Burn reconstruction

Many patients have undergone several operations, experienced complications and received different treatments. We review what has been done, how recovery progressed, and any concerns or past experiences that may influence your confidence and decisions today.

We assess scars, their adherence to underlying tissues, scar contractures and range of movement. How long a joint has been restricted also matters.

Photographs, videos and measurements help document function. When we suspect tendon or joint involvement, we coordinate assessment with orthopaedic surgery. Vascular investigations are reserved for reconstructions that require them.

We consider your priorities alongside the duration of each treatment and whether stages can overlap when their recovery requirements are compatible.

Some plans take months; others require longer. Where alternatives are possible, we explain different treatment sequences, taking into account the time and commitment you can manage.

Rehabilitation, physiotherapy, pressure garments, silicone and scar treatments can play an essential role. Surgery is considered when it offers an appropriate solution to the problem.

Healthy tissue is a limited resource. Reconstructing one area should not unnecessarily compromise the options available for treating other areas.

A tissue expander is placed beneath healthy tissue and gradually filled to provide additional coverage for reconstruction. Like a balloon being inflated, it increases in volume, allowing the overlying tissue to stretch and adapt.

We begin filling once the wound has healed, provided there are no contraindications. The pace is tailored to the tissue, location, your tolerance and practical arrangements, within medically appropriate limits.

We may slow down or pause filling if pain, wound problems, changes in circulation or signs of a complication develop. After reaching the target volume, a further period of tissue adaptation may be needed before reconstruction.

The expander creates a bulge that may be visible and uncomfortable. Before surgery, we explain its temporary impact on daily life and the follow-up visits required.

Infection, exposure of the expander through the skin, rupture or problems with the overlying skin may alter the treatment plan and require further surgery. Understanding these possibilities beforehand helps you approach the process with clear expectations.

Activity restrictions may be minor or require several weeks of protection. The area treated, any skin graft or flap, and the underlying structures involved determine positioning, wound care and movement recommendations.

We coordinate wound protection with rehabilitation medicine and physiotherapy. Movement, stretching and splints are adapted to tissue stability and healing progress.

Scarring of the skin and soft tissues can restrict movement, but tendons, muscles and joints may also have adapted to a longstanding limitation. Releasing the skin does not always restore function immediately.

Rehabilitation and the maturation of internal and external scars continue after surgery. Improvement may be partial and gradual.

Possible complications include delayed wound healing, infection, haematomas, seromas, and partial or complete loss of a skin graft or flap. The risks depend on the individual reconstruction.

Alongside explaining these risks, we discuss how they may be managed: wound care and observation for small affected areas, specific treatments, or further surgery when necessary. The available options depend on the cause, extent and tissues available.

Our nursing team provides wound care as often as needed. The medical team monitors healing and determines whether changes in treatment or further procedures are required.

Once there are no open wounds, pain is controlled and your general health allows, we can plan your return home and arrange continued follow-up, provided this is compatible with the next stages of treatment.

Sun protection, moisturising and scar massage are introduced once the team confirms that the wound has healed sufficiently. Silicone sheets or gel may be recommended depending on the area, the surgical technique and how healing progresses.

Care continues until the scars have matured clinically. Scars do not all mature at the same rate, even in the same person. If a scar becomes raised, firm, itchy or develops unfavourably, the Institut Ruiz Castilla (IRC) team will assess whether specific treatment is needed.

Contact us if you notice increasing pain, persistent bleeding, a rapid change in swelling, spreading redness or increasing warmth, fever, discharge, wound opening or any other change that concerns you. You do not need to decide whether it is a complication: the team will assess it.

Institut Ruiz Castilla (IRC) provides on-call medical support 24 hours a day, seven days a week. Medical and administrative contact numbers are included in your care instructions.

If you experience difficulty breathing, chest pain, fainting or another clear emergency, seek urgent medical attention rather than waiting for a scheduled appointment.