nigeria, thousands of people suffer burns every year due to fire accidents, gas explosions, chemical exposure, and electrical injuries. Unfortunately, many of these victims are left with disfiguring scars, contractures (tightened skin that restricts movement), and emotional trauma.

Plastic surgery plays a critical role in the treatment, reconstruction, and rehabilitation of burn patients. From emergency burn wound care to scar revision and reconstructive surgery, plastic surgeons help burn survivors restore their appearance, regain function, and improve their quality of life.

This article explores how plastic surgery aids in burn management, the various reconstructive techniques available, and how Nigeria can improve access to specialized burn treatment.

UNDERSTANDING BURNS AND THEIR SEVERITY

Burns are classified based on their depth and severity:

1. First-Degree Burns (Superficial Burns)

• Affect only the outer layer (epidermis).
• Cause redness, swelling, and mild pain.
• Heal naturally within a few days without scarring.
• Example: Sunburns and minor scald injuries.

2. Second-Degree Burns (Partial-Thickness Burns)

• Damage both the epidermis and the deeper dermis.
• Cause blisters, severe pain, and swelling.
• May take weeks to heal and can leave scars if not treated properly.
• Example: Severe hot water burns, chemical burns.

3. Third-Degree Burns (Full-Thickness Burns)

• Destroy all skin layers and may affect underlying tissues, muscles, or bones.
• Cause severe pain or numbness (if nerve endings are destroyed).
• Require skin grafting and reconstructive surgery for healing.
• Example: Fire burns, severe chemical exposure, electrical burns.

THE ROLE OF PLASTIC SURGERY IN BURN MANAGEMENT

Plastic surgeons are essential in treating severe burns, especially when injuries cause functional loss or significant scarring. The main objectives of plastic surgery in burn management include:

✔ Saving the skin and preventing infection
✔ Restoring movement and function
✔ Minimizing long-term scarring and disfigurement
✔ Helping patients regain confidence and psychological well-being

1. Emergency Burn Treatment: Saving the Skin

In the acute phase (first few days after the burn injury), plastic surgeons work with emergency teams to:

• Remove dead tissue (debridement) to prevent infections.
• Apply skin grafts or temporary coverings to protect exposed wounds.
• Prevent severe fluid loss and maintain skin hydration.

2. Skin Grafting: Rebuilding Lost Skin

For patients with deep burns, the damaged skin cannot regenerate on its own. Plastic surgeons perform skin grafting, where healthy skin is taken from another part of the body and transplanted onto the burned area.

There are two main types of skin grafts:

• Autograft: Uses the patient’s own skin (preferred for permanent coverage).
• Allograft: Uses donor skin or artificial skin substitutes (used temporarily in large burns).

3. Reconstructive Surgery for Severe Burn Deformities

After initial wound healing, burn survivors may experience:

• Contractures (tightening of the skin that limits movement).
• Facial or hand deformities.
• Uneven or disfiguring scars.

Plastic surgeons perform reconstructive procedures such as tissue expansion and flap surgery to restore both appearance and function.

SCAR REVISION SURGERY: IMPROVING APPEARANCE AND FUNCTION

Scarring is one of the most challenging consequences of burn injuries. Even after healing, some patients struggle with raised, thick, or discolored scars that affect self-esteem.

Plastic surgeons use various scar revision techniques to soften, flatten, or remove scars and improve skin flexibility.

1. Laser Therapy for Burn Scars

• Reduces redness and discoloration.
• Stimulates collagen production to smooth the skin.
• Works well for hyperpigmented or raised scars.

2. Steroid Injections and Silicone Sheets

• Help flatten keloids and hypertrophic scars.
• Reduce itching and discomfort in burn scars.

3. Surgical Scar Revision

• Involves removing thick scars and repositioning the skin for a smoother appearance.
• Often used for contracture scars that restrict movement.

4. Fat Grafting for Scar Softening

• Uses fat cells from another part of the body to improve scar texture and volume loss.
• Beneficial for deep burn scars that cause skin indentations.

THE PSYCHOLOGICAL IMPACT OF BURN INJURIES AND THE IMPORTANCE OF RECONSTRUCTION

Beyond physical pain, burn survivors often face emotional trauma, anxiety, and depression due to their altered appearance. Social stigma, self-consciousness, and loss of confidence are common.

Plastic surgery plays a critical role in restoring not just the body but also emotional well-being. By improving scars and deformities, reconstructive surgery helps patients regain their self-esteem and reintegrate into society.

THE CHALLENGES OF BURN TREATMENT IN NIGERIA

Despite advancements in plastic surgery, burn care in Nigeria faces serious challenges:

1. Limited Access to Specialized Burn Centers

• Many hospitals lack fully equipped burn units with intensive care facilities.
• Patients often travel long distances to major cities for specialized treatment.

2. High Treatment Costs

• Burn treatment, especially skin grafting and laser therapy, can be expensive.
• Many patients cannot afford the necessary reconstructive procedures.

3. Shortage of Trained Burn Surgeons

• Nigeria has few specialized plastic and burn surgeons compared to the number of burn patients.
• More training programs and government support are needed.

4. Lack of Public Awareness

• Many burn victims do not seek medical treatment early, leading to severe complications.
• Some rely on traditional remedies that can worsen the condition.

THE WAY FORWARD: IMPROVING BURN CARE IN NIGERIA

To enhance burn management and scar treatment in Nigeria, stakeholders must take urgent action:

✔ Establish more specialized burn treatment centers across Nigeria.
✔ Provide government-subsidized reconstructive surgery for burn survivors.
✔ Increase training programs for plastic and reconstructive surgeons.
✔ Launch public education campaigns on fire safety and first-aid burn treatment.

CONCLUSION

Burn injuries are devastating, but plastic surgery offers hope for recovery and a better quality of life. Through skin grafting, reconstructive procedures, and advanced scar treatments, burn survivors can regain both function and confidence.

However, Nigeria must invest more in specialized burn treatment centers, training programs, and affordable reconstructive care to ensure all burn victims receive the help they need.

No one should have to live with disfigurement and pain when modern plastic surgery can restore their dignity and well-being.

Dr. Aranmolate Rasheed Ayobami is a board-certified plastic surgeon and the founder of Grandville Medical & Laser. For consultations, visit www.gml.com.ng or visit any of our branches:

• Lekki: Plot 106 Taju Okoya Close, Eleganza Garden Estate, Opposite VGC, Lekki, Lagos. Tel: 0817 153 0599.
• Surulere: 76 Femi Ayantuga Street, Surulere, Lagos. Tel: 0816 454 8279, 0812 020 8868.
• Abuja: 5b Lephalala Close, Off Ganges, Maitama. Tel: 0817 323 3025.