Managing Burns and Limb Trauma

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Surgical Considerations

Zone of injury

Definition: The area surrounding a wound that is traumatised but may not appear so. Loos MS, Freeman BG, Lorenzetti A. Zone of injury: a critical review of the literature. Annals of plastic surgery. 2010 Dec 1;65(6):573-7.  It may be difficult to define the response of soft tissue and bone to traumatic injury. Thorough assessment and careful consideration of the zone of injury are needed when deciding the level of amputation.

Burn injuries produce a definable zone of injury. The Jackson’s Burn Model divides the wound into these zones: Whitaker I, Shokrollahi K, Dickson W. Burns. OUP Oxford, 2019.

Zone of coagulation

Zone of stasis

Zone of hyperaemia

Read more about the local response to burn wounds here: https://www.physio-pedia.com/Assessment_of_Infection_in_Burn_Injuries#Physiological_Response_to_Burn_Injuries

Consideration of zone of injury in amputation

How is MDT involved in discussion around zone of injury and amputation decisionsKeszler MS, Wright KS, Miranda A, Hopkins MS. Multidisciplinary amputation team management of individuals with limb loss. Current Physical Medicine and Rehabilitation Reports. 2020 Sep;8:118-26.

Flap techniques

Different flap techniques may be used to close the wound and create a functional stump. Techniques include:

Long posterior flap – this is the most commonly used technique

Benefits of posterior flaps: Dewi M, Gwilym BL, Coxon AH, Carradice D, Bosanquet DC. Surgical techniques for performing a through knee amputation: a systematic review and development of an operative descriptive system. Annals of Vascular Surgery. 2023 Jan 26.

Provides distal coverage

Improves vascularisation

May improve wound healing outcomes

Suture line is away from end weight-bearing surface

Skew flap

Sagittal flap

Medial flap

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