Introduction to management & intervention burn

Introduction burn management

1. Introduction to burn injuries 18 april , Jakarta Betty de Jong- Brouwer Hand( physio )therapist Msc

2. Epidemiology Per year 450.000 burn injuries getting medical treatment in US, 40.000 need hospitalization An estimated 265 000 deaths every year are caused by burns world wide In RSCM, 303 patients were registered during a two year period 2009-2010 Most patients were adult 15-54 years (68%), followed with skin graft. But 45 patients were between 1-4 years 125: burn < 20% 230: burn 20-50% 39: burn > 50% Most burns caused by LPG, second scald, third flames

3. Structure of the skin Epidermis: capable of regeneration, reduces loss of fluid from the body Dermis: collagen and elastic fibers and where nerves, blood vessels, sweat glands, and hair follicles reside Hypodermis: Hypodermis or subcutaneous (fat)tissue, where larger blood vessels and nerves are located. This layer is most important in temperature regulation and protects underlying tissues

4. Depth of burn First degree: superficial and causes local inflammation of the epidermis → spontaneous healing process, usually no scar tissue. Painful Second degree (superficial/ deep,partial thickness ): burn of epidermis and (part of) dermis . Painful, blistering of the skin. Spontaneous healing in 2/3 weeks without scar if only part of dermis. Full burn of dermis: healing process longer than 3 weeks, scar tissue will develop, often need skin graft. Third degree ( dermal,full thickness): involve all skin layers, also nerves and blood vessels damaged → not painfull , skin white and leathery. Only spontaneous healing possible from wound edges inwards. skin graft necessary. Fourth degree (subdermal: also underlying tissues like muscles and tendons damaged. Black color. Need surgery, necrotomie .

5. Extend of burn injury Total body surface area (TBSA) Rule of nines. Hand 1% Burn extend > 20% of the body is involved in a burn, significant fluid may be lost. Shock may occur if inadequate fluid is not provided intravenously. Burns involving greater than 50% have a significant mortality risk, depending upon a variety of factors, including underlying medical conditions and age.

6. Types of burn Thermal burns may damage superficial branches of the median, ulnar and radial nerves. Electrical injuries, which damage tissues along the pathway of the electrical current, may be insidious in onset and worsen over time. Chemical burns may penetrate to bone and may be deeper t han they initially appear. Radiation burns, often affecting larger areas than initially visualised , pose a risk of later malignancies.

7. Acute treatment Conservative treatment: Closed wound treatment Semi open wound treatment Open wound treatment Operative treatment: Split skin (epidermis and part of dermis) full sheet transplantation Mesh graft Escharotomy → to reduce pressure on blood vessels and nerves

8. Wound healing Inflammation → severe edema can develop Proliferation → scar tissue starts to develop Remodeling → scar tissue reaches final form after two years. More scar tissue will develop under high tension

9. Scar development Hypertrofic scars Keloid Scar retraction (de)pigmentation Itch (usually disappears after 12-18 months)

10. Multidisciplinary treatment important Burn injury specialist Surgeon Plastic surgeon Internal specialist Pediatrician Pulmonologist Intensive care specialist Rehabilitation specialist Microbiologist Anesthesiologist Physical therapist Occupational therapist Speech therapist Psychologist P sychiatrist Specialized nurse Nutritionist