BASICS OF BURN MANAGEMENT

Dr S M KeswaniDr S M KeswaniCosmetic SurgeonCosmetic Surgeon

National Burns Centre, Airoli,NaviNational Burns Centre, Airoli,Navi--MumbaiMumbaiBreach Candy HospitalBreach Candy HospitalWockhardt HospitalWockhardt Hospital

National Burns Centre, Airoli , Navi-Mumbai.

CLASSIFICATION

1. FIRST DEGREE 2. SECOND DEGREE3. THIRD DEGREE

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

Second-degree (partial thickness) burnsSecond-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.

Third-degree (full thickness) burnsThird-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.

First degree burns

Second-degree burns

Third-degree burns

Body Surface Area of Burns(% )

Rule of NinesRule of NinesRule of HandRule of HandLund and Browder ClassificationLund and Browder Classification

Chemical burns Thermal burns Electrical burns

Flash burns Inhalation burns Scald burns

INTERNAL BURN

Third degree burns of legs

SUPERFICIAL BURN

First-Aid In Burns

POUR WATER ON BURNS TILL POUR WATER ON BURNS TILL BURNING SENSATION SUBSIDESBURNING SENSATION SUBSIDESElectric BurnsElectric Burns--Separate from source of Separate from source of electricity and pour waterelectricity and pour waterChemical BurnsChemical Burns--Irrigate the burn with Irrigate the burn with waterwater--stand under a showerstand under a shower

First Aid

POUR WATER ON BURNS TILL PAIN SUBSIDES

CHEMICAL INJURY TO EYE

First Aid, Flash with Saline Continuously

Criteria for hospitalisation(American Burn Association)

Burns>20% in adult,10% in childBurns>20% in adult,10% in childChemical or Electrical BurnsChemical or Electrical BurnsInhalation burnsInhalation burnsBurns involving vital areaBurns involving vital area--face,genitals,hands,feetface,genitals,hands,feetCircumferential burnsCircumferential burnsBurns in elderly,neonates and medically Burns in elderly,neonates and medically compromisedcompromised

EARLY MANAGEMENT

INTRAVENOUS FLUIDSINTRAVENOUS FLUIDSNASAL OXYGENNASAL OXYGENPAIN MANAGEMENTPAIN MANAGEMENTINTRAVENOUS ANTIBIOTICSINTRAVENOUS ANTIBIOTICSBLOOD TRANSFUSIONBLOOD TRANSFUSIONNUTRITIONNUTRITION

Dressing Techniques

Puncture the blister Puncture the blister Do not remove the dead skinDo not remove the dead skinClean with normal salinClean with normal salinNonNon--adherent dressing(sofratulle)adherent dressing(sofratulle)Thick layer of 1%SilversulphadiazineThick layer of 1%SilversulphadiazineThick layer of absorbent gauzeThick layer of absorbent gauzeElastocrepe BandageElastocrepe Bandage

BURNS DRESSING

SILVER SULPHADIAZINE 1%SILVER SULPHADIAZINE 1%POVIDONE IODINE 5%POVIDONE IODINE 5%POTATO PEEL BANDAGEPOTATO PEEL BANDAGESOFRA TOULLE DRESSINGSOFRA TOULLE DRESSINGSKIN SUBSTITUTESSKIN SUBSTITUTES

The SKIN SUBSTITUTES now The SKIN SUBSTITUTES now available can be divided into three available can be divided into three categories, depending on their origin categories, depending on their origin and physiochemical composition:and physiochemical composition:

Biological skin substitutes Biological skin substitutes Synthetic skin substitutes Synthetic skin substitutes Biosynthetic skin substitutes. Biosynthetic skin substitutes.

BIOLOGICAL SKIN SUBSTITUTES

Pig skin Pig skin human amniotic membrane human amniotic membrane collagen derivatives collagen derivatives cultured allograft.cultured allograft.

AMNIOTIC MEMBRANE

IRRADIATED AMNION (TMH TISSUE BANK)

COLLAGEN APPLICATION

SKIN BANK

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

SYNTHETIC SUBSTITUTES

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

BIO SYNTHETIC SUBSTITUTES

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

SEVERE THERMAL BURN

BIOLOGICAL SKIN

IntegraIntegra

BIO- SYNTHETIC SKIN SUBSTITUTE .(BIOBRANE)

BIO-SYNTHETIC SKIN

BEFORE AFTER

GLYCEROL PRESERVED AUTOGRAFT (DONOR SKIN)

Tissue Culture

Allogenic keratinocytesAllogenic keratinocytesAutogenic keratinocytesAutogenic keratinocytesSKIN CAN NOW BE GROWN IN A SKIN CAN NOW BE GROWN IN A LABORATORYLABORATORY

Spray -on-skin

Skin is now available as Nasal Spray and Skin is now available as Nasal Spray and can be sprayed onto the burn woundcan be sprayed onto the burn wound

Fiona WoodsFiona Woods--awarded Australian Woman awarded Australian Woman of the Year AWARD for this monumental of the Year AWARD for this monumental workwork

SEVERE SEPSIS

LATE MANAGEMENT

SURGICAL SKIN GRAFTING.SURGICAL SKIN GRAFTING.SURGICAL TREATMENTSURGICAL TREATMENT

DELAYED DELAYED EXCISION&SSGEXCISION&SSG

Wait for slough to Wait for slough to separate outseparate out--3wks3wksSSG (Meshed) SSG (Meshed)

2 . DELAYED EXCISION & STSG.

1 . EARLY EXCISION & STSG

SURGICAL TREATMENTSURGICAL TREATMENT

GRAFTING IN GRAFTING IN STAGESSTAGES

One thigh and leg One thigh and leg used to graft part of used to graft part of opposite thigh, the opposite thigh, the anterior chest wall anterior chest wall and medial aspect and medial aspect of the rt.upper armof the rt.upper arm

DELAYED EXCISION & STSG IN STAGES

ANTERIOR CHEST WALL WAS COVERED WITH STSG FROM THIGH (FIRST STAGE)

SURGICAL TREATMENTSURGICAL TREATMENT

Opposite thigh Opposite thigh and leg and and leg and both upper both upper extremities are extremities are used to cover used to cover the remaining the remaining raw areasraw areas

FULLY COVERED WITH GRAFT (FINAL STAGE)

Burns following epileptic Convulsion

Post Skin Grafting

PRE OP VEIW POST OP VEIW

POST BURN AXILLARY CONTRACTURE RELEASE

Post burn contracture of hand

Post Burn Hypertropic Scaring of Hand

Tangential excision of Skin Grafting

Linear Scar on Face (Pre-op)

2- Plasty (Post-op)

Prevention- Early Resurfacing

Multiple Z- Plasties

Postburn Neck Contracture

Operative Procedure

Severe Post burn neck contracture

Release of contracture and skin grafting

Contracture released and skin grafted

PREVENTION OF CONTRACTURES & HYPERTROPHIC SCARS

EARLY EARLY PHYSIOTHERAPYPHYSIOTHERAPY

PRESSURE PRESSURE GARMENTSGARMENTS

CICA CICA CARE(Silicone gel CARE(Silicone gel sheeting)sheeting)

PRESSURE GARMENTSPRESSURE GARMENTS

BURN CENTRE

PLASTIC SURGEONPLASTIC SURGEONGENERAL SURGEONGENERAL SURGEONANAESTHETISTANAESTHETISTINTENSIVISTINTENSIVISTDIETICIANDIETICIANPHYSIOTHERAPISTPHYSIOTHERAPISTMICROBIOLOGISTMICROBIOLOGISTSOCIAL WORKERSOCIAL WORKERTRAINED PARAMEDICAL STAFFTRAINED PARAMEDICAL STAFF

The more you give the more you get,The more you give the more you get,Experience the joy of giving,Experience the joy of giving,Giving not money,but of yourself,Giving not money,but of yourself,It is only when you give of yourself,It is only when you give of yourself,That you truly give!That you truly give!

--Kahlil GibranKahlil Gibran(The Prophet)(The Prophet)

If my mind can conceive it,If my mind can conceive it,

If my heart can believe it,If my heart can believe it,

I know I can achieve itI know I can achieve it

--Jesse JacksonJesse Jackson