Dr. David Kaufman, 37, heads the burn unit at the Valley Medical Center. As a plastic surgeon on the faculty at the Medical School, Kaufman’s job is to restore – as best he can – the skin that fire, chemicals or scalding water have burned off in painful, disfiguring accidents or crimes.
But before he can remove and replace blistered or – in the case of fourth- degree burns, charred – skin, Kaufman has to keep patients alive.
“It’s truly dead man walking,” says Kaufman of some of the 100 or so burn victims he’s tended at the hospital, which is a Level One trauma center, meaning ambulances bring the most acute life-threatening cases there.
As soon as the burn victim is rushed through the door, Kaufman and his team of surgeons, specialists and nurses are battling against time for the patient’s life. They must make sure the patient does not become dehydrated. Because burned skin swells, they have to make sure the patient’s airway passage doesn’t swell and become blocked. They have to help the patient with the agonizing physical pain and mental horror.
And they’ve got to decide which patients are burned so badly over so much of their bodies that there is no hope of saving them.
That’s the worst, says Kaufman.
“Most are awake when they come in,” says Kaufman. “They’re not salvageable, but still coherent. You have to tell them: ‘We have to let you die.’ ”
Those patients who have a chance of survival are usually operated on within 48 to 72 hours. This is often the first of countless surgeries. As one of the two plastic surgeons on staff, Kaufman must peel off sections of the dead skin and graft onto the wound a layer of skin from a healthy section of the body. These early surgeries are not for aesthetics, he says, but are another life- saving measure. Healthy skin acts as a barrier to infection, and without it, burn victims are prone to bacteria that can kill them. In addition, skin protects the body from temperature loss.
The bigger the burn area on the body, the more surgeries are needed, Kaufman says, since there is less unaffected healthy skin to borrow, or harvest, for a graft. It takes about 10 days for harvested skin from the healthy areas to grow back to be used again. In general, there is a 1-to-2 ratio between the percentage of burn loss and the number of days a patient spends in the hospital. For example, someone with burns over 50 percent of his body spends about 100 days in the hospital.
After Kaufman has grafted skin onto the burn areas, he does post-burn reconstruction, helping to restore flexibility, strength and movement to the scar tissue. He also works on improving the look of some of the disfigurement. But the skin never looks or feels the same.
Burn victims aren’t Kaufman’s only patients. He also handles breast cancer reconstruction, facial traumas, microsurgery and hand surgery.
He chose plastic surgery because he felt it was creative work with a lot of instant gratification, as the results are physically apparent.
An only child, Kaufman’s parents divorced when he was young. He was raised by his mother, a stock portfolio manager. A stellar science student in high school, he went to a summer class at the Air Force Academy and decided he’d like to check out the military. He attended the U.S. Naval Academy, and served five years as a Navy SEAL. Life as a SEAL was a blast, he says, “parachuting, chasing girls, having fun on the beach, just having a wild time.” Then came Desert Storm.