Burn Treatment in Ankara, Turkey

Burn treatment aims to heal tissue damage in the skin caused by heat, chemicals, electricity, or radiation. The treatment process is planned according to the degree of the burn; mild superficial burns are healed with conservative methods, while deep burns may require surgical intervention.

In severe burns, necrotic tissues are removed early to prevent tissue loss, and skin grafts are applied. Infection control, fluid therapy, and wound care form the basis of treatment. A physical therapy process is also important to prevent loss of function.

Burn scar revision includes surgical and medical procedures performed to correct scars and deformities that occur during the healing process. Depressions, color irregularities, and raised areas caused by scar tissue can be surgically removed or softened with laser and filler methods.

The revision process varies depending on the location and depth of the burn and the patient’s skin structure. If necessary, reconstructive procedures targeting subcutaneous tissues can be performed. After treatment, aesthetic appearance is improved, functional limitations are reduced, and quality of life is increased.

What Are Burn Treatment and Burn Scar Revision?

Burn treatment involves repairing tissue damage in the skin caused by heat, chemicals, electricity, or radiation using medical or surgical methods according to the degree of injury. Burn scar revision refers to interventions aimed at correcting scars that occur after healing in terms of function and aesthetics. In this process, both appearance and mobility can be improved by using laser applications, surgical corrections, skin grafts, and medical treatments.

How should first aid be performed at the time of a burn, and what should be avoided?

The first steps taken when encountering a burn case directly affect the depth of the injury and the healing process. It is necessary to act without panicking at the scene and to avoid common misconceptions. First of all, the person must be removed from burning clothing and the caustic agent, meaning the burning process must be stopped.

Unfortunately, the common habit of applying household substances to the burn only increases the risk of infection. The burn area should be kept clean.

Substances that should never be applied to a burn include:

• Toothpaste
• Yogurt
• Tomato paste
• Egg white
• Olive oil
• Various creams
• Ice

Using ice is one of the most critical mistakes. The tissue has already been damaged by heat trauma; placing ice directly on it causes the vessels to constrict. This further reduces blood flow to the area, leading to tissue death and an increase in burn depth.

The most appropriate action is to rinse the burned area with lukewarm running tap water within the first 3 hours. The water temperature should be between 8 and 15 degrees. This should be continued for 5 to 20 minutes. Running water removes heat trapped in the deeper layers of the skin, preventing the burn from deepening and relieving pain. However, placing the patient entirely in cold water or keeping the process too long can cause body temperature to drop dangerously (hypothermia), so caution is required.

How does the degree of the burn affect the treatment plan?

Our treatment strategy is entirely related to how deep the burn goes. Our skin consists of layers: the epidermis (upper layer) and the dermis (lower layer). Which layer the damage stops in determines whether healing requires surgery.

First-degree burns are the mildest. Sunburn is the best example. There is redness and pain on the skin, but no blistering is seen. These burns affect only the topmost layer of the skin and heal on their own without leaving a scar.

In second-degree burns, the picture changes somewhat. These burns also affect the dermis layer. They are divided into superficial and deep. In superficial burns, fluid-filled blisters are seen, the base is pink and quite painful. In deep second-degree burns, the base is paler and the sensation of pain has decreased because nerve endings have begun to be damaged.

Third-degree burns are full-thickness burns. All layers of the skin, sweat glands, and hair follicles have been completely destroyed. The appearance may be leathery and firm, white, brown, or black.

Typical signs of a third-degree burn are:

• Painlessness
• Firm tissue
• Dry surface
• Leathery appearance
• Pale color
• Charring

At this stage, it is impossible to expect spontaneous healing because there are no cells left to regenerate the skin. Surgical intervention and skin grafting are absolutely required.

Why is body fluid balance of vital importance?

In extensive burns, the issue does not end with the skin. Substances released from burned tissue increase the permeability of blood vessels throughout the body. You can think of this like a garden hose with thousands of tiny holes. Fluid inside the vessels leaks into the spaces between tissues, causing severe edema in the body. However, the real danger is the decrease in circulating blood volume within the vessels.

This can lead to insufficient blood supply to vital organs and result in shock. Especially in the first 24 hours, the amount of intravenous fluid given to the patient is of vital importance. We calculate it with specific formulas according to the patient’s weight and the extent of the burned area. However, formulas are only a starting point; our main guide is the patient’s urine output. If the kidneys are adequately perfused and producing urine, our fluid therapy is on the right track.

In electrical burns, the situation is more specific. A protein called myoglobin released into the blood due to muscle breakdown can clog the kidneys. Therefore, we apply much more aggressive fluid therapy in electrical burns.

When is surgical intervention necessary in the acute period?

In deep burns, necrotic tissue (eschar) is a source of toxins for the body and creates an excellent environment for bacteria to grow. Therefore, in modern burn treatment, we do not want to keep dead tissue in the body. As soon as the patient’s general condition allows, we remove the dead tissues with a procedure called “debridement” or “excision.”

After dead tissue is removed, the resulting open wound must be covered. For areas too large to close on their own, we use a “skin graft,” meaning a skin patch. Typically, a thin layer of skin is harvested with special devices (a dermatome) from the patient’s thigh, hip, or back.

The advantages of a skin graft are:

• Prevents infection
• Stops fluid loss
• Reduces pain
• Speeds up healing
• Preserves function

If the burned area is very large and the patient has limited healthy skin, we perforate the harvested patch with a special device. With this method, called the “mesh” technique, the skin can be expanded like a fishnet stocking and can cover larger areas.

Which stages does the wound healing process consist of?

Closing the wound does not mean the treatment is finished. The healing mechanism of our body is quite complex, and a biological process that takes months begins.

The healing process includes the following phases:

• Inflammation phase
• Proliferation phase
• Remodeling phase

In the proliferation phase, the body rapidly produces collagen to hold the wound together. However, this initial collagen is coarse and irregular. During this period, the wound site becomes red, firm, and raised. Over time, in the remodeling phase, this coarse structure is broken down and a more organized tissue forms. This process may take 1–2 years. When planning post-burn scar treatment, it is necessary to respect this biological timeline and not rush.

What are the differences between hypertrophic scar and keloid?

One of the biggest problems we encounter after burns is pathological scarring. We often see healing tissues that are more raised, red, and firm than normal. We examine these in two main groups.

A hypertrophic scar is a raised scar that remains within the boundaries of the burn. It is generally seen in deep burns that take longer than 3 weeks to heal. Over time, especially with proper care, they tend to flatten and soften to some extent.

A keloid is a much more aggressive entity. It extends beyond the original boundaries of the wound and spreads outward. It has a cauliflower-like appearance. Genetic predisposition is very important here.

Common signs of keloids and hypertrophic scars are:

• Severe itching
• Redness
• Firmness
• Raised appearance
• Pain
• Tightness

Keloids are more difficult to treat and have a high risk of recurrence when surgically removed. Therefore, in keloid treatment, we more often prefer non-surgical methods or combined treatments.

What surgical techniques are used for burn scars?

In the correction of burn scars (scar revision), our aim is not to eliminate the scar completely; this is not medically possible. Our goal is to make the scar less noticeable, to release any functional restriction if present, and to improve aesthetic appearance.

The Z-plasty technique is one of the cornerstones of plastic surgery. It is used to change the direction of and lengthen a scar that runs in a straight line and creates tension. We make incisions resembling the letter “Z” over the scar and rearrange the tissues. In this way, tension decreases and the scar is hidden within the natural folds of the skin.

W-plasty is preferred in wider and more irregular scars. A straight line is very easily perceived by the human eye. With W-plasty, we turn the scar into a zigzag pattern, allowing light to break up and making it harder for the eye to perceive the scar. This is a kind of camouflage technique.

How is the tissue expander (balloon) method applied?

Sometimes the burn scar is so extensive that even if we excise it, we would not have enough skin to close the defect. Or in burns on the scalp, we need hair-bearing skin to cover an area of alopecia. In such cases, we use the method called “Tissue Expander.”

The procedure is two-staged. In the first surgery, we place a silicone balloon under the healthy skin next to the burn scar. After surgery, we inflate this balloon by injecting saline from the outside at regular intervals.

The advantages of this method are:

• Color match
• Tissue match
• Preservation of hair characteristics
• Preservation of sensation

As the balloon expands, the healthy skin over it stretches and enlarges (just like abdominal skin stretching during pregnancy). Once sufficient skin laxity is achieved, we perform the second surgery. We remove the balloon, excise the burn scar, and advance this expanded, high-quality, healthy skin into that area. It is one of the methods with the most satisfying aesthetic results.

Why are fat grafting and stem cell therapies important?

In recent years, “Lipofilling,” meaning fat grafting, has produced revolutionary results in the treatment of burn scars. We harvest fat from the patient’s own body (usually from the abdomen or waist area) and, after special processing, inject it under the burn scar.

This procedure should not be considered merely as a filler. Fat tissue is extremely rich in stem cells. These injected stem cells trigger the damaged tissue to repair itself. A hardened, adherent, and dull-looking burn scar softens after fat grafting, its color lightens, and its elasticity increases.

The effects of fat grafting are:

• Softening the skin
• Correcting color
• Reducing pain
• Adding volume
• Increasing elasticity

We frequently use this method especially in burn sequelae of the facial region to restore volume loss and revitalize the skin.

In which cases are laser treatments preferred?

With the advancement of technology, laser systems have become an indispensable part of burn treatment. We are no longer dependent solely on surgery. Lasers are used for widespread scars that are not suitable for surgery or to improve the outcome after surgery.

Fractional Carbon Dioxide (CO2) lasers are the technology we use most frequently. This laser creates microscopic holes on the skin that are not visible to the naked eye. This controlled injury causes the body to produce fresh and organized collagen in that area. As a result, hardened burn tissue softens, surface irregularities decrease, and the scar becomes flatter.

Pulsed Dye Laser (PDL) is more effective in red and vascular scars. The laser light targets the capillaries within the scar. As vascularity decreases, the redness of the scar fades, itching stops, and elevation decreases. These treatments are usually performed in sessions and require patience.

What is the approach in special areas such as the hand and face?

The face and hand are the most critical areas both aesthetically and functionally. In facial burns, our basic principle is the concept of the “aesthetic unit.” Our face is divided into regions such as the forehead, nose, cheeks, and chin. When performing a repair, we aim not only to replace the wound site but, if possible, to replace the entire aesthetic unit. In this way, patch-like borders are hidden within the natural transition lines of the face, preventing a “patchwork” appearance.

In hand burns, priority is always movement. Tightenings (contractures) that prevent finger flexion can turn a person’s life into a nightmare. If we are going to use a skin graft in these areas, we prefer full-thickness grafts with the lowest risk of contraction.

The functions we aim to preserve in hand burns are:

• Grasping ability
• Finger flexion
• Sense of touch
• Fine motor movements

If necessary, we salvage finger movements with more advanced techniques such as rotating tissues elevated from the side of the finger to the damaged area (flap surgery).

How effective are supportive methods and patient compliance in treatment?

Surgery and lasers are the physician side of the work, but a large part of success depends on the patient’s compliance and patience. Burn treatment is not a process that ends when you leave the operating room.

Compression garments are one of the most effective methods to prevent hypertrophic scar formation. These garments, tailored to the patient immediately after the burn has healed, should be worn for nearly 24 hours a day. Continuous pressure prevents collagen fibers from becoming disorganized and raised.

Silicone gels and sheets also regulate healing by keeping the scar moist. In addition, in stubborn and raised scars, we can suppress elevation by injecting steroids (cortisone) into the scar.

Things to pay attention to at home are:

• Sun protection
• Regular moisturizing
• Massage application
• Use of compression garments

Another method that has become popular in recent years is Botulinum Toxin (Botox). When applied early after the wound has closed, it helps a thinner scar remain by reducing tension in the muscles around the wound.