RECONSTRUCTIVE SURGERY IN PATIENTS RECOVERED FROM VERY EXTENSIVE BURNS

With the improvement on the cure rate of very extensively burned patients, the num-ber of survivors demanding reconstructive surgery is increased. These patients are char-acterized by multiple complicated scar contractures. a remarkable shortage of donor ar-eas. difficulty in establishing intravenous lines peri-operatively. and also handicaps often encountered in giving general anesthesia. This paper is to summarize the experiences gain-ed from the management of four patients who had had burn areas in excess of 90％ TBSA. with full-thickness injury exceeding 75％. 1. To facilitate the administration of endotracheal anesthesia for multiple operations. it is often preferable to correct the contracture over the anterior neck first. 2. Due to the difficulty in establishing intravenous lines. impeding replenishment of blood and fluid loss, it is wise to contain the extent of each operation to a smaller scale and lengthen the interval between two operations. 3. Repair contractures with modified Z-plasty. supplemented by skin-grafting. whenever feasible. 4. While skin grafts harvested from the scalp are used for reconstruction on the arms, legs and trunk. it is preferable to obtain skin grafts from other areas. even though they bear scars as a result of previous superficial partial-thickness burn. to repair con-tractures over the hands and face.