Burn surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]


Surgical procedures

Depend of the patient conditions in the burn, You may need one or more of the following procedures as ABC management: [1]

Debridement:[2] The term ''Debridement'' is not only a surgical procedure. Debridement can be performed by surgical, chemical, mechanical, or autolytic procedures. Surgical modalities including early tangential excision (necrectomy) of the burned tissue and early wound closure primarily by skin grafts has led to significant improvement in mortality rates and substantially lower costs in these patients [25,26]. Furthermore, in some circumstances, escharotomy or even fasciotomy should be performed.

Indications of surgical debridement: Dermal substitutes or matrices can be used if a large burn area exists. Here are some examples: Note that in many occasions, an immediate coverage of wounds cannot be achieved. In this case, a temporary coverage is favoured. After stabilization of patient and wound bed, a planned reconstruction takes place to close wounds permanently. In this point, some methods can be performed including:

1. Deep second degree burns.

2. Burns of any type, that are heavily contaminated

3. Third degree circumferential burns with suspected compartment syndrome (think of: Escharotomy)

4. Circumferential burns around the wrist (think of: Carpal tunnel release).

Benefits of surgical debridement:

1. To reduce the amount of necrotic tissue (beneficial for prognosis)

2. To get a sample for diagnostic purposes (if needed).

Complications of debridement:

1. Pain.

2. Bleeding.

3. Infection.

4. Risk of removal of healthy tissue.


1. Low body core temperature below 34°C.

2. Cardiovascular and respiratory system instability.

Any trainee should be aware of the following terms:

Tangential excision: Tangential excision of the superficial (burned) parts of the skin

Epifascial excision: This technique is reserved for burns extending at least to the subcuticular level.

Subfascial excision: indicated when burns extend very deep and reach the fascia and muscles. It is needed only in special cases.

Escharotomy: Indicated for third-degree and second degree deep dermal circumferential burns. This is used to prevent a soft tissue compartment syndrome, due to swelling after deep burn. An escharotomy is performed by making an incision through the eschar to expose the fatty tissue below.

Note that escharotomy lines on the thumb and little finger, as an international standard, should be always performed on the radial side and not on the ulnar side. Escharotomy incisions for the index finger, middle finger and ring finger are performed along the ulnar side.


  1. "Burns - Diagnosis and treatment - Mayo Clinic".
  2. "Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form".
  3. Kahn, Steven Alexander; Beers, Ryan J.; Lentz, Christopher W. (2011). "Use of Acellular Dermal Replacement in Reconstruction of Nonhealing Lower Extremity Wounds". Journal of Burn Care & Research. 32 (1): 124–128. doi:10.1097/BCR.0b013e318204b327. ISSN 1559-047X.
  4. . doi:10.1016/j. Missing or empty |title= (help)
  5. Ryssel H, Gazyakan E, Germann G, Ohlbauer M (2008). "The use of MatriDerm in early excision and simultaneous autologous skin grafting in burns--a pilot study". Burns. 34 (1): 93–7. doi:10.1016/j.burns.2007.01.018. PMID 17644263.

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