Information about the procedure
Treatment of acute and chronic wounds, burns and their after-effects, including reconstruction of scars and contractures.
On this page
What it involves
A wound is a break in the continuity of the skin; a burn is a specific type of injury in which depth determines everything — from the treatment to the final result.
Some wounds heal on their own with proper care. Others — deep, contaminated, chronic or with tissue loss — require surgical treatment.
A chronic wound that has not healed within 4–6 weeks is never just a local problem. There is almost always an underlying cause: vascular insufficiency, diabetes, pressure, infection or something else. Treatment begins with identifying it.
Types and approaches
Acute wounds
Cuts, lacerations and wounds containing a foreign body. They are debrided, cleaned and closed according to their type and how long ago the injury occurred.
First- and second-degree burns
Superficial burns heal conservatively with dressings. Deeper second-degree burns need careful assessment.
Deep burns
When the full thickness of the skin is affected, the burn will not heal without surgery. The dead tissue must be excised and the area covered with a skin graft.
Chronic wounds
Diabetic foot, venous ulcers and pressure ulcers. They require a comprehensive approach: treating the cause, regular wound care and, where indicated, surgical closure.
After-effects of burns
Contractures that restrict movement, and hypertrophic scars. They are corrected with Z-plasties, flaps or grafts.
Who it is suitable for
Suitable for
- A wound that has not healed within 4 weeks
- A deep burn with skin loss
- A contaminated wound or a wound containing a foreign body
- A burn scar that restricts movement of a joint
- A chronic wound associated with diabetes or venous insufficiency
- A wound that keeps recurring in the same place
Not suitable, or postponed, in cases of
- A chronic wound whose underlying cause has not been identified and treated — surgery alone will not solve it
- Severe active infection that first requires systemic treatment
- Continued smoking when reconstruction is planned
- Poor general health that has not been stabilised beforehand
Preparation
- Identifying the cause of a chronic wound — vascular assessment, blood sugar control, pressure assessment
- Microbiological testing if infection is suspected
- Optimising nutrition — healing requires protein
- Stopping smoking, which directly impairs the blood supply to the wound
- Planning regular dressing changes and follow-up
How it is performed
Small wounds are treated as day cases under local anaesthesia. Extensive burns and reconstructions require general anaesthesia and a hospital stay.
In deep burns, the dead tissue is excised and the defect is covered with a skin graft taken from a healthy area of the body.
The donor site heals on its own in about two weeks and leaves a paler scar.
Recovery
- The first few daysRegular dressing changes. With a skin graft, the dressing is left undisturbed for several days so that the graft can adhere to the wound bed.
- The first weekThe graft take is assessed. Pain relief as needed.
- 2–4 weeksThe donor site heals and the graft stabilises. Mobilisation begins if a joint is involved.
- 1–3 monthsActive phase of scar formation. Compression therapy and silicone scar care begin for burns.
- 6–24 monthsScar maturation. In burns this process is particularly long and requires patience and consistency.
Pain and discomfort
Burns are among the most painful injuries, especially superficial second-degree burns, in which the nerve endings are preserved. Pain relief is planned and given before dressing changes, not after them. In chronic wounds the pain tends to be constant and dull, and requires a different approach.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- Wound infection
- Partial or complete loss of the graft
- Hypertrophic scars and contractures, especially after burns
- Restricted movement where a scar crosses a joint
- Change in pigmentation of the healed skin
- Recurrence of a chronic wound if the cause has not been eliminated
- Prolonged pain and itching in the healed area
Results and longevity
Superficial burns heal without a permanent scar. Deep burns always leave a mark.
In chronic wounds, the result depends far more on control of the underlying condition than on the surgical technique.
Burn scars mature slowly — over up to two years. Compression therapy and silicone products during this period make a real difference to the final appearance.