Integ. Unit 11 Burns/Flaps/Grafts Flashcards
What are the determinants of death in burn populations?
- Severity of burn injury (extent, depth, and location of burn, infection)
- Age (Children vs. elderly)
- Etiology of the burn
- Presence of a respiratory burn/inhalation injury
- Co-existing injuries or pre-existing illness
What is the Etiology of burns?
The transfer of heat, and the heat itself destroys the tissue
What does Thermal heat include?
Includes electrical burns, frostbite, scalding flame, steam contact, sunlight
How can Radiation burns happen?
- Sun, tanning booths, sunlamps, Radiation
- Less vascular, fibrotic, prone to a injury with thermal modalities
- Treatment from cancer
How do Friction burns occur?
Friction burns that can occur where a person may be sliding along a street, falling off a motorcycle, and/or sliding on carpet
What are the Characteristics of Chemical Burns?
Which happen either in the home or can happen with work related issues dealing with industrial chemicals
- They tend to have more of a coagulation issue, a denaturing of the protein, and ionization of the cellular contents as well
The skin is a relatively poor heat conductor, what is the temperature it can tolerate?
- Can tolerate up to 44°C (111°F) for 6 hours before irreversible damage
- Recommended setting of home
water heaters =120°
What does the conductivity of the skin depend on?
- Water content, natural oils or secretions, and intact stratum corneum
- Local tissue blood flow
What are the Determinants of Mortality in Burn Populations?
Immediate death from burn injury results from co-existing trauma or airway obstruction or broncho-constriction
- Check at least 24 hrs for signs of inhalation/respiratory complications
–Edema develops limiting chest excursion
{Full-thickness burns encircle the neck and thorax}
–Changes in the voice
{Carbon in sputum;Facial burns or singed facial or nasal hairs}
–Altered Mental Status
{Hypoxia; Carbon monoxide poisoning}
What are the Characteristics of Electical Burns?
Usually, the wounds are a entrance and exit point within the body, so the hand and the foot both became dramatically burned
- Cardiac arrests or arrhythmias can be delayed up the 24 to 48 hours after someone’s been injured
What is an example of Cold theramal Injury?
Frostbite, this can lead to necrosis of those limbs based on the extent of the injury that could have occured
What takes place during Burn Management?
- Nutrition
-Enteral nutrition with glutamine preserves
mucosal integrity
-Parenteral: IV in the first 24 hours (IV fluid volume based on TBSA and weight; 5% dextrose in lactated Ringer (5000
mL/m2 of TBSA burned plus 2000 mL/2) (5% albumin) - Respiratory support
- Early debridement and excision of burns
- Skin substitutes
With Facial injuries, what are some problems that may arise?
- Infection
- Scarring
- Compromised immunity
- Changes in appearance, and body image
-Hyper or hypopigmentation (Melanin pigment loss and marked hypertrophy in all skin layers)
Rule of 9’s
What is the % of the head?
9%
- The front of the head is 4.5% and the back of the head is also 4.5%, togther making 9%
Rule of 9’s
What is the % of Frontal Truncal?
9%
Rule of 9’s
What is the % of Back Truncal?
9%
Rule of 9’s
What is the % of Front Abdomen?
9%
Rule of 9’s
What is the % of Lower abdoment, buttock?
9%
Rule of 9’s
What is the % of the legs?
9%
Rule of 9’s
What is the % of the Arms?
4.5%
What is the London-Browder Chart?
This is another method to estimate burns, however its a more
accurate quick estimate for children
What are the Characteristics of Superficial Burns?
(appearance, pain, edema, healing time, scarring)
Sunburn
- Appearance: Pink, red, erythematous; dry surface; no blisters
- Pain: Resting inflammatory pain and tender to touch
- Edema: Minimal tissue edema
- Time to healing: 2-5 days
- Scarring: No scarring
What are the Characteristics of Superficial Partial-Thickness Burns?
(appearance, pain, edema, healing time, scarring)
- Appearance: Blisters; moist, Bright red surface; blanches with normal capillary refill
- Pain: Very painful, sensitive to touch, pressure, temperature change
- Edema: Minimal to moderate tissue edema
- Time to healing: 7-14 days
- Scarring: Minimal to no scarring
What are the Characteristics of Deep Partial-Thickness Burns?
(appearance, pain, edema, healing time, scarring)
- Appearance: May have broken blisters; red, pale, or white; moist; blanching with delayed capillary refill
- Pain: Painful; sensitive to touch and pressure
- Edema: Moderate to marked tissue edema
- Time to healing: 21-35 days
- Scarring: Scarring
Greater potential for hypertrophic scar
What are the Characteristics of Full-Thickness Burns?
(appearance, pain, edema, healing time, scarring)
- Appearance: Dry, firm, leathery eschar; white or pale yellow to a dark red to black; no blanch or refill
- Pain: Insensitive to touch; pain associate with inflammation of associate viable tissue
- Edema: Marked tissue edema
- Time to healing: Weeks; requires skin graft
- Scarring: Scarring
What are the Characteristics of Subdermal Burns?
(appearance, pain, edema, healing time, scarring)
- Appearance: Relevent tissue exposure
- Pain: Damaged tissue is generally insensate; inflammation pain of associated viable tissue
- Edema: Moderate to marked tissue edema
- Time to healing: Weeks; requires surgical intervention
- Scarring: Scarring; potential for tissue defects
How can most burn deformities and stage 3 and 4 pressure ulcers can be corrected?
With surgical release and grafting procedures
- High priority for early reconstruction
-Around the mouth or the neck that makes airway access difficult
Surgical Procedures for Burns: Grafts/Flaps
What are Autografts?
This is a graft from the patients own tissue
Surgical Procedures for Burns: Grafts/Flaps
What are Allografts?
- From cadaver tissue
- Carries donor antigens and can transmit infectious disease
Surgical Procedures for Burns: Grafts/Flaps
What are Synthetic grafts?
- Dermagrafts, et cetera, are highly being used at this point with the increased production
Surgical Procedures for Burns: Grafts/Flaps
What are Skin Flap Reconstruction?
This is where they actually take musculocutaneous flaps and other free flaps from the body and transfer those over to the burned areas to reconstruct
Surgical Procedures for Fullthickness Burns: Grafts/Flaps
What intervention is used when the patient has < 30% TBSA?
TBSA: Total body surface area
Split-thickness auto or allograft
- Sheets or meshed can be complemented by allograft
Surgical Procedures for Fullthickness Burns: Grafts/Flaps
What intervention is used when the patient has > 40% TBSA?
TBSA: Total body surface area
Split-thickness auto or allograft
- Sheets or meshed can be complemented by allograft
Surgical Procedures for Fullthickness Burns: Grafts/Flaps
What intervention is used when the patient has > 90% TBSA?
TBSA: Total body surface area
It’s going to take up to 10 cycles of autografting may be required to provide the skin barrier for this patient
What happens if skin grafts are applied to granulating bone?
Breakdown quickly when applied to granulating bone preventing healing
