Improving Surgical Treatment of Skin Burns to Reduce the Incidence of Pathologic Scarring

Abstract

Background: In some parts of the world, the incidence of postburn pathologic scars reaches 16%. One should understand reconstructive surgery techniques and prioritize scar prevention during burn wound treatment. Inadequate wound management affects scar tissue formation and may cause pathologic scarring. Optimal timing of skin restoration operations reduces the risk of postoperative complications.Objective: To demonstrate that the surgical removal of fibrotic dermis and granulation tissue is feasible to reduce the incidence of pathologic scarring.Materials and methods: We studied treatment results in 57 patients with deep burns who were divided into 2 groups based on surgical treatment types before autologous skin grafting. Group 1 underwent total excision of granulation tissue, removal of fibrotic dermis, and excision of wound edges on day 27–31 after the injury. On day 22–28 postburn, group 2 had tangential excision of granulation tissue, removal of the upper skin layers only (the fibrotic dermis preserved), and then autologous skin grafting. The patients were followed up postoperatively at 1, 6, 12 months. During the examinations we assessed the formed scar tissue and perfusion of the burn injuries. Types and features of the scar tissue were identified by histologic examination of biopsy tissues.Results: We identified statistically significant differences between the analyzed patient groups based on the perfusion values measured by laser Doppler flowmetry and found a relationship between surgical approaches, wound perfusion, and the incidence of pathologic scarring.Conclusions: When early debridement is unfeasible, the preferred surgical approach for deep burns is a staged wound cleansing from necrotic tissue followed by total removal of granulation tissue and fibrotic dermis, and finally autologous skin grafting. This approach prevents pathologic scarring.