PLASTIC SURGERY
REFLECTIONS ON Burn Care
Joshua Choo, MD
A
severe burn injury is a life-al-
tering event, with devastating
effects that are immediately felt
and have lasting repercussions.
Acutely, a severe burn is one of
the most painful and complex physiologic
insults that one can experience. This is evi-
denced by the sheer number of people who
are involved in the care of the massively burned patient, each with
a very vital job to perform. Burn care truly demands a multidisci-
plinary approach.
In most burn centers, care is directed by a burn surgeon, who
usually has a background in general surgery and critical care or
plastic surgery. At the University of Louisville, the trauma team
directs the care of the burned patient. As plastic surgeons, our role
in the treatment of burn patients is focused on the care of burns to
the face and hands.
As a rough rule of thumb, each hand comprises one to two
percent of the total body surface area, and the head and neck nine
percent. The percentage of total body surface area burned is a ma-
jor factor in the overall survival of a burned patient. When viewed
in terms of surface area, the care of the burned face and hands
comprises only a small component of the acute physiologic insult.
However, the effects of severe burn injuries last far beyond the
acute insult, and in many cases, they are life-long. As if surviving a
severe burn injury weren’t enough, patients who recover from their
acute injury will have to come to terms with a loss of their former
identity, irreversible changes to their appearance, and a newfound
vulnerability and loss of functional ability. Many times, it is in the
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LOUISVILLE MEDICINE
aftermath when the emotional, physical and psychological toll of
the injury really hits home.
The importance of loss of form and function can be felt anywhere
in a burn patient, but it would not be unfair to say that the face and
hands is where this loss can be most evident and impactful. These
two areas of the body contribute enormously to a person’s sense
of self and of self-sufficiency. Therefore, even though the face and
hand are small parts of the body, they carry outsize implications
for burn survivors.
In burn recovery, an important goal is restoring or improving
a person’s form and function. Scarring, in particular, is one of the
sequela of burns that has the most profound impact on form and
function, and thus quality of life, following a burn. Disfiguring
scarring of the face following a burn not only has a profound impact
on one’s body image, but a burn survivor’s changed appearance,
especially of the face, is often a painful and visible reminder of the
trauma they have experienced. When scarring involves the hand,
the experience of disability and the threat of being unable to re-
gain abilities are also some of the most challenging aspects of burn
recovery. What interventions can be made to reduce scarring and
forestall the cosmetic and functional issues related to burn injury?
What can be done to help the loss of form and function that a pa-
tient has experienced, and thereby improve the patient’s quality of
life? A plastic surgeon’s interventions in the acute burn period, and
afterward—in the rehabilitation and recovery period—are always
with this question in mind.
Dr. Choo is a practicing surgeon at UofL Hospital, specializing in burn
care.