Trauma and Burns

Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in General Surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff as well as resident physicians in teaching hospitals.

WHAT IS A TRAUMA SURGEON?   

Trauma surgeons (also called critical care and acute care surgeons) specialize in performing emergency surgeries on people who’ve had a critical injury or illness. Trauma surgery requires extensive knowledge of surgical procedures and how to manage different types of injuries. A trauma surgeon can help you pull through a critical injury or an acute illness.

    

WHAT DOES A TRAUMA SURGEON TREAT? 

Trauma surgeons are qualified to diagnose and surgically repair trauma caused by injuries and illness. They must quickly evaluate a person’s condition and determine what type of operation--if any--is necessary.

  

If you see a trauma surgeon, it’s usually after you arrive at a hospital’s emergency room. They come onto your care team if it’s possible that you’ll need surgery to treat your illness or injury.

  

CONDITIONS A TRAUMA SURGEON MIGHT TREAT INCLUDE:  

* Blunt or Penetrating Trauma

* Blunt trauma is any injury from a forceful impact. Common causes are motor vehicle crashes, falls, or assaults. Penetrating trauma is an injury from an object that pierces the skin and other tissues, including gunshot wounds, stab wounds and farm equipment injuries.

  

Continued...

  

BURNS

You may need a trauma surgeon to treat severe burns, such as thermal burns, chemical burns, frostbite, and inhalation injury burns. Treatment options can include emergency surgery, skin excision, and skin grafting procedures. inhalation injury burns. Treatment options can include emergency surgery, skin excision, and skin grafting procedures.

  

Acute Care & Emergency General Surgery Conditions: -

Sometimes people have unexpected medical emergencies that need immediate surgical intervention. Trauma surgeons can treat appendicitis, diverticulitis, cholecystitis, a perforated bowel, a perforated ulcer, abdominal abscesses, incarcerated hernias, and bowel obstructions.

  

Surgical Critical Care Conditions: -  

Trauma surgeons also perform surgical critical care procedures on patients who were already in the hospital for another surgery or procedure. This includes people with sepsis, respiratory failure, multi-organ failure, or coagulopathy.

  

Plastic surgery to treat burns

 

WHAT IS BURN SURGERY? 

There are two main categories of burn surgery: acute and reconstructive. Acute burn care occurs immediately after the injury. It is delivered by a team of trauma surgeons (General Surgeons) that specialize in acute burn care. Complex burns often require consultation with plastic surgeons, who assist with the inpatient and outpatient management of these cases. Large burns, or burns of critical body areas, should be treated at a verified burn center, such as the Trauma Burn Center here at the University of Michigan. Many smaller burns can be treated with outpatient options. Some patients may need reconstructive burn surgery after the initial burn wounds have healed. This type of care is usually provided by a plastic surgeon. The goals of reconstructive burn surgery are to improve both the function and the cosmetic appearance of burn scars. This involves altering scar tissue, with both non-operative and operative treatment. The relationship between the burn patient and the reconstructive burn surgeon often lasts many years. Treatments for scar tissue often take several months to be effective, and new scar contractures can appear long after these injuries, especially in young patients who are still growing.

  

WHAT ARE THE BENEFITS OF RECONSTRUCTIVE BURN SURGERY? 

Surgery will not be able to remove a patient’s burn scars entirely, but it will help improve basic functions and make scars less noticeable. Scarring can limit the normal motion of the neck, shoulder, hands, or legs. Often surgery to help release this contracture can help a patient regain range of motion. Facial scarring that leads to problems with the eyelids, lips, nose, or hair loss can also be helped with reconstructive burn surgery. Scars that are abnormally thick, wide, or discolored might also be improved by a variety of operative and non-operative methods.

  

WHAT ARE THE OPTIONS FOR RECONSTRUCTIVE BURN TREATMENT? 

Non-operative therapies might involve scar massage, application of pressure garments, or other topical therapies. An occupational therapist at the University of Michigan can help fit patients with pressure garments. The team includes specialty hand therapists who help with the rehabilitation of hand burns and scars. Surgical options consist mainly of scar release procedures. The tight scar tissue is released and the open area closed by a plastic surgeon. There are a variety of ways to close these wounds depending on a patient’s needs. Skin grafts, skin rearrangement (sometimes called Z-plasty), and more complex skin donor flaps could be used, depending on the location of the scar and a patient’s personal goals. Most minor procedures are performed as outpatient surgery, but the larger grafts and flaps would likely require an inpatient stay. Tissue expansion can also be used as an alternative to skin grafting. Excellent results are commonly attained when performing tissue expansion to regions of the face, neck, arms, hands, and legs.

  

IF YOU NEED RECONSTRUCTIVE BURN TREATMENT 

The first step is to schedule a personal consultation with a plastic surgeon. Communication is crucial in reaching your goals. You will have the opportunity to explain the results you'd like to see from therapy. Together, you and your surgeon will reach an understanding of what you can expect from procedures and the long-term benefits you will experience. Every patient is different, and your surgeon will choose the surgical technique and treatment plan that is right for you. During the initial consultation, you should expect:

  

To provide a complete medical history, including information about previous surgical procedures; past and present medical conditions; and any medications or herbal supplements you are taking.

 

Your surgeon to conduct a complete physical examination.

 

To discuss possible risks and complications of the procedure.

 

If you choose to have surgery at U of M, you will be given a pre-operative information packet that explains everything you should do and know before your surgery date. Your procedure will take place at the University of Michigan Hospital which provides state-of-the-art surgical suites and recovery areas. The majority of these procedures are completed on an outpatient basis. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on preoperative skin cleansing, eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

  

AFTER SURGERY 

Following post-surgery instructions are important to heal and obtain the best possible outcome, both in terms of function and physical appearance. You will have to follow up appointments so your surgeon can assess your long-term results and answer any questions or concerns you may have. Since a variety of procedures can be performed, your individual postoperative instructions may vary. In general, skin grafts require a kind of "bolster" dressing to keep them in place for 3-5 days without any movement of the skin graft. The bolster helps the skin graft "stick" to the wound and begin to heal. Smaller operations (scar revisions, Z-plastics) might require only a small, soft dressing afterward. After scar releases on the hand, your surgeon may place you in a larger dressing that incorporates a plaster splint for support after surgery. In general, follow-up visits are scheduled within two weeks of surgery, and there may be stitches to remove at that time. Additional physical therapy or occupational therapy may be required in the weeks and months following surgery to ensure complete recovery of function. This may involve splints or casts, as well as exercises you perform at your treatment visits and on your own at home. Your surgeon and therapists will work together to develop the plan that is best for you.nd stigmata associated with burn injuries.