BURN AND RECONSTRUCTIVE SURGERY CLINIC

Acta, vol. 45 - 2003

BURN AND RECONSTRUCTIVE SURGERY CLINIC

FACULTY HOSPITAL OF THE MASARYK UNIVERSITY IN BRNO - 20 YEARS


In 2002 twenty years passed since the foundation of the first specialized burn center in Brno. We would like to take advantage of this anniversary to reflect back on the past and also to consider what can be done better in the future and how.

Independent Burn Center in Brno was, in the concept of Czechoslovak healthcare, founded soon after the Second World War. Particularly owing to Prague based academician Frantisek Burian, Czechoslovakia had very soon a good plastic surgery concept, which has taken into account also the network of burn clinics. In Prague such workplace was founded already in 1953 as the first one in continental Europe. Burn centers in Ostrava, Kosice and Bratislava followed. On the whole there was, typical for that time, lack of will to build up a similar workplace also in Brno. Burned patients in southern Moravia where shared by the Trauma hospital, Plastic surgery clinic in Berkova street and district or city hospitals on their surgery and children's departments.

The main impulse to establish an independent burn center in the setting of the Trauma hospital were three accidents in Brno's heating plant, which caused dozens of victims. The unit had a capacity of 10 beds with one to two intensive care beds with small dressing change room.

In December 1. 1989 the unit moved as an independent unit to a newly built Faculty Hospital in Bohunice. The workplace was named "The Center for the Burned". In 1990 children's burn unit was transferred there from the Surgery unit at the Children's hospital. Another significant move forward was building up a skin bank within the Tissue center for skin cultivation at the Teaching hospital of Masaryk University.

At Christmas 1995 Department of Reconstructive surgery joined to the center and the capacity of the whole workplace increased from 30 to 60 beds. The name has been changed to Burn and Reconstructive surgery centre".

The workplace has significantly participated in activities within the Teaching hospital and Medical Faculty at the Masaryk University medical students training, post gradual training of doctors, lectures, publications, and organization of international symposiums etc.

As an expression of respect from the scientific community, our workplace has been given the statute of Clinic. The Clinic of Burn and Reconstructive Surgery of the Medical Faculty of the Masaryk University in Brno has been established as a teaching and medical workplace. Presently the clinic is divided into two parts: the burn department and the department for reconstructive surgery. The burn department has three units the Intensive care unit with five beds, this unit is equipped far resuscitation of any type and extent of a burn injury within any age group. The intermediate care unit with 3 beds is associated with standard 13 beds unit and children's unit with 9 standard beds. The total capacity is 30 beds for acute burn care. The department of Reconstructive surgery in the 10'° floor has 6 Intensive care beds and 18 standard beds for reconstructive surgery. The total capacity of the Clinic is 54 beds. We have 2 outpatient departments admission and specialized outpatient departments, three operating rooms and a small rehabilitation unit.

The clinic employs 24 doctors, of which 11 are plastic surgeons, 7 surgeons before the 2"d attestation and one pediatrician. Internist and psychologist are our regular visiting consultants. There are 54 nurses, 13 members of auxillary staff and 3 therapists.

The clinic treats yearly 10 000 outpatients, approximately 1300 patients are hospitalized, out of which 300 patients are admitted with acute burns. 35%-40°% of all burns are scalded kids under 3 years. Other patients are admitted for reconstructive surgeries, mainly hand surgery, where we cooperate with the Surgery clinic.

The clinic provides complex and continuing therapy of burned patients (not only acute, but all continual care) from southern Moravia and adjacent parts of the former Northern Moravia district, Southern and Eastern Bohemia districts. By completing therapy of 300 acutely burned patients the Clinic becomes a big burn center by the all-European standard. Medical care for acutely admitted burned patient is ensured by burn specialized surgeon that is continually on-call. An erudite anesthesiologist is also available in cooperation with the Resuscitation unit.

The department of reconstructive surgery deals with the following problems:

• Treatment of chronic wounds and soft tissue defects, particularly pressure sores, calfulcers, diabetic necrosis etc. The department cooperates with surgical clinic, Dermatological and Venereological clinics.

• Hand surgery - defects of soft tissues of the hand, bone and tendon injuries - in cooperation with Surgical and Orthopedic clinics.

• Lawful operational treatment of transsexuals cooperation with Sexology department.

• Treatment of the defects of soft tissues in face, particularly tumors - cooperation with departments of Otorhinolaryngology and Stomatoplasty.

When we speak about the history and present of the Burn and reconstructive surgery, clinic bare list of functions and activities would not enough. It is important to reflect on our strengths and weaknesses, what we have done well and what could be done better. Our strengths are in particular:

Complexity - by centralization of the treatment of burned patients, equipment of our workplace and continual professional education of the team we are getting more success and economy of therapy of critical burns. It is well known that by the establishment of specialized burn centers efficiency of the treatment improves and that has also been our case. Although there is not enough statistics, evidently in the past 20 years the percent of survival of the critically burned patient and patients with inhalation injuries has increased so much so that today it is not exceptional that patients who sustain injury to 75-80°/ of their body surface can survive.

Skin bank and cultivation laboratory gives us the possibility to prepare various modern biological skin replacements, such as cultivated keratinocytes in vitro, preparation of allogeneic acellular dermis etc. There are only few burn centers with similar possibilities. That is the cause of growing interest of the foreign countries to participate in clinical studies.

Microsurgery, particularly microvascular technique is a modern part of present plastic surgery and opens the possibility to freely transplant complex parts of body (skin, muscle, bone) to another location - free flaps. The presently build microsurgery team is able to offer a wide spectrum of possibilities not only to the patients treated on our clinic, but also to other surgery units at the hospital.


Prospects of the Burn and reconstructive surgery clinic

The prospects of future development of the Burn reconstructive surgery clinic can be seen in three main areas:

  1. Development of the speciality - it is possible to expect further improvement in resuscitation of critically burned patient and increased survival rate of patients with an extreme extent of injury. Better quality of reconstructed skin determines quality of life after major burn injury.
  2. European integration - brings and will bring many more tasks in everyday life by means of standardization of terminology, equipment of the workplace and all steps of treatment of burr, injury patients. This will lead to consistent application of the ISO quality standard and successive accreditation of our workplace, so that all "western-European" standards are accomplished. When the borders are abolished and population is moving more freely, we will frequently be treating patients with insurances other than Czech.
  3. Development of the clinic - Although we consider the present capacity of the clinic insufficient relatively to its function, the next development is not going to be extensive growth, but improved quality of work. This means particularly improvement of economic results, faster application of new information in resuscitation care in our practice, better quality of reconstructed skin by widening the spectrum of biological skin grafts and widening the spectrum of plastic surgeries. We would also like to improve the work of the two outpatient departments, so that these could work in defined conditions, to increase outpatient surgeries and also widen the rehabilitation services. In relation to Medical Faculty we would like to improve the quality of pre and post graduate teaching, improve the quality of published materials, aspire on success in obtaining grants and participate maximally in national and international research programs.

In conclusion, I would like to thank the management of the Faculty Hospital in Brno and to the management of the Medical Faculty of the Masaryk University for continuous efforts to promote good working conditions in times which are not easy. I would like to also thank my colleagues for everything they have done for growth of our workplace, its good reputation and particularly what they have done for the patients.



Professor P. Brychta, M.D., PhD.
Chief of the Clinic
Department for Burn, and Reconstructive Surgery
Jihlavskŕ 20
625 00 Brno
Czech Republic