Burns and advanced technology: innovative care models at Niguarda

A place where every step is planned, every environment is protected, and every action is supported by the most advanced technology: the new Burn Center of Niguarda Hospital in Milan is now one of the most advanced facilities in Europe for the treatment of burn patients.
An ambitious project, funded by the Lombardy Region, marking a major leap forward in emergency management and reconstructive medicine.

Leading the new centre, Professor Franz Wilhelm Baruffaldi Preis, Director of the Complex Unit of Plastic and Reconstructive Surgery and Burn Centre at Niguarda, explains: «What we needed was a modern facility, with more beds and with an intensive care unit inside it».
The centre has a total of twelve beds, seven of which are for sub-intensive care and can be converted to intensive care in the event of emergencies or large-scale accidents. A crucial aspect concerns the patient’s pathway for access and treatment. «Patients arriving from the helipad are taken directly to the shock room inside the burn centre. Here they are prepared, treated, cleaned, and intubated. After that, they reach their station without having to move through the hospital».

Another strength is the direct connection to the operating room of the Emergency Department (DEA). «Previously, patients had to leave the burn center to reach the operating room. Now, thanks to the renovation of the ward, the patient goes directly from their room to the operating room and back to the burn center, avoiding discomfort for both patient and staff. This also prevents possible contamination with the external environment».

Burn treatment in line with European Standards

The new center also stands out for its internal organisation. Under Professor Baruffaldi Preis, Dr. Antonella Citterio, plastic surgeon, anesthesiologist, burn specialist, and head of the Niguarda burn center, plays a key role. «Thanks to her work, our collaboration, and the improvements implemented, we expect to receive recognition from the European Burn Association, becoming the first Italian burn center to meet full European standards».
Staff expansion is another major advancement: alongside fifteen full-time plastic surgeons, five dedicated intensivists will provide around-the-clock care for the most critical patients.

Cutting-Edge Solutions for Burns

New technologies support tissue regeneration and reduce healing times. These include advanced dermal substitutes and the Tissue Bank. «Niguarda is one of the few hospitals in Italy with a Tissue Bank where skin from organ donors is processed and made available to patients through a cooling and freezing cycle – the professor states – We are also studying the possibility of lyophilisation. This donor skin allows us to repair and cover patients in the intermediate phase, between admission and the definitive reconstruction using autologous tissue».

The new center also performs enzymatic debridement, meaning «the removal of necrotic tissue when the patient arrives in the acute phase, within the first or second day, using a substance that eliminates dead tissue without harming vital tissue. This reduces trauma and bleeding». Performed within the first 24–48 hours, this treatment prepares the patient for temporary coverage with donor skin.

A multidisciplinary path toward healing

A multidisciplinary approach is essential for burn patients, who often present complex conditions. The presence of dedicated anesthesiologists helps make care more humane.
«Until the 1980s, burn patients were treated while awake. You can imagine the pain caused by removing dressings stuck to the burn, an unbearable trauma. Today, no patient is expected to suffer: every surgical action, from procedures to dressing changes, is performed under sedation, even when dressings are required on alternate days for months».

Beyond reconstruction, the goal is to help patients resume social and working life, restoring an appearance that is acceptable both to them and to others. Niguarda uses innovative lasers and medications that modulate scar rigidity and thickness, improving movement and function.

The patient population is equally complex, including elderly individuals with comorbidities, patients on dialysis, and those undergoing chemotherapy whose immune response is compromised. In these cases, collaboration with infectious-disease specialists is essential to manage infections, properly adjust antibiotic therapy, and prevent resistance.
«It is important to remember that every medication, including antibiotics, brings benefits on one side but is still a toxin on the other, since drugs can cause organ issues and toxicity. This is why they must be managed correctly, and having an infectious-disease specialist calibrate therapy daily is crucial for our patients».

Ensuring safety and continuity of care

One of the most significant advances in burn care is the precise modulation of fluid therapy in the acute phase. «If fluid, protein, plasma, and electrolyte therapy is correct and calibrated, the patient maintains adequate circulation, ensuring better outcomes in subsequent phases of healing». Errors in this phase can cause organ damage, such as fluid accumulation in the lungs or tissues, complicating future therapies.

For this reason, it was established with the Lombardy Region that all burn patients should be brought to Niguarda’s emergency department, where they can be evaluated and stabilized immediately by intensivists.
Transfers across the region are coordinated by AREU (the Regional Emergency Agency), which ensures an efficient network among major Lombardy emergency departments. «Thanks to this network, stabilisation can occur directly in our emergency department or remotely, as emergency staff can consult directly with the burn centre».

Surgery, rehabilitation, and psychology

Major complications affect patients with extensive burns who require many surgeries and long hospitalisations. Limited availability of autologous donor sites makes reconstruction difficult, while prolonged immobility may cause joint dysfunction. Aesthetic challenges also remain significant due to disfiguring scars on the face and body.

Functional and aesthetic improvement may be limited if patients do not follow rehabilitation properly after hospitalisation. This is why psychological support is essential: motivation and active participation greatly influence outcomes.

For extensive burns affecting over 60–70% of the body surface, aggressive treatments are required. The remaining 30% of intact skin is often insufficient to cover the affected areas, making donor skin necessary.

Minor burns can sometimes be managed independently by removing clothing, disinfecting, and covering the lesion. However, an emergency department evaluation is still recommended.
«It is important to understand the depth of the burn, and if you are not familiar with medical evaluation, the best option is to go to the emergency department where a doctor can assess it properly. For more significant burns, the indication is always to go to the emergency department for a precise clinical evaluation».

A daily challenge

«A major focus must be on prevention, because everyday life contains many dangerous substances whose improper use can change someone’s life in an instant. Alcohol is one such substance – says Baruffaldi Preis – There are also many domestic accidents to consider. For instance, we see many children burned while inhaling steam over hot water. It seems trivial, but it has led to many hospitalisations and significant surgical procedures. Prevention campaigns would be enough to avoid such serious harm; even if they are done occasionally, people often forget the basic rules of what can happen».