Hi Andreas. Have you been referred to a burns unit as an adult within the NHS?
A possible solution is tissue expansion.
This is taken from the NHS site.
This is a method that is used to ‘grow’ more skin. It is most commonly used in breast surgery for reconstruction following mastectomy, or for example when breast development has not occurred or there is a difference in breast sizes. It is also used in reconstructive surgery for burns patients where it can be used to expand hair bearing scalp to cover areas when the hair has been burnt away. It can also be used for breasts and scalps, that have been affected by cancer, injury, or abnormalities that are present from birth. There may be other reconstructive methods that can be used so it is important that you talk to your surgeon to decide if this is the best method for you. A tissue expander is a balloon made from silicone that is attached to a small inflation port. It is placed under the skin. It comes in various shapes and sizes. The balloon is gradually filled by injecting fluid through the inflation port to allow the body to ‘grow’ more skin.
This method is likely to produce a good match for the colour and texture of your existing skin. You will need a general anaesthetic for this operation. The surgeon is careful to place the injection port in an easily accessible site, away from the expander itself. Sometimes the port is actually part of the expander and located with a magnet (see second image above) During the operation, saline (salt water) will be injected into the expander. Once you have been discharged you will need to go to the outpatient department, so that more fluid can be injected into the expander. This is a time consuming process and it needs to be repeated several times so that the skin can gradually stretch to allow the insertion of a prosthesis (implant), or enough extra skin has been grown to cover the adjacent area. The amount of fluid that is injected at any one time depends on how your skin looks whilst the fluid is being injected and how much discomfort you have.
The fluid cannot escape from the expander as there is a valve between the expander and the tube. This method of reconstruction takes place over many weeks. Once the period of adding fluid is finished, the expander is kept in place for several weeks to allow the skin to adjust before it is removed. Are there any risks? Tissue expansion works very well in breast reconstruction and on the scalp. When used in other parts of the body it may not achieve the desired results. This is because a hard surface under the skin, such as the scalp, is needed so that the skin can be stretched. There are very few risks associated with tissue expansion. It is a common operation and it is generally safe. However, all surgery comes with some element of risk. The most common side effects are swelling and bruising often associated with pain or discomfort. Scars This operation cannot be performed without causing a scar.
The position of the scar depends on why and where the tissue expander is placed. Stitches are normally dissolvable (they do not need to be removed). Sometimes scars can become very ‘raised’ and look unsightly. They can also be red and itchy. They tend to improve over time. Haematoma Despite the use of drains, blood does sometimes collect around the expander. This is called a haematoma. Sometimes a second small operation will be necessary to remove this. Wound breakdown and infection Sometimes wounds heal more slowly than expected and might occasionally weep or ooze. Antibiotics may be required to treat this. If the scar breaks down or a deep abscess forms that exposes the tissue expander it may have to be removed. Treatment with a high dose of antibiotics will also be given. This complication rarely happens and you would have to discuss future attempts at tissue expansion with your surgeon. Rupture of the tissue expander Rarely, the tissue expander can rupture or tear. If this happens and the expander cannot be inflated, it will have to be removed. The fluid inside the balloon is sterile saline and will not cause any problems. Again, your options about further surgery will have to be discussed with your surgeon. Deep vein thrombosis (venous thromboembolism - VTE) This is caused by a blood clot forming in the leg veins. To help prevent this you will be encouraged to be up and about as soon as possible after the operation. Blood clots are a serious complication and if a clot breaks away from the vein in the leg it can travel to the lungs and cause a pulmonary embolism which can be fatal. To help prevent this happening you may be given a small injection of a blood thinning medicine every day. This makes your blood take slightly longer than normal to clot which reduces the risk of a blood clot forming.