Burn excision and grafting

Overview of Treatment

Burn debridement and skin grafting is a surgical procedure used for severe burns, primarily aimed at repairing damaged skin tissue and restoring the body's barrier function. This treatment combines tissue excision with autologous skin grafting techniques, suitable for patients with second- to third-degree burns. It effectively reduces the risk of infection and promotes wound healing. The goal of the treatment is to reconstruct the skin structure, improve appearance and function, and reduce long-term sequelae.

Types of Treatment and Mechanism

The treatment is divided into two stages: first, mandatory removal of necrotic tissue (excision), which clears damaged dermis and epidermis to prevent the spread of infection. The second stage involves skin grafting, where full-thickness or split-thickness skin is harvested from a healthy area of the patient (such as the thigh or back) and transplanted to the wound area. The grafted skin is anastomosed with surrounding blood vessels to form a permanent repair.

Indications

Main indications include:

Second-degree burns (dermal damage)
Third-degree burns (full-thickness skin necrosis)
Organ necrosis caused by chemical or electrical burns
Chronic non-healing burn ulcers

Usage and Dosage

The surgery requires general anesthesia and involves the following steps:

Debridement: removal of necrotic tissue using a surgical knife or electrocautery until healthy tissue is reached
Skin harvesting: obtaining a 0.3-1.2mm thick skin graft from the donor site (such as the thigh)
Graft fixation: suturing or bonding the skin graft onto the damaged area using biological glue

Benefits and Advantages

Main advantages include:

Rapid restoration of skin barrier function, reducing water loss
Significantly lowering complication risks such as cellulitis or gas gangrene
Improving long-term scar contracture issues
Enhancing sensation and motor function in the affected area

Risks and Side Effects

Serious risks: infection, graft rejection, hematoma, or graft failure. Common side effects include:

Short-term pain and swelling
Delayed wound healing at the donor site
Color mismatch or scar formation

Patients must strictly follow postoperative care instructions to reduce risks.

Precautions and Contraindications

Contraindications include:

Uncontrolled systemic infection
Coagulopathy
Severe cardiopulmonary insufficiency

Patients should discontinue anticoagulants before surgery and control blood glucose and blood pressure within normal ranges.

Interactions with Other Treatments

Must be combined with antibiotic therapy to prevent infection, and physical therapy of the graft area should be coordinated. Patients undergoing radiotherapy or chemotherapy need dose adjustments as these may affect wound healing.

Treatment Outcomes and Evidence

Clinical studies show that this treatment can increase the healing rate of deep burns to over 85%, with scar appearance improving by 40-60%. Long-term follow-up indicates an average 30% improvement in quality of life (QOL) scores for treated patients. However, the effectiveness is closely related to the burn area and overall health status of the patient.

Alternatives

Alternatives include:

Autologous skin substitutes (such as Integra) for temporary coverage
Micrograft skin transplantation techniques
Skin regeneration cell therapy

However, these methods may require multiple stages and may not provide as durable results as traditional grafting.

Frequently Asked Questions

What preparations are necessary before surgery to ensure smooth burn debridement and skin grafting procedures?

Patients need to undergo a full-body assessment including blood tests, cardiopulmonary evaluation, etc. Fasting for 6 to 8 hours before surgery is required, along with cleaning the injured area. The medical team will explain the procedure and obtain informed consent. If the patient has special conditions or is on medication, they should inform the doctor in advance to adjust medications accordingly.

Is it normal to experience itching or swelling at the skin graft site after surgery? How should it be handled?

Itching and mild swelling are usually natural responses of tissue repair and are normal. It can be alleviated with antihistamine ointments or oral antihistamines as advised by the doctor. Avoid scratching the graft site, and monitor daily for signs of redness, swelling, or pus indicating infection. Seek medical attention immediately if abnormalities are observed.

Can the grafted area contact water during recovery? What daily care precautions should be taken?

Initially, contact with water should be avoided; typically, waiting 7 to 10 days until the sutures are initially healed is recommended before gently exposing the area to water as per doctor’s instructions. Keep the graft area clean and dry, use non-irritating skincare products, and follow medical advice for dressing changes. Avoid excessive pulling or pressure on the damaged area.

What factors influence the success rate of burn debridement and skin grafting?

The success rate is closely related to the depth of the burn, infection control, overall health status, and postoperative care. The survival rate of grafts in second- to third-degree burns is about 70-90%. Conditions such as infection or chronic diseases like diabetes may reduce efficacy. Strict adherence to medical instructions can significantly improve treatment outcomes.

How long after treatment can normal activities be resumed? What actions should be avoided?

Light activities like walking can usually be gradually resumed around 2 weeks post-operation, but lifting heavy objects or vigorous exercise should be avoided for 6 to 8 weeks. Direct sun exposure on the graft area should be avoided to prevent uneven pigmentation. Patients should follow rehabilitation plans recommended by their doctor, as premature exertion may cause the graft to rupture and prolong recovery.