Introduction:
Although he did not open the burn center at University of California Irvine, Bruce Achauer was the pioneer who subsequently edited the benchmark: Burn Reconstruction.
We are at the precipice of a “mass extinction”. The practice of several elegant burn reconstruction techniques he described are quickly becoming “lost art”—surgeons with first-hand experience retiring without having passed on that knowledge in a living fashion.
Contrarians would point to these techniques in printed pages. But no discourse would equal the value of surgical nuances passed on from mentor to surgical pupil—scalpel in hand.
Others see advanced techniques readily done by non-burn surgeon consultants. The seminal message: out of the hands of generalist burn surgeons—responsible for all aspects of burn care—availability, nuanced execution, seamless integration, and compulsory follow up are substandard. Non-burns consultant surgeons don’t have experience working injured/scarred skin.
Examples:
Conclusion:
In 2024, a huge range of techniques has moved surgical art forward. New forces are at play--economically biased interests: expensive new biologics and medical devices for burns. The realities of medicolegal risk progressively shear scope of practice for the burns generalist--accelerating this extinction of prior savoir faire. Without passing on the knowledge in “living fashion”, no recourse in the future will reincarnate these priceless “lost arts”.