Burn Reconstruction

Burn reconstruction is a series of surgical procedures that repair skin and tissue damaged by burns, restoring as much function and appearance as possible.

When a burn destroys the outer and deeper layers of skin, the body forms scar tissue (tough, fibrous material that replaces normal skin). This scar tissue can tighten across joints, limit movement, change the shape of features like the nose or mouth, and cause ongoing pain. Burn reconstruction addresses these problems by removing, releasing, or covering damaged tissue and replacing it with healthy skin — either taken from another part of the patient's own body (a skin graft) or created using tissue-expanding techniques or flaps (sections of skin and muscle moved from a nearby area).

Burn reconstruction is considered when burn scars or contractures (bands of tight scar tissue that restrict movement) cause functional problems, significant disfigurement, or ongoing discomfort. It may be planned months or even years after the original burn injury, once the scars have matured and stabilised.

• Contractures (scar tightening) across joints such as the fingers, hands, elbows, knees, or neck that limit everyday movement
• Facial disfigurement affecting the eyelids, lips, nose, or ears — especially when normal functions like blinking or eating are affected
• Hypertrophic scars (raised, thickened scars) or keloids (overgrown scar tissue that spreads beyond the original wound) that cause pain or itch
• Deep burn wounds that did not heal fully and require skin grafting to close
• Scarring of the chest or abdomen that restricts breathing
• Psychological distress caused by visible scarring that affects daily life and self-confidence

Burn reconstruction may not be advisable in certain situations. Your surgeon will carefully assess your overall health before recommending surgery.

• Active infection in or around the burn scar area
• Very poor general health that makes anaesthesia (the medication used to keep you unconscious and pain-free during surgery) too risky
• Scars that have not yet fully matured — surgeons usually wait at least one to two years after a burn before reconstructing, though this varies
• Unrealistic expectations about the outcome, which are better addressed through counselling before any surgery is considered

Burn reconstruction is major surgery, and like all major surgery it carries recognised risks — your surgical team will discuss these with you in detail before you give consent.

• Graft failure — the transplanted skin does not attach properly and may need to be redone
• Infection at the graft site, the donor site (where skin was taken from), or deeper in the wound
• Scarring and recurrence of contracture (the tightening can come back, especially without physiotherapy)
• Bleeding during or after the procedure
• Poor wound healing, particularly in patients who smoke or have diabetes
• Numbness or altered sensation in the reconstructed area, which may be permanent
• Anaesthesia-related complications such as breathing difficulty or allergic reaction
• Mismatch in skin colour or texture between the grafted area and the surrounding skin
• Psychological adjustment difficulties — results take time and multiple surgeries may be needed
• Blood clots (deep vein thrombosis — a clot in a leg vein) or, rarely, a clot travelling to the lungs (pulmonary embolism)

Preparation for burn reconstruction involves several steps to make surgery as safe as possible. Your team will give you personalised instructions, but the points below reflect common practice.

Before the day of surgery, you will usually be asked to stop smoking for at least several weeks — smoking reduces blood flow to the skin and significantly increases the risk of graft failure. Alcohol should also be avoided in the days leading up to surgery. Blood-thinning medications (such as aspirin or anticoagulants) are typically paused under your doctor's guidance, as they increase bleeding risk. Some herbal supplements can also affect bleeding and anaesthesia, so inform your surgeon about everything you take.

You will be asked to fast (eat and drink nothing) for a period before surgery — usually from midnight the night before, though your team will confirm the exact time. Fasting is required so that the stomach is empty when anaesthesia is given, reducing the risk of inhaling stomach contents.

Pre-operative tests commonly ordered include:

• Blood tests to check general health, anaemia (low red blood cell levels), clotting ability, and kidney and liver function
• An ECG (electrocardiogram — a trace of the heart's electrical activity) to check heart health, particularly in older patients
• Chest X-ray to assess the lungs and heart size
• Nutritional assessment — burns affect nutrition, and adequate protein levels support healing
• Photographs of the affected area for surgical planning

On the day of surgery, here is what typically happens:

• 1. You arrive at the hospital and nursing staff check your vital signs and confirm your identity and consent forms.
• 2. An intravenous (IV) line is placed in your arm to deliver fluids and medications.
• 3. The anaesthetist (the doctor who manages your sleep and pain) meets you to review your health and explain the type of anaesthesia planned — general anaesthesia (fully asleep) is most common for this procedure.
• 4. The surgeon marks the areas to be treated on your skin.
• 5. Once in the operating theatre, anaesthesia is given and you are positioned carefully to protect pressure points.
• 6. The surgeon releases or removes the scar tissue — for contractures this may mean making cuts along the scar and inserting flaps or grafts to fill the gap.
• 7. If a skin graft is used, skin is carefully harvested from a donor site, thinned to the right thickness, and placed over the prepared wound bed.
• 8. The graft or flap is secured with sutures (stitches), staples, or special dressings, and the donor site is covered and protected.
• 9. Dressings are applied and you are moved to the recovery area as anaesthesia wears off.
• 10. The length of surgery varies considerably depending on the size and complexity of the reconstruction.

Recovery from burn reconstruction takes time and varies widely depending on the extent of the surgery. Most patients spend at least a few days in hospital so that the grafts or flaps can be monitored closely in the critical early period — this is when the new skin is establishing its blood supply. Full recovery and the final appearance of the reconstructed area may not be apparent for many months.

• Wound and graft care: Dressings over the graft and donor site are changed regularly by the nursing team. You will be taught how to care for them at home before discharge. Keeping the area clean and protected from sun exposure is important.
• Movement restrictions: The reconstructed area is usually immobilised (kept still) for the first several days to prevent the graft from shifting. Your team will advise when gentle movement can resume.
• Physiotherapy (physical therapy): This is a key part of recovery. Regular exercises and stretching help prevent contracture from returning. A physiotherapist will usually begin working with you soon after surgery and continue for months.
• Compression garments: Custom-fitted elastic garments worn over the healed area help control scar thickness and may reduce the chance of contracture recurring. These are often worn for many months.
• Silicone sheets or gel: These may be applied over scars to soften and flatten them — your care team will advise on whether this is appropriate for you.
• Pain management: Discomfort is expected and will be managed with appropriate medications prescribed by your team.
• Activity restrictions: Heavy lifting, strenuous exercise, and activities that stretch the reconstructed area are avoided until your surgeon confirms healing is sufficient.
• Follow-up appointments: These are essential. Your surgeon will check graft survival, scar maturation, and function at regular intervals. Do not skip these visits.
• Nutrition: A diet with adequate protein and vitamins supports wound healing. If nutritional deficiencies are identified, supplementation may be recommended.
• Sun protection: New skin grafts are very sensitive to sun damage and should be kept covered or protected with high-factor sunscreen for at least a year.
• Psychological support: Adjusting to changes in appearance can be challenging. Counselling or support groups are often recommended alongside physical recovery.