Burn surgery

[Anasazi]

I am an MSIV about to finish up a two week surgery rotation on a burn service which covers adult burns and pedi patients at a shriner's hospital. It has been an excellent experience. The fellows and attendings are more approachable than any I've been around, the lifesaving nature of the treatment seems pretty high-yield, and there's a lot of critical care involved, especially with the bigger burns. It's been an adjustment to be in an OR with >80 temperatures and the debridement and grafting is some of the bloodiest surgery I've seen. After my exposure here, I have looked to see which of the programs I applied to have burn exposure. My question to you more experienced folks is; why is burns so obscure on the spectrum of surgical subspecialties? My impression is that burn fellowships are easy to come by, and they seem to provide quite a niche if you combine it with trauma/critical care. I can imagine several reasons why burn surgery wouldn't appeal to most general surgeons, but I'm curious what the reality is. Thanx

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[Winged Scapula]

I am an MSIV about to finish up a two week surgery rotation on a burn service which covers adult burns and pedi patients at a shriner's hospital. It has been an excellent experience. The fellows and attendings are more approachable than any I've been around, the lifesaving nature of the treatment seems pretty high-yield, and there's a lot of critical care involved, especially with the bigger burns. It's been an adjustment to be in an OR with >80 temperatures and the debridement and grafting is some of the bloodiest surgery I've seen. After my exposure here, I have looked to see which of the programs I applied to have burn exposure. My question to you more experienced folks is; why is burns so obscure on the spectrum of surgical subspecialties? My impression is that burn fellowships are easy to come by, and they seem to provide quite a niche if you combine it with trauma/critical care.

That's one of the problems...its a niche specialty which requires an inordinate amount of resources. You simply cannot do a burn fellowship and set up shop in Podunk USA.

There are also political issues with regards to who runs a burn unit...is it the general surgeon who is fellowship trained in burns, is it the plastic surgeon, or is it the general surgeon with trauma training?

The other issues you may have suspected are those of any critical care specialty...lots of emotional trauma, social work duties, call, late nights, sick patients, etc. Many people are also unattracted to the specialty because the procedures are mind-numbingly boring without a lot of variety (after awhile) and its mostly critical care.

 

[Blade28]

What KC said.

Keep in mind that the majority of Burns cases are "TE & STSG" (tangential excision and split-thickness skin graft), trach/PEG, or the occasional rotational/advancement flap.

We have a great Burns experience here (large regional burn center), but it's mainly those procedures, every single day.