Functional and Aesthetic Reconstruction of Burned Patients

This timely source comprehensively examines the reconstructive issues faced in the treatment of burn survivors and thoroughly reviews key principles in the care of thermal, chemical, and electrical injuries -- clearly demonstrating new and effective techniques for the reconstruction and rehabilitation of burn patients. Emphasizing not only improved function, but also aesthetic restoration, this guide discusses challenges associated with burns of the head, neck, torso, and upper and lower extremities; and reconstruction of delicate parts of the skull, scalp, and face including the eyelids, ears, cheeks, lips, nose, and neck. Front cover......Page 1 Preface......Page 8 Contents......Page 10 Contributors......Page 14 I. INTRODUCTION......Page 18 A. Anatomy......Page 19 REFERENCES......Page 38 II. PATHOPHYSIOLOGY OF THE BURN WOUND......Page 40 III. REPARATIVE PROCESS OF WOUNDS......Page 42 A. Inflammatory Phase......Page 43 B. Proliferative Phase......Page 48 C. Maturational and Remodeling Phase......Page 50 D. Factors Affecting Wound Healing......Page 52 REFERENCES......Page 55 II. BURN MORTALITY......Page 60 A. Initial Wound Care......Page 61 C. Escharotomies......Page 62 D. Initial Wound Assessment......Page 64 IV. INITIAL WOUND MANAGEMENT AND OPERATIVE PLANNING......Page 65 V. SPECIAL AREAS......Page 69 A. Integra......Page 71 VII. METABOLISM AND WOUND HEALING ADJUNCTS......Page 72 IX. CONCLUSIONS......Page 73 REFERENCES......Page 74 I. INTRODUCTION......Page 76 III. ACUTE CARE......Page 77 V. WOUND CARE......Page 78 C. Injuries to the Torso......Page 81 REFERENCES......Page 83 I. INTRODUCTION......Page 86 III. CASE 2: HYDROFLUORIC ACID BURN TO THE FINGERS......Page 87 IV. CASE 3: ASSAULT TO THE PENIS BY ACID......Page 88 V. CASE 4: ASSAULT TO THE FACE WITH AN UNKNOWN CHEMICAL......Page 89 REFERENCES......Page 92 I. INTRODUCTION......Page 94 III. RECONSTRUCTION OF FACIAL BURNS......Page 96 V. RECONSTRUCTION OF EXTREMITY BURNS......Page 99 VII. SUMMARY......Page 100 REFERENCES......Page 101 I. INTRODUCTION......Page 102 A. Airway Evaluation......Page 103 B. Pulmonary Evaluation......Page 105 III. MANAGEMENT OF ANESTHESIA......Page 106 A. Preoperative Preparation......Page 107 B. Airway Management......Page 109 D. Pharmacologic Considerations in Patients Undergoing Burn Reconstruction......Page 112 F. The Biology of Nausea and Vomiting......Page 113 G. Antiemetic Agents......Page 114 I. Postoperative Analgesia......Page 115 REFERENCES......Page 117 I. HISTORY A. Autografts......Page 122 C. Skin Grafts......Page 123 II. HARVESTING A. Free-Hand Harvesting......Page 124 A. Revascularization......Page 125 IV. GRAFT FAILURE......Page 126 REFERENCES......Page 127 I. OBJECTIVES OF SKIN SUBSTITUTES......Page 130 II. REQUIREMENTS A. Anatomic and Physiologic......Page 132 A. Components......Page 133 B. Process......Page 134 A. Surgical Considerations......Page 135 C. Assessment......Page 136 V. REGULATORY ISSUES......Page 137 VII. FUTURE DIRECTIONS......Page 138 B. In Vitro Angiogenesis......Page 139 REFERENCES......Page 140 I. INTRODUCTION......Page 146 II. PATHOLOGY OF BURN WOUNDS......Page 147 III. PREOPERATIVE EVALUATION......Page 148 A. Functional Considerations......Page 149 B. Aesthetic Considerations......Page 151 VII. TIMING OF MICROSURGICAL RECONSTRUCTION......Page 152 X. INTRAOPERATIVE CONSIDERATIONS IN FREE-FLAP RECONSTRUCTION......Page 153 XIII. CONCLUSION......Page 154 REFERENCES......Page 155 I. INTRODUCTION......Page 158 B. Dermis......Page 159 A. Incisions: Paralesional or Remote......Page 160 D. Rate of Expansion......Page 161 E. Techniques in Tissue Expansion......Page 162 A. Burn Alopecia......Page 163 B. Face and Neck......Page 164 C. Breasts......Page 165 E. Upper Extremities......Page 166 F. Lower Extremities......Page 167 V. COMPLICATIONS OF TISSUE EXPANSION......Page 168 VI. CONCLUSIONS......Page 170 REFERENCES......Page 171 I. INTRODUCTION......Page 174 IV. TREATMENT A. Hyperpigmentation Following Superficial Burns......Page 176 B. Nonsurgical Methods......Page 177 V. SURGICAL THERAPY A. Primary Excision......Page 182 C. Treatment of Hypopigmentation Changes......Page 183 VI. SURGICAL TREATMENT......Page 184 A. Grafts......Page 185 VII. TREATMENT OF IMMATURE HYPERTROPHIC RED SCARS......Page 186 REFERENCES......Page 187 I. INTRODUCTION......Page 190 II. PATHOGENESIS OF HYPERTROPHIC SCAR, KELOIDS, AND CONTRACTURES A. Histopathology and Ultrastructure......Page 191 B. Macromolecular Composition of the Extracellular Matrix......Page 193 B. Fibroblast Proliferation and the Possible Failure of Apoptosis......Page 195 IV. WOUND CONTRACTION FOLLOWING THERMAL INJURY......Page 196 V. FIBROGENIC CYTOKINES......Page 197 C. Insulin-Like Growth Factor-1......Page 198 E. The Role of the Th1/Th2 Paradigm After Burn Injury......Page 199 A. Prevention of Dermal Fibroproliferative Disorders......Page 200 B. Conservative Therapy for Keloids, Hypertrophic Scar, and Contractures......Page 201 C. Intralesional Corticosteriods......Page 202 D. Surgical Therapy......Page 203 F. Laser Therapy of HSc and Keloids......Page 204 VII. NEW PHARMACOTHERAPIES FOR HYPERTROPHIC SCARRING A. Antifibrotic Factors: IFN-alpha2b and IFN-gamma......Page 205 C. Modulators of Fibroblast-Mediated ECM Metabolism......Page 207 REFERENCES......Page 208 I. INTRODUCTION......Page 216 A. Argon Laser......Page 217 C. Copper Vapor and Copper Bromide Lasers......Page 218 F. V-Beam PDL System......Page 219 REFERENCES......Page 220 I. INTRODUCTION......Page 222 II. ACUTE TRAUMA: OPERATIVE VS. CONSERVATIVE THERAPY AND PREVENTION OF SECONDARY DEFORMITIES A. Principles and Other Considerations......Page 223 B. Scalp......Page 224 D. Ears......Page 225 E. Eyelids and Eyebrows......Page 226 G. Lips and Mouth......Page 227 I. Prevention of Secondary Problems......Page 228 B. Aesthetic Reconstruction......Page 229 C. Decision Making......Page 230 E. Compression Therapy......Page 231 F. Artificial Skin Coverage......Page 232 REFERENCES......Page 233 I. INTRODUCTION......Page 234 A. Scalp Burns without Bony Involvement......Page 235 B. Scalp Burns with Involvement of the Skull......Page 238 REFERENCES......Page 242 II. HISTORICAL PERSPECTIVE......Page 244 III. ANATOMICAL PERSPECTIVES......Page 245 B. Types of Skull Wounds......Page 246 D. Treatment Modalities......Page 247 REFERENCES......Page 249 I. ROLE OF MICROGRAFTS AND MINIGRAFTS IN BURN RECONSTRUCTION......Page 250 A. Technique......Page 252 II. CASE 1......Page 254 III. CASE 2......Page 255 IV. CASE 3......Page 256 REFERENCES......Page 257 I. INTRODUCTION......Page 258 A. Eyelid Margin......Page 259 B. Special Considerations in Eyelid Burn Management......Page 262 C. Acute Management and Early Reconstruction......Page 277 REFERENCES......Page 283 I. INTRODUCTION......Page 286 II. ANATOMY......Page 287 IV. RECONSTRUCTION A. Skin Grafts......Page 294 C. Tissue Expansion......Page 296 D. Free-Tissue Transfer......Page 300 REFERENCES......Page 301 I. INTRODUCTION A. Historical Perspective......Page 304 III. CURRENT CONCEPTS IN THE ACUTE CARE OF THE BURNED NOSE......Page 305 IV. GENERAL CONCEPTS OF NASAL RECONSTRUCTION......Page 306 V. CLASSIFICATION OF POSTBURN NASAL DEFORMITY......Page 308 VI. RECONSTRUCTIVE OPTIONS......Page 309 A. Nasal Prosthesis......Page 313 VII. POSTBURN NASAL RECONSTRUCTION IN THE PEDIATRIC PATIENT......Page 315 REFERENCES......Page 316 I. INTRODUCTION......Page 318 A. Ears......Page 319 B. Facial Burns......Page 321 B. Full-Thickness Burns......Page 322 C. Acute Problems with Ear Burns......Page 323 A. Hypertrophic Scars and Keloids......Page 324 B. The Constricted/Contracted Ear......Page 325 C. Helical Rim Defects......Page 326 D. Partial Ear Defects......Page 327 E. Implants......Page 330 IV. CONCLUSION......Page 332 REFERENCES......Page 333 B. Surface Anatomy......Page 336 C. Functional Anatomy......Page 338 D. Function......Page 339 F. Reconstruction......Page 340 II. COMMISSURE INJURIES A. Electrical Burns......Page 342 C. Surgical Techniques......Page 345 REFERENCES......Page 346 I. INTRODUCTION......Page 348 II. ANATOMY A. Muscular Anatomy of Lip and Chin......Page 349 B. Surface Anatomy of the Lip and Chin......Page 350 III. ACUTE FACIAL BURNS......Page 351 B. Chin......Page 352 V. RECONSTRUCTION A. Lower Lip Reconstruction......Page 354 B. Chin Reconstruction......Page 355 VI. CONCLUSION......Page 359 REFERENCES......Page 362 II. ACUTE CARE......Page 364 III. NORMAL NECK CONTOUR......Page 365 B. Grade II Contractures......Page 366 D. Grade IV Contractures......Page 367 VI. FLAPS......Page 368 VII. MICROVASCULAR FREE-TISSUE TRANSFER......Page 372 REFERENCES......Page 373 I. INTRODUCTION......Page 376 II. PREOPERATIVE EVALUATION......Page 377 III. SURGICAL OPTIONS......Page 378 IV. INTRAOPERATIVE CONSIDERATIONS......Page 379 V. PITFALLS......Page 381 IX. CONCLUSION......Page 382 REFERENCES......Page 383 II. PREOPERATIVE EVALUATION......Page 384 A. Local Flaps......Page 385 B. Fasciocutaneous Flaps......Page 388 C. Muscle and Myocutaneous Flaps......Page 390 E. Tissue Expansion......Page 391 V. PITFALLS......Page 392 VI. NURSING ISSUES......Page 393 REFERENCES......Page 394 II. INCIDENCE......Page 396 A. Reconstruction of the Burned Breast Mound......Page 398 B. Reconstruction of the Nipple–Areola Complex......Page 404 REFERENCES......Page 407 II. PREOPERATIVE EVALUATION......Page 410 III. SURGICAL OPTIONS......Page 411 IV. INTRAOPERATIVE CONSIDERATIONS......Page 424 VI. NURSING ISSUES......Page 425 REFERENCES......Page 426 I. INTRODUCTION......Page 428 III. SURGICAL OPTIONS......Page 430 V. PITFALLS......Page 431 VII. REHABILITATION ISSUES......Page 432 REFERENCES......Page 433 II. ACUTE CARE......Page 434 III. RECONSTRUCTION......Page 436 REFERENCES......Page 440 II. PREOPERATIVE EVALUATION......Page 442 III. SURGICAL OPTIONS......Page 443 C. Techniques of Excision and Grafting......Page 444 D. Techniques to Salvage Length with Fourth-Degree Injury......Page 445 V. PITFALLS......Page 446 VI. NURSING CONSIDERATIONS......Page 449 VII. REHABILITATION ISSUES......Page 450 REFERENCES......Page 451 I. INTRODUCTION......Page 454 III. SKIN SUBSTITUTES......Page 455 A. Integra......Page 456 A. Soft Tissue Deformities......Page 458 B. Joint Deformities......Page 467 C. Amputations......Page 471 V. ELECTRICAL BURNS......Page 472 A. Initial Management......Page 473 B. Outcome......Page 474 C. Reconstruction......Page 475 VI. CONCLUSION......Page 476 REFERENCES......Page 477 I. INTRODUCTION......Page 480 II. HISTORY......Page 481 V. OVERVIEW OF TECHNIQUE......Page 482 D. Specific Digits......Page 483 VIII. TECHNIQUE A. Preparation......Page 484 C. Surgery......Page 485 D. Postoperative Care/Lengthening......Page 486 X. REHABILITATION AND OCCUPATIONAL THERAPY......Page 487 XIII. ADVANTAGES......Page 488 B. Alternate Procedures for Shortened Digits......Page 489 REFERENCES......Page 490 I. INTRODUCTION......Page 492 III. PATHOPHYSIOLOGY OF THE BURNED HAND......Page 493 VI. EVALUATION BEFORE MICROSURGICAL RECONSTRUCTION......Page 494 IX. MICROSURGICAL FREE TISSUE TRANSFER FOR RESURFACING......Page 495 X. MICROSURGICAL TOE TRANSFER FOR DIGIT RECONSTRUCTION A. Toe Dissection......Page 496 B. Recipient Site Preparation......Page 497 C. Completion of Toe Transfer......Page 498 D. Functional and Aesthetic Modifications in Toe Transfers......Page 499 E. Distal Digit Reconstruction with Various Tissues from the Foot......Page 500 F. Thumb Reconstruction......Page 501 XII. REHABILITATION......Page 502 C. Donor Site......Page 503 REFERENCES......Page 504 36 Rehabilitation of the Burned Hand......Page 506 A. Evaluation of the Burned Hand......Page 507 II. EDEMA MANAGEMENT......Page 508 III. ANATOMY......Page 511 IV. ORTHOTICS......Page 513 A. Static Splints for the Burned Hand......Page 514 B. Dynamic Splints for the Burned Hand......Page 520 C. Serial Casts......Page 522 E. Active Range of Motion......Page 524 G. Prolonged Stretch......Page 526 I. Scar Management of the Burned Hand......Page 527 J. Physical Agent Modalities Utilized in Burn Hand Scar Management......Page 530 V. CAPSULOTOMY......Page 531 REFERENCES......Page 532 B. Special Considerations in Acute Care......Page 538 II. RECONSTRUCTION OF THE BURNED LOWER EXTREMITY......Page 540 A. Early Reconstruction......Page 541 B. Late Reconstruction......Page 546 REFERENCES......Page 559 I. INTRODUCTION......Page 566 II. ANATOMY OF THE FOOT......Page 567 III. CLASSIFICATION OF BURN SCAR CONTRACTURES A. Dorsal Burn Scar Contractures......Page 568 B. Plantar Surface Burn Scar Contractures......Page 569 C. Joint Deformity......Page 570 B. Surgical......Page 572 V. PHYSIOTHERAPY AND SPLINTING......Page 574 VI. PITFALLS......Page 576 X. CONCLUSION......Page 577 REFERENCES......Page 578 II. ACUTE MANAGEMENT OF FOOT BURNS......Page 580 A. Scarring and Deformities......Page 581 C. Treatment Options......Page 582 D. Ilizarov External Fixator......Page 583 G. Post Surgery Care Following Placement of External Fixator......Page 584 H. Post-Ilizarov Care......Page 585 I. Follow-up Results......Page 586 REFERENCES......Page 587 Index......Page 588 About the Editor......Page 598 Back cover......Page 603

This timely source comprehensively examines the reconstructive issues faced in the treatment of burn survivors and thoroughly reviews key principles in the care of thermal, chemical, and electrical injuries — clearly demonstrating new and effective techniques for the reconstruction and rehabilitation of burn patients.

Doody Review Services

Reviewer:Jeffrey S. Rosenthal, MD(Bridgeport Hospital)
Description:Burn reconstruction requires a team effort to mend severely injured individuals. Dr. McCauley and his contributors offer the reader the information necessary to accomplish the Herculean task of rehabilitating a burn patient.
Purpose:The author wishes to address the reconstructive problems associated with burn treatment by reviewing the pertinent anatomy and the reconstructive ladder of techniques available for this purpose. What should be in the forefront of the clinician's mind is that a functioning human requires more than salvage to produce salvation. The process of rehabilitation must consider the final aesthetic results to enable re-entry into society as a functioning and productive human being.
Audience:The author is from a premier burn center and his writing associates have been chosen for their expertise in selective areas of burn reconstruction. Residents in plastic and general surgery, medical students who wish to obtain a better insight, and physicians who routinely treat or wish to treat the burn injured will benefit from this book.
Features:The task of assembling a single book on burn care is daunting and will become more so as the field continues to expand commensurate with the enormous amount of information available. Thus, this book cannot stand alone but is a resource. The 39 chapters present an overall review of the principles of burn care, followed by a systematic approach to the problems and treatment of burns of the face, head, neck, body, and extremities. Black-and-white photos of the burn patients and subsequent reconstructive endeavors adorn many of the chapters, allowing the reader a visual connection to the written word. Issues centered upon whether to close a burn with a graft or take advantage of a flap technique are discussed along with the pertinent historical background, surgical techniques, and plans to optimize the end aesthetic appearance of each patient. Each chapter commences with a clear-cut truncated index to allow the reader a glimpse of the topics to come.
Assessment:The treatment of burn patients requires the restoration of the physical attributes that we associate with being and looking human. Dr. McCauley's book goes a long way toward supplying the reader with this information.

This timely source addresses the reconstructive issues encountered in burn survivors by reviewing principles of wound healing, treatment strategies, and new and effective techniques for reconstruction and rehabilitation. Surgical and nonsurgical methods for the optimization of appearance and function are also covered. Short Contents