Name of the Procedure:

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children

Summary

This procedure involves surgically preparing a recipient site on the body by removing open wounds, burn eschar (dead tissue from a severe burn), or scars. It also can involve releasing a scar contracture, where the skin has tightened and tightened around a wound or burn. The initial area treated is up to 100 square centimeters or 1% of the body area, especially for infants and children.

Purpose

The procedure addresses various skin abnormalities like open wounds, burn eschar, and scars that may limit mobility or function. The goal is to create a clean, healthy site for healing, potentially aiding in further treatments like skin grafting or overall improvement in mobility and aesthetics.

Indications

• Large or complex open wounds.
• Significant burn scars (eschar).
• Scars causing contractures, limiting motion or causing discomfort.
• Preparation for skin grafting.
• Patients, particularly infants and children, meeting these criteria.

Preparation

• Fasting may be required before the procedure, depending on anesthesia needs.
• Adjustments or cessation of certain medications may be necessary.
• Pre-operative blood tests and imaging studies to assess the condition of the tissue.
• Pre-procedure consultation to discuss patient history and any allergies.

Procedure Description

1. Anesthesia: General anesthesia is typically administered to ensure patient comfort.
2. Incision: The surgeon makes precise incisions to remove dead tissue, burn eschar, or scars.
3. Excision: Using surgical tools, the affected tissues are excised, including subcutaneous tissues if needed.
4. Scar Release: Any scar contractures are carefully released to improve movement and function.
5. Closure: The site may be closed with sutures or prepared for additional procedures like grafting.
6. Dressing: A sterile dressing is applied to protect the area and aid in healing.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and area involved.

Setting

Performed in a hospital operating room or surgical center equipped for pediatric care.

Personnel

• Surgeons specializing in plastics or burns.
• Pediatric nurses and surgical assistants.
• Anesthesiologists for managing general anesthesia.

Risks and Complications

• Infection at the surgical site.
• Bleeding and hematoma formation.
• Scarring at the site of surgery.
• Anesthesia-related complications.
• Delayed healing or adverse reactions to surgical materials.

Benefits

• Restoration of normal function and mobility.
• Enhanced aesthetic appearance of the treated area.
• Preparation for further reconstructive procedures, such as skin grafting.
• Improved quality of life by alleviating symptoms associated with the wounds or scars.

Recovery

• Postoperative care includes pain management, typically using prescribed medication.
• Instructions for wound care and hygiene to prevent infection.
• Limitations on physical activity to ensure proper healing.
• Follow-up appointments to monitor healing and assess the need for further intervention.

Alternatives

• Non-surgical wound care, though less effective for severe cases.
• Physical therapy for minor contractures.
• Laser treatments for some types of scars.
• Topical treatments for minor wounds or scars.

Patient Experience

During the procedure, with general anesthesia, the patient will not feel any pain. Postoperatively, there might be some discomfort, manageable with prescribed pain relievers. Some swelling, bruising, or tenderness at the site is expected and will subside with time. Parents should prepare for possible hospital stay for recovery and follow all post-op care instructions to ensure proper healing.