BURNS Flashcards
Depth of Burns
1st Degree: superficial
2nd Degree: Partial Thickness (superficial and deep)
3rd Degree: Full thickness
Superficial Burn
- layer
- sx
- heal time
- physiology
- epidermis only
- erythema (redness), painful
- heals quickly (3-5 days)
- physiologically unimportant
Superficial Partial Thickness
- layer
- sx
- heal time
- physiology
- epidermis and some dermis
- blisters, very red, edema, pain, wet, weepy
- heals in 10-14 days
- permanent changes are rare
Deep Partial Thickness
- layer
- sx
- heal time
- physiology
1. epidermis, most of dermis some skin appendages intact 2. pain, mottled, red/white/yellow, mot as weepy as superficial, large blisters, edema 3. heals in 3-4 weeks! 4. get scars
Full Thickness
- layer
- sx
- heal time
- physiology
- epidermis, dermis, appendages
- white/red/black/brown, dry, leathery, firm, thrombosed vessels, minimal pain initially, need skin graft
- heal time -not given
- poor skin quality, thick scarring
Phases of Wound Healing
- inflammatory: cleaning
- proliferative: rebuilding
- remodeling
Inflammatory Phase of Wound Healing
Time: 24hrs-5 days
vascular response: vasoconstriction (clotting) and then vasodilation
cellular/molecular response: phagocytosis
Proliferative Phase of Wound Healing
rebuild:
DERMIS: need GRANULATION TISSUE
1. fibroplasia: fibroblasts produce collagen [strength]
2. angioplasia: (neovascularization)–new blood supply (endothelial buds) [vascularity]
EPIDERMIS: heal outside in and bottom up:
Epithelialization: epithelial cells do mitosis and rebuild the epidermis
contact inhibition: resurface the wound and add to the thickness
-mitosis-epidermal thickness of cells that migrate from edge to center
-epithelial buds-epidermal cells from dermal appendages move up from the bottom
Remodeling Phase of Wound Healing
Time: 3-18 Months
MATURATION PHASE
-Hypertrophic Scar: fibroblasts produce collagen in disorganized bundles
-myofibroblasts
-rich blood supply
-imbalance between collagen production and lysis
rule of 9s
measure size of wound (more specific if use the lund browder chart)
color coding
red/pink: clean, granulation or epithelial tissue
yellow: epithelial buds,
eschar (black?)
black: dirty, necrotic tissue
goals of dressing
clean and prevent infection moist environment to heal temporary wound coverage decrease evaporative water and heat loss protect exposed tendons from desiccation
dressing types
- biological dressing
2. silver
surgical manage: indicated, benefits
indicated:
- facilitate healing time
- decrease inflammation
- limit scar formation
benefits:
increase function
decrease hospital stay
decrease long term rehab, follow up, and reconstruction surgery
skin graft types
temporary:
allograft (homograft)-cadaver
heterograft (zenograft)-pigskin
integra-bovine collagen and silicone
permanent:
autograft
cultured epidermal autograft (CEA)