Functional and Aesthetic Reconstruction of Burned Patients

603 Pages·2005·24.34 MB·English

by  Robert L. McCauley

Functional
and Aesthetic
Reconstruction
of Burned
Patients
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Functional
and Aesthetic
Reconstruction
of Burned
Patients
Edited by
Robert L. McCauley, MD, FACS
University of Texas Medical Branch
Shriner’s Hospital for Children—Galveston Unit
Galveston, Texas, U.S.A.
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Published in 2005 by
Taylor & Francis Group
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© 2005 by Taylor & Francis Group, LLC
No claim to original U.S. Government works
Printed in the United States of America on acid-free paper
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International Standard Book Number-10: 0-8247-2583-2 (Hardcover)
International Standard Book Number-13: 978-0-8247-2583-9 (Hardcover)
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In Loving Memory
Thisbookis dedicatedto thememory ofmy mother and father, Hattieand Willie McCauley,
who built a well ofinspiration and supportso deep that Icontinue
todrink from iteach and every day.

Preface
Overthepasttwodecades,advancesinthemanagementoftheacuteburnedpatientshaveresultedintheroutinesurvivalof
patientswith80–90%totalbodysurfaceareaburns.Needlesstosay,thereconstructiveneedsofthesepatientsarenumer-
ous. This book addresses the reconstructive problems encountered in burn survivors by reviewing principles of wound
healing, prioritizing their reconstructive needs and categorizing the multitude of techniques available to plastic surgeons
for reconstruction. Surgical as well as non-surgical methods for improving the appearance and function are brought to
the forefront.
Thistext,FunctionalandAestheticReconstructionofBurnedPatients,systematicallydissectsproblemsassociatedwith
burnsoftheheadandneck,burnsofthetorso,perineumandupperextremityandburnsofthelowerextremitiesandfeet.
Theindicationsforvariousreconstructiveproceduressuchasgrafts,flaps,tissueexpansion,andmicrovascularfreetissue
transfersareincorporatedthroughoutthetext.Theadvantagesandlimitationsofthesetechniquesarethoroughlydiscussed.
Inaddition,theapplicationofcertainprinciplesofaestheticsurgeryareappliedtothesepatients.Regardlessoftheextentof
theburninjury,woundclosureissimplynotenough.Today,asreconstructivesurgeons,wemuststrivenotonlyforfunction
but also for the aesthetic restoration of our patients. The reintegration of burn patients back into society as productive
members,inmany ways, isdependent upon the restoration of formand function.
I would like to thank all the contributors to this book for their dedication and hard work. The secretaries in the
Medical Staff Office, the Graphic Arts Department as well as the Medical Records Department at the Shriners Hospital
for Children—Galveston Unit, alldeservea special thanks for their unyielding supportinthe completion ofthis project.
Robert L. McCauley
v

Contents
Preface . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. v
Contributors . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. xi
1. Properties of the Skin . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 1
John D.Bauer
2. Wound Healing . . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 23
Michael K. Obeng, Linda G.Phillips
3. Principles inManagement of Acute Burns . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 43
Steven E. Wolf, DavidN. Herndon
4. Management of Electrical Injuries .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 59
Hazel Joseph, Robert L. McCauley
5. ChemicalBurns: Small Burns with SevereConsequences . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 69
David G.Greenhalgh
6. Reconstructive Needs ofthe Burn Patient . . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 77
W.John Kitzmiller, Robert L. McCauley
7. Anesthesia for Reconstructive Burn Surgery . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 85
Lee C. Woodson,Edward R.Sherwood, JoaquinCortiella, Lynn Peterson
8. Skin Grafts . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 105
Prema Dhanraj, Robert L. McCauley
9. Skin Substitutes:Theoretical andDevelopmentalConsiderations . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 113
Steven T. Boyce, Dorothy M.Supp
10. Microsurgical Free Tissue Transfer in BurnReconstruction: Overview .. . . .. . .. . . .. . . .. . . .. . .. . . .. 129
Fu-Chan Wei, Tewodros M.Gedebou
11. Principles ofTissueExpansion . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 141
Robert L. McCauley,Michael K. Obeng
12. Management of PigmentationChangesinBurn Patients . . . .. . . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. 157
Prema Dhanraj, Robert L. McCauley
vii