Approximately 2.2 million people are burned in the United States each year. Of those, 60,000 people are hospitalized and 5,500 die. The cost for this hospital care is over one billion dollars annually with rehabilitation costs in excess of three billion dollars. In addition, over one million workdays are lost each year.
To deal with the burn-injured patient, a multidisciplinary burn unit concept has developed that allows for the acute care, reconstructive care, and rehabilitation of the burn patient. To this end the burn unit requires multidisciplinary team of trauma surgeons, plastic surgeons, pediatric surgeons, nurses, physical therapists, occupational therapists, social workers, psychologists, pastoral care, dietitians, and recreational therapy.
The Burn Unit of Wake Forest Baptist Medical Center is staffed by physicians from trauma, pediatric and plastic surgery. While the trauma and pediatric surgeons coordinate the immediate critical care, plastic surgery is involved from the beginning in the management of critical burn areas such as the face and hand. Our burn unit hospitalizes nearly 200 patients per year and is one of only two active burn units in the state.
Contemporary care of the burn wound requires immediate prophylaxis from infection using such topical treatments as silver sulfadiazine, Acticoat®, and Transcyte®. While second-degree partial thickness burns may heal with such treatment alone, deeper third degree burns require excision of non-viable skin and placement of skin grafts. Such patients may also be candidates for coverage with products such as Integra®, an artificial skin equivalent.
Management of the burned hand and face presents exceptional challenges. To preserve quality of life, the reconstructed burn face must have minimal scarring for cosmetic reason as well as to preserve the function of critical areas such as the eyelids and mouth. The reconstructed burn hand must have an acceptable appearance but also a durable cover that can tolerate injury from the activities of daily living.
In addition to acute and long-term reconstruction of the burned hand and face, the plastic surgeons at Wake Forest Baptist Medical Center Burn Unit may also be involved in reconstruction of other scarred areas that develop tight scars. This can include release of scars in the axilla, arms, legs, groins and neck. Such surgery may require skin grafts or focal flaps, Z-plastics, tissue expansion, and free flaps may be necessary. As a result, while the burn patient may leave the burn unit after several weeks or months, the plastic surgeon may continue to participate in their care for many years until the optimum cosmetic and functional result is obtained.