Burn injury is a trauma that has variable scarring outcomes dependent on both the size and the depth of the burn. This chapter will discuss the pathophysiology of wound healing by both primary and secondary intention and its applicability to burn wounds. The importance of accurate assessment of burn depth and its impact on the primary treatment and subsequent scar outcome will be explored. Special anatomic areas such as the face, hands and neck will be highlighted. Skin grafting and skin substitutes as treatment options will be reviewed. Improvements in burn care have enabled people to survive larger burns that may once have proved fatal. The emphasis of treatment, once healing has been achieved, is now focused upon rehabilitation and scar management. Scar management strategies including pressure garments and silicone therapy are highlighted along with secondary scar revision strategies.
Part of the book: Scars
Skin substitutes have modernised burn wound reconstruction since their use was first pioneered by Burke and Yannas in the 1980s. Skin substitutes offer a solution to the problem of insufficient autologous skin graft availability in major burn wound closure. A growing body of evidence supports the role of skin substitutes in both acute major burns and secondary burn scar resurfacing. Classification of skin substitutes has become increasingly complex given the large variety of synthetic and biologic dermal matrices now available as the result of ongoing advances in regenerative medicine techniques. Classification systems are required to assist clinicians with selection and comparison of outcomes across a wide diversity of skin substitutes. Professor John Greenwood, invented, designed and developed one such dermal substitute, \'Biodegradable Temporising Matrix\', which is approved for use across the globe for reconstruction of major burns and complex wounds. This chapter provides a review of available classification systems for skin substitutes with a summary of the latest evidence in relation to their role and impact on burn wound outcomes. Future developments toward the elusive ‘ideal’ skin substitute may be possible through ongoing research efforts focused on clinical translation of modern skin tissue engineering techniques for burn wound reconstruction.
Part of the book: Wound Healing