Severe burns often require multiple skin graft surgeries and reconstructive procedures to close wounds, restore function, and improve appearance. These surgical treatments are complex, expensive, and may continue for years after the initial injury. Understanding skin grafting and reconstruction helps burn victims know what to expect and ensures legal claims capture the full extent of surgical needs.
Types of Skin Grafts
Split-thickness skin grafts (STSGs) take the epidermis and part of the dermis from donor sites, usually the thighs or back. The donor site heals on its own as the remaining dermis regenerates new skin. STSGs are commonly used for large burns because donor sites can be reharvested after healing. However, split-thickness grafts tend to contract and may have different texture and color than surrounding skin.
Full-thickness skin grafts (FTSGs) take the entire epidermis and dermis. These grafts provide better cosmetic results and contract less than split-thickness grafts, making them preferred for visible areas like the face and hands. Full-thickness grafts require closure of donor sites, limiting the amount of skin that can be harvested and making them impractical for extensive burns.
Sheet grafts use intact sheets of harvested skin applied without meshing. These grafts provide the best cosmetic results but cover less area per harvest. Sheet grafts are typically reserved for the face, hands, and other highly visible areas where appearance matters most.
Meshed grafts are expanded by cutting small slits that allow the graft to stretch, covering larger areas with less donor skin. Meshing leaves a characteristic pattern as skin grows into the slits. Meshed grafts are practical for large burns but produce less cosmetically appealing results.
The Grafting Process
Wound bed preparation through debridement removes dead tissue and creates a surface where grafts can take. Burn wounds must be clean and well-vascularized for grafts to survive. Multiple debridement procedures may be needed before wounds are ready for grafting.
Graft surgery harvests donor skin and applies it to prepared wound beds. Surgery may last several hours depending on the extent of burns being grafted. Multiple operations may be needed to graft all wounds, with intervals for donor site healing between surgeries.
Post-operative care protects grafts while they establish blood supply from the wound bed. Grafts are typically immobilized for five to seven days. Dressings protect grafts from shearing forces that could dislodge them. Successful graft take requires careful nursing care during this critical period.
Reconstructive Procedures
Scar revision surgery improves the appearance and function of burn scars. Procedures include scar excision, Z-plasty to release contractures, and dermabrasion to smooth irregular surfaces. Multiple revisions may be needed to achieve optimal results.
Tissue expansion grows additional skin by placing inflatable devices under healthy skin near burn scars. The expanders are gradually filled over weeks to months, stretching skin to provide tissue for reconstruction. This technique provides skin that matches the area being reconstructed in color and texture.
Flap surgery moves skin along with underlying blood supply to reconstruct complex areas. Local flaps rotate nearby tissue into defects. Free flaps transfer tissue from distant body areas using microsurgical techniques to reconnect blood vessels. Flaps are used for areas needing substantial tissue replacement.
Expected Outcomes
Skin grafts and reconstructed areas will never look like normal unburned skin. Grafted skin differs in color, texture, and hair growth from surrounding areas. Setting realistic expectations helps patients adjust to permanent appearance changes while understanding that surgery can significantly improve severe burn wounds.
Functional restoration may be incomplete despite successful surgery. Range of motion limitations, sensation changes, and weakness may persist after grafting and reconstruction. Physical and occupational therapy maximize function within the limitations created by burn injuries.
Ongoing surgical needs extend for years in many burn cases. Children require revision procedures as they grow. Adults may need additional reconstruction as scars mature and change. Planning for future surgery ensures adequate compensation for lifetime surgical needs.
Surgical Complications
Graft failure occurs when grafts do not establish blood supply and die. Infection, hematoma, and movement can cause graft loss. Failed grafts must be replaced with additional surgery. Some wounds require multiple grafting attempts before successful coverage.
Contracture develops when scar tissue tightens, limiting range of motion across joints. Contractures are particularly problematic when burns cross joints. Surgery may release contractures, but they can recur without ongoing therapy and splinting.
Donor site complications include scarring, infection, and delayed healing. While donor sites typically heal better than graft sites, they still represent additional wounds requiring care. Prominent donor site scars may need their own revision surgery.
Costs of Surgical Treatment
Skin graft surgery typically costs $10,000 to $30,000 or more per procedure depending on extent and complexity. Patients requiring multiple grafting operations face total surgical costs of $100,000 or more for acute treatment alone.
Reconstructive procedures continue adding costs for years. Each revision surgery, tissue expansion procedure, or flap reconstruction generates additional expenses. Lifetime reconstructive costs may exceed initial grafting costs for patients requiring extensive revision.
Conclusion
Skin grafting and reconstructive surgery are essential components of severe burn treatment that significantly improve outcomes but cannot fully restore burned skin to normal. Understanding surgical techniques, expected outcomes, and ongoing needs helps burn victims navigate treatment and ensures legal claims capture the full extent of surgical expenses extending throughout recovery.