Sequellae of Chemical Burn.. Scar management in burn patient
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1 Sequellae of Chemical Burn.. Scar management in burn patient ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก กก ก ก ก ก ก (hypertrophic scar) ก ก ก ก ก ก ก ก ก immature ก ก กก ก ก ก ก ก ก ก ก ก ก ก immature (2-9 ) ก ก ก ก ก (Widespread hypertrophic scar) ก ก ก ก (Deep partial thickness and/or full thickness burn) ก ก deep partial thickness burn ก (Spontaneous healing) dermis ก ก collagen fiber ก ก deep partial thickness burn ก ก ก ก ก ก full thickness burn ก ก ก superficial partial thickness burn active stage ก ก ก ก ก ก ก ก ก ก ก ก mature ก ก ก ก (Widespread hypertrophic scar) ก 25. ก / - 1 -
2 mature ก ก ก ก ก ก ก ก ก ก 1. elastic bandage ก ก ก ก ก ก pressure garment 2. Tubigrip ก ก 3. Pressure garment pressure garment ก ก กก 25. collagen fiber ก ก pressure garment ก ก 1-3 pressure garment ก ก ก conformers ก ก ก conformers ก low pressure thermoplastics ก ก ก ก ก ก ก ก ก high temperature thermoplastics ก plaster ก ก 4. ก ก ก ก / 5. ก (surgical releases) ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก conformers ก ก ก 2 pressure garment ก 2-3 pressure garment - 2 -
3 Chemical burn ก ก ก ก ก ก ก ก ก ก ก กก ก ก ก ก ก ก ก ก ก ก ก ก ก deep partial thickness burn full thickness burn ก full thickness tissue loss, ก ก ก ก ก ก ก ก ก 1 ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก pressure garment ก ก ก ก maturity ก ก ก ก 2 ก ก ก - 3 -
4 ก ก ก ก ก ก ก pressure garment collagen fiber ก ก 3 ก pressure garment burn 4 ก silicone gel sheath ก ก ก silicone gel sheath International Clinical Recommendations on Scar Management Murtoe T.A. et.al. silicone gel sheath ก ก ก ก ก ก ก ก ก ก full thickness skin graft aesthetic unit ก ก ก ก ก ก ก ก 5 aesthetic unit - 4 -
5 ก ก ก aloplecia hair follicles ก ก ก 6 ก Juri s flap ก aloplecia ก burn ก aloplecia ก ก serial excisions tissue expander flap (Juri s flap) ก hair grafting ก ก ก ก ก scalp graft ก ก long term result graft 10% ก hair grafting ก ก ก hair follicle 1-2 hair follicle(s) ก ก ก ก ก ก ก ก ก K.N. Thai ก ก Cincinnati ก 30 deep burn 78% TBSAB full thickness burn partial burn ก (cornea) ก resuscitate Baxter formula escharotomies 2 ก acute resuscitation ก staged excision eschar ก split thickness skin graft debridement ก ก Candida albicans Gram-positive cocci ก exudates ก ก ก - 5 -
6 antibiotic ophthalmic ointments visual acuity test light perception ก donor tissue ก ก free tissue transfer ก ก canaliculi medial punctum ก Conjunctivodacryocystorhinostomy conjunctival flaps cornea nasal septal cartilage tarsal plate ก conjunctival flaps dorsalis pedes free flap end to end ก superficial temporal vessels 47 flap ก ก ก intraabdominal abscess ก ก ก ก ก ก temporal area superficial temporal fascia local flap ก thick split thickness skin graft 7 ก ก ก ก deep partial thickness burn ก ก ก ก 8 ก ก - 6 -
7 ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก ก 9 ก ก ก 3 ก ก ก ก ก ก ก ก thick split thickness ก ก 30 ก ก ก ก ก ก silicone ก ก ก silicone ก ก ก ก ก silicone ก ก epithesis implant ก ก mastoid ก ก ก ก ก ก ก ก ก ก ก ala wing ก composite graft ก ก ก ก ก total nose reconstruction oblique paramedian forehead flap ก ala cartilages nasal septum ก ก ก ala cartilages nasal septum ก total nose reconstruction ก ก ก free flap nasal surface costal cartilage graft ก ก oblique forehead flap - 7 -
8 กก ก ก ก forehead flap ก ก frontalis muscle ก ก paramedian oblique forehead flap forehead flap ก forehead flap กก ก 10 ก ก ก ก ก ก ก ก aesthetic subunit ก ก ก ก ก ก full thickness ก quilting ก recipient site ก ก hematoma, seroma ก philtrum composite graft root helix ก inferior crus antihelix ก ก (concave) 11 ก ก ก aesthetic unit - 8 -
9 ก ก ก ก ก ก soft collar ก mature ก ก ก ก ก ก ก ก ก ก ก ก thick split thickness free tissue transfer ก ก redial forearm free flap ก ก soft collar ก ก mature ก ก ก 12 ก ก ก free flap transfer 13 ก ก ก - 9 -
10 Squamous cell CA on burn scar ก ก ก ก ก ก ก squamous cell carcinoma ก ก ก ก ก ก ก ก ก squamous cell carcinoma ก ก ก ก ก ก ก lymph nodes resection ก wide excision 1 2 ก ก ก ก Marjolin s ulcer References 1. Schneider R.M., Simonton-Thorne S.: Treatment of Joints and Scars in Management of the Burn Patient B.M. Achauer ed., Appleton & Lange 1987, P Murtoe T.A. et.al.: International Clinical Recommendations on Scar Management, Plastic and Reconstructive surgery, 110: , Press B.: Thermal and electrical injuries in J.W. Smith, S.J. Aston(Eds), Gralbb and Smith Plastic Surgery 4 th ed. Liltle, Brown and Company 1991,P, Thai K.N., Billinire D.A., Yakuboft K.P.: Total Eyelid Reconstruction with Free Dorsalis Flap after Dacial Burn. Plast. Reconst. Surg. Vol 104(4) September P Brent B.: Technical Advances in Ear Reconstruction with Autogenous Rib Cartilage Grafts: Personal Experience with 1200 cases. Plastic & reconstructive Surgery. 104(2): Walton R.L., Beahm E.K.: Auricular Reconstruction for Microtia:Part ll. Surgical Techniques. Plastic & Reconstructive surgery. 110(1): , Chichareon V., Donsakul N.: Total Ear Reconstruction, J. PRAS of Thailand, 1988;4(1-2): Beahm E.K., Daniel R.K., Menick F.J. and Waton RL.: Challenges in Achieving Satisfactory Outcomes in Cosmetic and Reconstructive Nasal Surgery. Annual Meeting of American society of Plastic Surgeons, Plastic Surgery October 25 th -29 th, San Diego, CA
11 9. Brackley P.TH., Spencer J.N.: The Use of a Periostial/Forehead Flap with Sandwiched Conchal cartilage graft: A novel Approach for Nasal Reconstruction in the Absence of a Nasal septum. Plast & Recon.Surg. 110(3): , Chichareon V., Donsakul N., Chowehurej V., Sanguanchua P.: Nose Reconstruction in Burn Patients at Songklanagarind Hospital, 26 th Annual Meeting of Royal Collage of Surgeons of Thailand, Pataya. Cholburi Thailand July 5 th Song, R, Ling y., Wang b, et.al.: One-Stage reconstruction of nose : The Island Frontal Flap and the conjoined frontal flap. Clin.Plast. Sure, 9:37,
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