Before Surgery Evaluation:

• Assessment:

  • Physical Exam: Evaluates scar maturity (stable vs. immature), contracture severity, range of motion (ROM), and extent of tissue loss.

  • Functional Tests: Assesses joint mobility, hand function, or eyelid closure (e.g., 30–40% of cases involve restricted joint movement).

  • Blood Tests: Blood sugar, clotting profile, infection screening (e.g., for chronic wounds).

  • Photos: For surgical planning and post-op comparison.

• Planning: Often requires multiple stages (2–5 surgeries over months/years) based on burn severity; prioritizes function (e.g., hand mobility) before aesthetics (e.g., facial scarring).

• Preparation: Stop smoking (increases graft failure risk by 20–30%) and blood thinners (e.g., aspirin) 5–7 days prior if safe; fasting 6–8 hours for general anesthesia. Consent includes risks like graft failure or recurrence.

• Multidisciplinary Team: Involves plastic surgeon, anesthesiologist, physiotherapist (post-op), and sometimes a psychologist (for trauma or body image concerns).

Surgical Techniques:

1. Burn Reconstruction:

   • Performed under general anesthesia, lasting 1–4 hours per stage.

   • Techniques:

     • Contracture Release: Incisions (e.g., Z-plasty, Y-V plasty) to release tight scars, increasing mobility (50–60% of cases); often combined with grafting.

     • Skin Grafting:

       • Split-thickness grafts (thin layer from thigh/buttock): Covers large defects after scar excision (30–40%).

       • Full-thickness grafts (thicker, from groin/abdomen): For smaller, high-mobility areas (e.g., hands, face; 10–20%).

     • Flap Surgery:

       • Local flaps (e.g., advancement flap): Uses nearby healthy tissue (20–30%).

       • Pedicled or free flaps: Transfers tissue with blood supply (e.g., for deep defects or facial reconstruction, 10–15%).

     • Tissue Expansion: Expander placed under healthy skin near scar; inflated over 6–12 weeks to stretch skin, then used to cover defect (5–10%, e.g., scalp burns).

     • Feature Reconstruction: Ear reconstruction (cartilage grafts), eyebrow restoration (hair transplant), or nasal reconstruction (flaps/grafts; 5–10% of cases).

   • Closure: Sutures secure grafts/flaps; vacuum-assisted closure (VAC) dressings may be used to promote graft take.

2. Adjunct Therapies:

   • Fat grafting: Improves contour and scar texture (5–10% of cases).

   • Laser therapy (post-op): Fractional CO2 or pulsed dye laser to reduce scar thickness (₱20,000–₱50,000/session).

3. Intraoperative Tools:

   • Dermatome: Harvests skin grafts with precision.

   • Microsurgery instruments: For free flap transfer (e.g., anastomosis of blood vessels).

   • Doppler ultrasound: Confirms flap blood supply.

   • Laser: Intraoperative scar revision or tissue ablation.

After Surgery:

• Hospital Stay: 2–7 days (shorter for simple releases, longer for flaps or extensive grafts).

• Care:

  • Splints or casts to maintain joint position (e.g., neck extension, finger separation) for 1–2 weeks.

  • Pressure garments (custom-fitted) for 6–12 months to reduce hypertrophic scarring (₱10,000–₱20,000).

  • Pain management with oral analgesics (e.g., ibuprofen, tramadol) for 3–7 days.

  • Dressings changed every 3–5 days to monitor graft take (90–95% success with proper care).

• Instructions: Avoid tension on grafts/flaps (e.g., no stretching or heavy lifting); start physiotherapy 1–2 weeks post-op to restore movement; keep surgical site dry.