BASICS OF BURN MANAGEMENT

Transcription

1 BASICS OF BURN MANAGEMENT Dr S M Keswani Cosmetic Surgeon National Burns Centre, Airoli,Navi-Mumbai Breach Candy Hospital Wockhardt Hospital

2 National Burns Centre, Airoli, Navi-Mumbai.

3 CLASSIFICATION 1. FIRST DEGREE 2. SECOND DEGREE 3. THIRD DEGREE

4 First degree ( superficial ) burns First-degree burns involve only epidermis of skin.the burn site appears red and it is very painful.

5 Second-degree (partial thickness) burns Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.

6 Third-degree (full thickness) burns Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. The burn site appears white or charred. There is no sensation in the area since the nerve endings are destroyed.

7 First degree burns

8 Second-degree burns

9 Third-degree burns

10 Body Surface Area of Burns(% ) Rule of Nines Rule of Hand Lund and Browder Classification

11 Chemical burns Thermal burns Electrical burns Flash burns Inhalation burns Scald burns

12 INTERNAL BURN

13 Third degree burns of legs

14 SUPERFICIAL BURN

15 First-Aid In Burns POUR WATER ON BURNS TILL BURNING SENSATION SUBSIDES Electric Burns-Separate from source of electricity and pour water Chemical Burns-Irrigate the burn with water-stand under a shower

16 First Aid POUR WATER ON BURNS TILL PAIN SUBSIDES

17 CHEMICAL INJURY TO EYE First Aid, Flash with Saline Continuously

18 Criteria for hospitalisation(american Burn Association) Burns>20% in adult,10% in child Chemical or Electrical Burns Inhalation burns Burns involving vital area- face,genitals,hands,feet Circumferential burns Burns in elderly,neonates and medically compromised

19 EARLY MANAGEMENT INTRAVENOUS FLUIDS NASAL OXYGEN PAIN MANAGEMENT INTRAVENOUS ANTIBIOTICS BLOOD TRANSFUSION NUTRITION

20 Dressing Techniques Puncture the blister Do not remove the dead skin Clean with normal salin Non-adherent dressing(sofratulle) Thick layer of 1%Silversulphadiazine Thick layer of absorbent gauze Elastocrepe Bandage

21 BURNS DRESSING SILVER SULPHADIAZINE 1% POVIDONE IODINE 5% POTATO PEEL BANDAGE SOFRA TOULLE DRESSING SKIN SUBSTITUTES

22 The SKIN SUBSTITUTES now available can be divided into three categories, depending on their origin and physiochemical composition: Biological skin substitutes Synthetic skin substitutes Biosynthetic skin substitutes.

23 BIOLOGICAL SKIN SUBSTITUTES Pig skin human amniotic membrane collagen derivatives cultured allograft.

24 AMNIOTIC MEMBRANE IRRADIATED AMNION (TMH TISSUE BANK)

25 COLLAGEN APPLICATION

26 SKIN BANK SKIN BANK ARE SIMILAR TO BLOOD BANK. THEY STORE SKIN FROM DONORS. DONORS SKIN IS CALLED ALLOGRAFT. IT IS PRESERVRD IN SOLUTION OR FROZEN. THIS SKIN IS TEMPORARY COVER. MANY TIMES THIS GRAFT IS REJECTED.

27 SYNTHETIC SUBSTITUTES Duoderm (polyurethane and hydrocolloids) Opsite (polyurethane film) Omiderm (acrylamide film and hydroxyethylmethyerylate with polyurethane).

28 BIO SYNTHETIC SUBSTITUTES Yannas and Burke's artificial skin (Silastle film, collagen, chondroitin sulphate) Biobrane (silicone film, nylon, collagen -derived peptides).

29 SEVERE THERMAL BURN

30 BIOLOGICAL SKIN Integra

31 BIO- SYNTHETIC SKIN SUBSTITUTE.(BIOBRANE)

32 BIO-SYNTHETIC SKIN BEFORE AFTER

33 GLYCEROL PRESERVED AUTOGRAFT (DONOR SKIN)

34 Tissue Culture Allogenic keratinocytes Autogenic keratinocytes SKIN CAN NOW BE GROWN IN A LABORATORY

35 Spray -on-skin Skin is now available as Nasal Spray and can be sprayed onto the burn wound Fiona Woods-awarded Australian Woman of the Year AWARD for this monumental work

36 SEVERE SEPSIS

37 LATE MANAGEMENT SURGICAL TREATMENT SURGICAL SKIN GRAFTING. DELAYED 1. EARLY EXCISION & EXCISION&SSG STSG 2. DELAYED EXCISION & STSG. Wait for slough to separate out- 3wks SSG (Meshed)

38 SURGICAL TREATMENT DELAYED EXCISION & STSG IN STAGES GRAFTING IN STAGES ANTERIOR CHEST WALL WAS COVERED One thigh WITH and leg STSG used FROM to graft THIGH part of (FIRST opposite STAGE) thigh, the anterior chest wall and medial aspect of the rt.upper arm

39 FULLY COVERED WITH GRAFT (FINAL STAGE) SURGICAL TREATMENT Opposite thigh and leg and both upper extremities are used to cover the remaining raw areas

40 Burns following epileptic Convulsion

41 Post Skin Grafting

42 POST BURN AXILLARY CONTRACTURE RELEASE PRE OP VEIW POST OP VEIW

43 Post burn contracture of hand

44 Post Burn Hypertropic Scaring of Hand

45 Tangential excision of Skin Grafting

46 Linear Scar on Face (Pre-op)

47 2- Plasty (Post-op)

48 Prevention- Early Resurfacing

49 Multiple Z- Plasties

50 Postburn Neck Contracture

51 Operative Procedure

52 Severe Post burn neck contracture

53 Release of contracture and skin grafting

54 Contracture released and skin grafted

55 PREVENTION OF CONTRACTURES & HYPERTROPHIC SCARS EARLY PHYSIOTHERAPY PRESSURE GARMENTS PRESSURE GARMENTS CICA CARE(Silicone gel sheeting)

56 BURN CENTRE PLASTIC SURGEON GENERAL SURGEON ANAESTHETIST INTENSIVIST DIETICIAN PHYSIOTHERAPIST MICROBIOLOGIST SOCIAL WORKER TRAINED PARAMEDICAL STAFF

57 The more you give the more you get, Experience the joy of giving, Giving not money,but of yourself, It is only when you give of yourself, That you truly give! -Kahlil Gibran (The Prophet)

58 If my mind can conceive it, If my heart can believe it, I know I can achieve it -Jesse Jackson

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