Plastic reconstruction and skin cover after injuries and burns.

THE PURPOSE of this paper is to summarize, for the benefit of busy surgeons in Casualty and Accident Departments, the role of plastic surgery in relation to injuries-including bums-in which the patient has suffered a serious breach of the 'skin envelope'; and also to consider certain aspects of facial injuries. It is not easy to cover so wide a subject in a small space, and technical details can only be given for some of those procedures which lie reasonably within the compass of an Accident Department; but at the same time it is possible to hint at more complex procedures which may be carried out in an appropriate specialist unit. The normal physiology of the body demands integrity of the skin envelope, and any serious breach in this may endanger life as well as health. In all serious burns and in many other injuries such a breach occurs, and the patient with a large exposed area suffers a double danger: on a systemic scale there is the hazard of a generalized infection where the entry of organisms can cause bacteraemia or septicaemia; and at the same time, particularly in burns, there is a gross disturbance of the body's biochemical balance. The local effects, also, are often serious; these include infection, oedema and pain. They do not necessarily endanger the patient's life but they are certainly a menace to comfort and often to function.