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Burn treatment and plastic surgery
Superficial burns (1st and 2nd degree)
Superficial burns involve the upper part of the skin (the epidermis, and the upper part of the dermis.) They are sometimes referred to 1st degree burns (epidermis only) and 2nd degree burns (epidermis and upper part of the dermis) Superficial burns are often quite painful (as the little nerves in the skin become exposed.)
Superficial (1st degree) burns are very common. Sunburn is a typical first-degree burn. The skin is red, swollen, and painful. 2nd degree burns are slightly deeper than 1st degree burns and are also painful. The skin is red, swollen and may be shiny and wet. Blisters are also present.
All burns should be treated as quickly as possible with cool running water for first aid. This should be done for twenty minutes as quickly as possible after the burn. First aid is useful for up to 3 hours following the burn - it cools the skin and provides some comfort too. There is very good evidence that burn wounds that are treated with good first aid require less surgery and have less scarring too. Dress the wounds with clean ‘non-adherent’ dressings and seek further care at your GP, Emergency Department, Burns Clinic or at my clinic. With good dressings these injuries are likely to heal with minimal scarring or pigmentation issues. Despite being superficial (and very unlikely to need surgery) these burns still require expert nursing, occupational therapy and physio. Dr Rawlins and his team can coordinate this care and ensure the very best outcome.
Deep burns (3rd and 4th degree)
As with superficial burns, these injuries require 20 minutes of cool running water for first aid and a good dressing. Antimicrobial dressings are often used in burn injuries to reduce the risk of the burn getting infected. Silver dressings have antimicrobial properties and are often the dressing of choice. Burn injuries that are full thickness will almost always require surgery to get them healed - and to minimise scarring and deformity. The majority of cases are treated with skin grafts (sometimes combined with ReCell (spray-on skin).
In very deep injuries where a skin graft is unlikely to work, Dr Rawlins uses innovative techniques such as biological dressings, dermal matrices, perforator flaps and free flaps to get the very best possible outcome. Following these acute plastic surgery procedures for burns there will be input from nurses, physiotherapists and occupational therapists to make sure your outcome is the very best it can be. Dr Rawlins will review you in his clinics for many months following your burns surgery to ensure the scars settle down appropriately. He may discuss other treatments for your scars (or scar revision surgery) if there are ongoing problems.
"Burns surgery is one of the most complex and challenging areas of plastic surgery. Debridement (removing the dead burnt tissue) is done with great precision and the skin grafts, skin cells and/or flaps are individualised for each and every patient. The multi-disciplinary team that I lead ensures the best outcomes."
Reconstructive plastic surgery for burn scars (scar revision)
Following burn injuries (that may or may not have had surgery) patients can be troubled by their scars. Dr Rawlins has sub-specialty expertise in the management of burn scars (and other types of scarring) - offering comprehensive assessment and management.
Like the acute surgery, scar revision surgery is done by a multi-disciplinary team including nurses and therapists. Scar revision is offered to patients who have functional difficulties with their scars (contractures) and to patients who are concerned about the aesthetic (cosmetic) appearance of their burn scars.
Contracture release: Following a burn the scar can tighten and cause a contracture. This might be across a joint (finger, elbow, foot etc) or it may affect the normal function of eyelids, mouth, breasts, genitalia etc. A contracture release allows the tight scar to be cut, opened-up and resurfaced with skin grafts, dermal matrices or flaps.
Skin grafts: Further skin grafts may be used to ‘fill the defect’ following contracture release, or they may be used to resurface a rough area of scar or an area of abnormal pigmentation.
Z-plasty and other ‘local flaps’: Where a skin graft is likely to ‘recontract’ or will not provide pliable enough tissue then a local flap of nearby tissue is used to correct a burn scar.
Perforator flaps: These are more complex flap procedures based on tiny blood vessels that supply a ‘patch’ of skin and can be moved into an area of troublesome scar. Dr Rawlins has a particular interest and expertise in these perforator flaps and uses them in many areas of his reconstructive plastic surgery practice.
Free flaps: A free flap procedure transplants skin and subcutaneous fat from one area of the body to an area requiring scar revision. It requires microsurgical techniques for Dr Rawlins to dissect the tissue on individual arteries and veins and then reconnect them to arteries and veins at the site of the scar. Occasionally muscle or bone is also moved to reconstruct very complex defects. These procedures are complex, (and like the perforator flaps) Dr Rawlins has considerable experience in this field - also using them in upper and lower limb reconstruction and craniomaxillofacial / head and neck reconstruction.
Tissue expanders: Tissue expander scar revision is a useful procedure that allows Dr Rawlins to ‘stretch’ or expand the normal skin that lies next to a scar and then use this expanded skin to replace an area of scar. It is a two stage procedure (and requires regular review in the clinic between the two stages), but provides some of the best ‘like for like’ reconstructions in plastic and reconstructive surgery.
Dermabrasion / Microneedling and ReCell: When a (burn) scar is rough, irregular, or has abnormal pigmentation (either hypopigmentation or hyperpigmentation) then the scar can be ‘smoothed’ and then new skin cells can be applied (ReCell).
Fat grafting: In this procedure some fat is taken (from the lower abdomen / buttocks / thighs) and is injected underneath (and into) an area of scar. This helps to ‘fill out’ an area of burn scar and also improves the overall quality and appearance of the scar.
Laser: Different laser treatments can be used to improve the quality of the burn scar.
Why Dr Jeremy Rawlins as your preferred Perth burn care surgeon?
Since his undergraduate days, Jeremy has worked in the specialist area of Burns and Burns Reconstruction. Jeremy is a member of the Australian Society of Plastic Surgeons (ASPS) and the British Association of Plastic Surgeons (BAPRAS). This commitment to burns surgery is supported by a passion for precision and quality reconstructive plastic surgery.
Jeremy maintains a 360-degree approach to this area, through his involvement in research and audit within the burns multi-disciplinary team. He also contributes to surgical education and burns management training across Australia, New Zealand and around the world.
The connection between trauma surgery, burns surgery and his work in cosmetic surgery, is very natural for Dr Rawlins. Whatever causes you to need bespoke plastic surgery, his absolute focus is precision, aiming for quality outcomes, and clear communication. If you need surgery for acute burn injuries or burns reconstruction please contact the practice and book an appointment.
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St John Of God Wexford Clinic
Level 1, Suite 26
3 Barry Marshall Road
MURDOCH WA 6150
St John of God Mount Lawley hospital
Suite 2, Level 1 Medical Centre
MT LAWLEY WA 6050
Mon-Fri from 9am-5pm
Closed for public holidays