Burns: Acute Care and Reconstruction

Burns are devastating injuries whose impact on society continues to grow as people are surviving their initial injuries due to improvements in critical care management. Initial burn management involves identifying the mechanism, depth, and extent of the injury. A key component to initial management is fluid resuscitation. It is also important to rule out inhalation injury when fires located in closed spaces are the cause of injury. Once the patient has been resuscitated, managing the sequela of these injuries is a complex task that can be approached by focusing on the timing of surgery, available reconstructive options and the anatomical location of the burn. Early treatment of burn injuries typically involves debridement and coverage with several types of graft options available depending on the health of the wound bed. Intermediate reconstruction focuses on managing the scars maturation while late reconstruction deals with the sequela of wound healing like scar contracture. Burn reconstruction encompasses the entire reconstructive ladder and the appropriate reconstructive option depends on the extent of the burn, location, and availability of surrounding tissues. The different options for grafting, local, region, and free tissue rearrangements, and nonoperative treatment options, as well as how the anatomical location of the burn guides the reconstructive options, are discussed.