About the Burn Reconstruction Program
There are two main categories of burn surgery: acute burn management and secondary burn reconstruction. Acute burn management begins immediately after an injury. A team of trauma surgeons who specialize in acute burn care perform this type of surgery. The Burn Reconstruction Program at Children’s Hospital Colorado focuses on secondary reconstructive burn surgery. This type of surgery improves the function and appearance of burn scars.
Acute burns must be fully healed before starting secondary burn reconstruction. Burn scars and burn scar contractures (tight scar bands) can appear months to years after a burn injury.
Young patients typically have an easier time healing than adults, but the scars tend to become an issue during a growth spurt, when a burn scar does not stretch and grow like the skin around it. Older children may complain about how a burn scar feels or looks, or that scars make it hard to do some activities. Burn scar reconstruction surgery can improve kids’ appearance, confidence and quality of life.
Tight scar bands called contractures can prevent or limit joint movement in the neck, shoulders, arms, hands, legs and feet. Releasing contractures with surgery can restore movement, especially when burn scars are thick, wide or discolored.
This type of surgery can also help with facial scarring that causes problems with the eyelids, lips or nose, or causes hair loss. Surgery can’t remove burn scars, but it can help improve basic functions and make scars less noticeable.
Your child’s doctor may also recommend nonoperative treatments, either by themselves or together with surgical burn reconstruction. Nonoperative treatments include steroid injections, serial casting or splinting, and certain types of laser treatments.
Conditions we treat at the Burn Reconstruction Program
Burns that involve damage to the deep layer of skin, the dermis, usually heal with a scar. Scar tissue is usually firmer and has less stretch than normal tissue.
Sometimes the scarred skin extends past the boundary of the original burn injury, creating a raised (hypertrophic) scar. Hypertrophic scarring leads to wound contracture, which can be a problem if the scar affects a joint.
Scar tissue over a joint is firmer and harder to stretch than normal skin and restricts joint movement. Over time, scar tissue can reduce range of motion around the joint. Skin contractures can also cause pain and disrupt daily activities.
Some of the most common conditions we treat in the Burn Reconstruction Program include:
- Hypertrophic (raised) burn scar
- Burn scar contractures that limit joint mobility or impact normal function
- Burn scars causing webbing
- Unstable burn scars
- Hair loss from burns
Techniques and types of treatment we use at the Burn Reconstruction Program
The operative techniques we use depend on the type and location of the scarring. We use a wide variety of operative techniques to meet each patient’s specific needs.
Scar release surgery
We can perform scar release surgery to reduce skin constriction and improve mobility. The procedure involves cutting out scar tissue to release tight skin between the joints and muscles. Removing scar tissue takes away skin, so patients often need a skin graft or flap surgery to replace the removed skin.
This procedure involves covering open surfaces that lack skin with healthy skin taken from somewhere else on the body, usually the buttocks or inner thigh. Once the graft is in place, it begins to form new blood vessels. Though burn scars are less visible after a skin graft, new scars often take their place as the graft itself heals.
Z-plasty is a surgical technique that rearranges usable soft tissue to close wounds after scar tissue has been removed, allowing for improved flexibility and range of motion.
The surgeon makes a Z-shaped incision on the sides of a burn scar that is removed, creating two triangle-shaped flaps. These flaps are then rotated and secured into a new position with sutures. This technique releases skin contractures, disrupts the scar line to prevent re-contracture and lengthens tissue to improve range of motion.
If there is not enough healthy skin for a skin graft or z-plasty, we may recommend tissue expansion.
A tissue expander is a sterile balloon that is surgically implanted under the skin. It is slowly inflated over several weeks with sterile salt and water (saline). As the balloon expands, it stretches the overlying skin until enough skin is available.
We then remove the tissue expander, remove the problematic scar and move the newly expanded, extra skin to cover the exposed area where the scar was.
Flap surgery involves transplanting a piece of skin, fat or muscle. We move this tissue from one area of the patient’s body to another area where scar tissue has been removed. Flap surgery generally usually involves microsurgical techniques that use a surgical microscope.
Splints are an effective way to manage burn contractures and an important part of secondary burn rehabilitation. Scars often cause webbing across concave areas and joints like the neck, knee and axilla.
Splints work to remodel scar tissue and maintain the normal curves of the body. Splinting applies controlled, gentle force to soft tissues for enough time to start the body’s natural tissue remodeling process.
Laser resurfacing procedures
Certain burn scars may benefit from lightening and laser resurfacing procedures. Light-based treatments target red areas of the scar and lighten those areas to better match the unscarred skin color.
Laser treatment procedures use fractional laser technology to soften firm, dense scar tissue seen in hypertrophic scars.
Pressure garments can improve the appearance and texture of a burn, decrease itching and protect burn-injured skin from injury. Custom garments increase pressure on the scar to help flatten and moisturize the healing skin. Soft plastic inserts can be sewn into pressure garments to further improve scar appearance and unwanted symptoms.
Occupational and physical therapists measure and fit patients for pressure garments. Our team also includes pediatric hand therapists who specialize in evaluating and treating children with burn injuries on their hands and fingers.
Why choose us for burn scar reconstruction
Children’s Colorado is proud to offer the largest pediatric burn scar reconstruction team in the Rocky Mountain region. Our team specializes in a variety of operative and nonoperative techniques, so we can recommend the best treatment for your child’s unique situation.
Not every child needs an operation to improve scarring. With our extensive experience caring for children, we know when to use nonoperative treatments to reduce pain, discomfort and recovery time.
After a traumatic injury like a severe burn, children want to get back to doing what they did before their injury. Reducing scars can improve a child’s self-esteem, range of motion and mobility. Getting back to the activities they love helps them move past a traumatic injury.
Contact the Burn Reconstruction Program
If you are interested in the program, please contact the Department of Pediatric Plastic Surgery at 720-777-6409.
This program is held at the Anschutz Medical Campus in Aurora, CO.