Visão geral dos procedimentos cirúrgicos usados no tratamento de queimaduras

Abstract

Introduction: Burns are a specialized form of trauma and, as such, are managed according to recognized trauma resuscitation protocols. Typically, these protocols assess the trauma/burn patient through a structured approach that includes a primary survey of life-saving priorities, a secondary survey of head-to-toe injury examination, and a process of ongoing stabilization and reassessment that ultimately refers the patient to a definitive care facility. Objective: To discuss an overview of surgical procedures used in the treatment of burns. Methodology: Literature review from Scielo, PubMed, and BVS databases, from April to June 2024, with descriptors “Surgical Procedures”, “Burns” and “Treatment”. Articles from 2019-2024 (total 70) were included, excluding other criteria and selecting 05 full-text articles. Results and Discussion: Burns present many challenges to the surgeon due to the nature and extent of the injuries. The patient often suffers extensive skin loss that may occur in multiple anatomic locations, and patients with multiple injuries may also have other injuries that impact their treatment (e.g., inhalation injury, head injury, extremity trauma). The immediate goal of surgery in the treatment of burns is to restore function. Although appropriate measures are taken to limit scar formation, burns may require subsequent revision to achieve an optimal cosmetic outcome. Excision of burn wounds is essential in the treatment of deep burns to eliminate necrotic and potentially infected tissue. Early excision and coverage of burn wounds within the first five days is ideal but is not always possible. Split-thickness skin grafts are used to reconstruct large areas of burn wounds and provide coverage for donor flap sites. When donor sites are limited, expansion of split-thickness skin grafts using mesh techniques and harvesting of healed donor sites allows coverage of large surface area burns. Full-thickness skin grafts provide a more satisfactory aesthetic appearance due to their flexibility and are used in areas of special anatomic and functional importance. If autologous skin coverage is not possible, temporary skin coverage should be attempted. During recovery, a balance must be struck between immobilization to allow the skin grafts to heal and mobilization to restore function. Conclusion: Reconstruction of the dermis begins 3 to 4 days after the initial injury and is characterized by the formation of granulation tissue. Granulation tissue is interconnected with angiogenesis (formation of new vessels from pre-existing vessels). These are newly formed tissues with fibrous tissue cells.