BURNS
Dr OKORIE G
CONSULTANT PLASTIC SURGEON
BURNS
• DEFINITION
• COAGULATIVE OR LIQUEFACTIVE NECROSIS OF
TISSUE AS A RESULT OF EXPOSURE TO THERMAL &
NON THERMAL AGENTS
CLASSIFICATION OF BURN
• BASED ON AETIOLOGY
• THERMAL BURN: CHER
• C= CHEMICAL
• H = HEAT
• E = ELECTRIC
• R = RADIATION
• NON - THERMAL : FROST BITE
• CRYOTHERAPY
CLASSIFICATION OF BURN
Cont'd
• BASED ON DEGREES
• 1ST DEGREE..... FLASH, ERYTHEMA
• 2ND DEGREE...... BULLAE, BLISTERS
• 3RD DEGREE...... INVOLVEMENT OF EPIDERMIS & DERMIS
• SKIN IS REDDENED, SENSATE
• 4TH DEGREE..... ENTIRE SKIN
• SKIN IS LEATHERY, NON SENSATE
CLASSIFICATION Cont'd
• BASED ON SKIN THICKNESS INVOLVEMENT
• PARTIAL THICKNESS : EPIDERMIS + DERMIS
•
• A. SUPERFICIAL DERMAL
• B. DEEP DERMAL
• FULL THICKNESS : ENTIRE SKIN
AMERICAN BURN ASSOCIATION (
ABA) CLASSIFICATION
• MINOR
• MODERATE
• SEVERE
PATHOPHYSIOLOGIC
CLASSIFICATION
• JACKSONIAN ZONES
• DEFINED IN 1947 BY IAN JACKSON
• 3.ZONES
• ZONE OF HYPERAEMIA
• ZONE OF STASIS
• ZONE OF COAGULATION
JACKSONIAN
ZONES
ZONE OF HYPERAEMIA
ZONES OF STASIS
ZONES OF COAGULATION
SEVERITY OF BURN
INJURIES
• DEPENDS ON
• 1.EXTENT OF BURN INJURY
• 2. DEPTH OF BURN INJURY
• 3. DURATION OF EXPOSURE
• 4.AGE OF PATIENT
• 5. CO-MORBIDITIES
• 6. AETIOLOGIC AGENTS
• 7. INHALATION COMPONENT
ELECTRICAL BURN
• KOUWENHAVEN FACTORS
• DVT. RAP
• D =. DURATION OF EXPOSURE
• V = VOLTAGE
• T =. TYPE OF CURRENT ( AC. Vs DC)
• R = RESISTANCE
• A =. AMPERAGE
• P =. PATHWAY OF CURRENT
ESTIMATION OF EXTENT OF
BURN INJURY
• WALLACES'S RULE OF 9
• MODIFIED WALLACES'S RULE OF 9
• PALMAR METHOD
• LUND & BROWDER CHART
PAEDIATRIC WALLACES'S
RULE OF 9
LUND AND
BROWDER Click icon to add picture
CHART
FOR PAEDIATRIC BURN
ESTIMATION
MANAGEMENT OF BURN
INJURIES
• 7 Rs
• R = Rescue
• R = Resuscitate
• R = Review
• R = Restore
• R = Resurface
• R = Rehabilitate
• R = Reconstruct
PRE HOSPITAL CARE
• STOP.......... DROP.......... ROLL
• SECURE ENVIRONMENT
• EXTRACT PATIENT
• STOP FURTHER BURN BY PUTTING PT UNDER
RUNNING TAP WATER
• COVER WITH CLEAN CLOTHES
• SCOOP AND RUN
ER MANAGEMENT
• ATLS PROTOCOL
• 2 WIDE BORE CANNULAS / CENTRAL LINE
• CATHETERIZE PATIENT
• PRIMARY AND SECONDARY REVIEW
• NEBULIZATION WITH HEPARIN
• INVESTIGATIONS
• ESCHAROTOMY / FASCIOTOMY
RESUSCITATION
1. PARKLAND ( BAXTER) FORMULA
4 ml X %TBSA X. Pt's Wt
• 1/2.OF FLUID = 1ST 8HRS
• 1/2 OF FLUID = NEXT 16HRS
• 1/2 OF PREVIOUS DAY TOTAL FLUID FOR THE NEXT DAY
OTHER FORMULAS
2. BROOKE 1.5ml /%TBSA/Wt ( CRYSTALLOID) + 0.5ml/%TBSA /Wt
( COLLOID) + 2000ml DEXTROSE
3. MODIFIED BROOKE
4. MUIR & BARCLAY
RESUSCITATION
• ELECTRIC BURN
• 7 - 9ml / %TBSA / Wt
• ALKALINIZE URINE WITH NaHCO3
• PREGNANT WOMAN :
• Add 5% TO %TBSA
RESTORE
• INFECTION CONTROL
• CORRECTION OF ELECTROLYTE IMBALANCE
• ANAEMIA CORRECTION
• MALNUTRITION PREVENTION/ CORRECTION
• DVT PROPHYLAXIS
• SPLINTAGE
• PHYSIOTHERAPY
• TREATMENT OF COMORBID CONDITION
RESURFACE
• WOUND CARE
1. DRESSING
2. TANGENTIAL EXCISION
+
STSG
3. FASCIAL EXCISION
DRESSING:
OCCLUSIVE
PARTIAL OCCLUSIVE
NON OCCLUSIVE/ OPEN
RESTORE contd.
1. DRESSING
2. TANGENTIAL EXCISION
3. FASCIAL EXCISION
DRESSING:
OCCLUSIVE
PARTIAL OCCLUSIVE
NON OCCLUSIVE/ OPEN
COMPLICATIONS OF BURN
1. EARLY COMPLICATIONS
• EXCESSIVE SCARS
HYPERTROPHIC SCARS
KELOIDS
• INTRACTABLE ITCHING
• HYPERPIGMENTATION/ HYPOPIGMENTATION
• ALOPECIA
2. LATE COMPLICATIONS
• CONTRACTURE
• ACQUIRED SYNDACTYLY
• MARJOLIN’S ULCER
• UNSTABLE SCAR
REHABILITATION
• PHYSICAL
• OCCUPATIONAL
• PSYCHOSOCIAL
RECONSTRUCTION
• CONTRACTURE RELEASE
• GRAFTING STSG, FTSG
• SYNDACTYLY RELEASE
• ULCER EXCISION + COVER
PREVENTION
• PRIMARY
• SECONDARY
• TERTIARY
PRIMARY PREVENTION
• STOP BUSH BURNING
• STORAGE OF INFLAMMABLE SUBSTANCES AT HOME
• STOP CANDLE USE OR OTHER OPEN LANTERNS
• DISCOURAGE THE USE OF ADULTRATED
PETROLEUM PRODUCTS
• USE OF PHONES IN THE KITCHEN OR FUEL STATIONS
SECONDARY
PREVENTION
• ESTABLISHMENT OF BURN UNITS, CENTRES
• TRAINING OF BURN PERSONNEL
• AVAILABILITY OF SPECIALIZED BURN DRESSINGS
TERTIARY PREVENTION
• CLEAR BURN REGULATIONS
• FUNCTIONAL & EFFICIENT FIRE SERVICE DEPT.
• SAFETY BUILDING REGULATIONS eg FIRE ALERT
SYSTEMS
• GOOD ENTRY AND EXIT WAYS IN ALL BUILDINGS
• SPECIAL INSURANCE POLICY FOR BURN PATIENTS
• RESTRICTION OF FUEL / GAS STATIONS AMONG
RESIDENTIAL AREAS
