Management of Acute Trauma (Injury) including Burns

Injury is the commonest reason for medical advice. It can be of several types Mechanical injuries, thermal injuries (Burns due to flame heat or excess of cold) or Chemical. In the modern day plastic Surgery forms an important pillar in the management of all forms of trauma. Burns are injuries produced by Heat, Cold or Chemicals . These types of injury often lead to Destruction of Skin. These injuries require specialized treatment which is pioneered by plastic Surgeons.

Injury due to mechanical force injury may be limited to cuts over the skin or to broken bones to very sever injury to the limbs with multiple bony fractures and wounds. Very sever injury can lead to total detachment of body parts. Simple cuts over the face or exposed parts of body is repaired with precision to produce minimal scar by plastic Surgery, Complex injuries leading to skin loss over the face & else where over the body.

Fractures of the Facial Bones produce some of the biggest challenge for treatment and are treated by plastic surgery. The Development of newer mini & micro plating systems to stabilize the bones in their correct position without producing any externally visible scar has been mastered by plastic Surgeons. Fractures of the limbs that are associated with wound either upper limb or lower limb needs attention of Plastic Surgeon along with orthopedic surgeon right from the first day of management. The use of microsurgery and use of muscle flaps in the early period of injury has improved recovery and made even very severely injured limbs salvageable.

One of the most charismatic advance in plastic surgery. Microvascular surgery requires special training. This advance has made it possible to reattach a totally amputated part from the body. The surgery is called Replantation the replanted part will look normal and functions normally. Some of the commonly amputated parts are Fingers, Thumb, Hand from wrist or whole of the arm. Some times other parts of body like the, Hairs of head get entangled in drive belts and get detached, these also can be put back by Microvascular surgery.

First aid and preservation is very important for the success of such cases :
Any part that is totally amputated from the body should be sealed in a clean polythene bag, within 2 hours of amputation. This polythene should be kept over ordinary ice. Once preserved in this way the patient can be transported to the hospital. Replantation can be successfully done even upto 24 hours. We have successfully replanted more than 300 such cases and the longest duration after which replantation has been successful was 22 hours.

Even if the amputation is not complete in sever injuries the blood supply to the limb may be severed. Partial or completed severance of blood Supply to a part of the body requires plastic surgeons to perform Micro vascular Repair and thus salvage the body part. Injury to hand is complex and requires the careful & delicate repair under magnification thus are best performed by Plastic Surgeons trained in Micro vascular surgery. It is advised not to even put one stitch over injured hand without using magnification.

Injury to nerves gives best results when repaired under magnification. Old injuries to nerves can also be repaired or nerve grafts put to bridge the gaps.