BACKGROUND: When the skin comes in contact with something hot, cells in the skin die. The depth of the injury depends on the intensity of the heat and length of time that it is applied. If severe enough, the full thickness of the skin can be destroyed, along with tissues under it. Burns can also result from contact with certain chemicals. Burns are classified by the depth of each the injury so that the appropriate treatment is used.
· First Degree: superficial-redness of skin without blisters
· Second Degree: partial thickness skin damage-blisters
· Third Degree: full thickness skin damage-skin is white and leathery
· Fourth Degree: 3rd degree with damage to deeper structures, like tendons, joints, and bone (Source: http://www.assh.org)
TYPES: There are many different types of burns. Heat burns (thermal) are caused by fire, hot objects, heat, steam, or hot liquids. Cold temperature burns are caused by skin exposure to windy, wet, or cold conditions. Chemical burns are caused by contact with household or industrial chemicals in a liquid, solid, or gas form. Natural foods, like chili peppers, contain a substance that irritates the skin and cause a burning sensation. Electrical burns are caused by contact with electrical sources or by lightning. Radiation burns are caused by the sun, sunlamps, tanning beds, X-rays, or radiation therapy for cancer treatment. Friction burns are caused by contact with any hard surface like roads, carpets, or gym floor surfaces. Breathing in hot air or gases can injure your lungs. Breathing in toxic gases, like carbon monoxide, can cause poisoning in the lungs. (Source: www.webmd.com)
NEW TECHNOLOGY: For severe cases, tissue expansion is an option. Tissue expansion is a procedure that allows the body to grow extra skin. It is done by inserting a silicone balloon expander underneath the skin that needs to be repaired. Then the balloon gradually fills with salt water over time causing the skin to grow and stretch, keeping the skin under tension causes new cells to form. Tissue expansion is used in conditions like breast reconstructive surgery, repairing burns, scars, large birth marks, and hairy areas like the scalp. After the skin stretches, the scaring is removed surgically and the expanded skin is extended to meet healthy un-scarred skin. The expanded skin has a smaller risk of dying because the skin is still attached to the donor’s area blood and nerve supply. The main advantage of the procedure is that it provides a good match of texture, color, and hair bearing quality. The main disadvantage of the procedure is related to the length of time needed to stretch and grow the skin, which can be three to four months. Repeated visits to the surgeon are required for salt water injection to expand the balloon. Risks related to the anesthesia and the surgery can include bleeding and infection. (Source: http://www.burn-injury-resource-center.com/2013/01/)
Dr. Joseph Williams, Chief of Plastic Surgery at Children’s Healthcare of Atlanta, talks about an innovative procedure that helped one young burn victim get her hair back.
When you saw Luci for the first time, how old was she?
Dr. Williams: She was probably around two years old.
What did you see? What was the first thing that you were going to try to tackle?
Dr. Williams: Well, the first thing I saw was a girl that was completely engaging. It was very easy to overlook the physical issues that brought her to me. The most obvious physical problems she had was that she had no hair and that she had obviously suffered a significant burn to her scalp which had destroyed a large part of the hair band area. That was her mother’s main concern as well.
How were you going to handle that? That is such a big part about being a girl; to look like everybody else.
Dr. Williams: It’s a very difficult problem. The only real hair substitution is through a transplant of hair follicles, and that requires both a healthy area to take the hair from and a reasonably healthy area for the hair to be transplanted.
So she didn’t have that, right?
Dr. Williams: She didn’t have either one. She had I would say, 80 to 85% of her scalp was involved and the hair was missing, so she had of a small strip in the back.
All of that was covered with scar tissue, which made a hair transplant impossible, correct?
Dr. Williams: What remained on the scalp was scar tissue and graft, and so that was also a very difficult recipient site for the hair follicles. We understood that that option was not going to work well. Even if that was a possibility, that required her to be much older because that’s in an office procedure completed by people who do hair transplants. So that wasn’t a good option. The second option is to try to recruit scalp from what is there, and that was a possibility. The third option would be a synthetic coverage like a wig.
You only had, how much? Could you put that into a perspective for people to work with?
Dr. Williams: Between two and three inches of hair in the back.
What were you going to have to do?