Burn Surgery and Skin Grafting

Burn surgery is performed for deep partial-thickness (deep dermal) and full-thickness burns that will not heal spontaneously within 3 weeks. Early excision (within 3-7 days) followed by autografting reduces sepsis, length of stay, and mortality compared with conservative management. The choice between tangential and fascial excision depends on burn depth, location, and patient stability.

Tangential excision uses Watson, Goulian, or Versajet hydrosurgery to remove necrotic tissue layer-by-layer until viable bleeding tissue is reached. Hemostasis with topical thrombin, epinephrine compresses, and electrocautery is critical to reduce blood loss. Temporary cover with biologic dressings (xenograft, allograft) or synthetic substitutes (Biobrane, Suprathel) is used when immediate autografting is not feasible.

Autologous split-thickness skin grafts (0.012-0.018 inch) harvested from thigh, buttock, or scalp are meshed at 1:1.5 to 1:6 ratio depending on coverage area. Sheet grafts are preferred for face, hands, and joints. Dermal substitutes (Integra, Matriderm, Alloderm) are layered for full-thickness defects requiring durable cover. Postoperative care includes compression dressings, splinting, early mobilization, and intensive scar management with silicone sheets, pressure garments, and laser therapy. Burn rehabilitation continues for 12-18 months.