Pastic surgery Flashcards
1
Q
WHat is a burn
A
Trizone injury - Zone of coagulation, Zone of statis, Zone o hyperaemia.
All treatment is aiming to restore the zone fo stasis
2
Q
Types burns
A
- Thermal
- Chemical
- Electrical
- Radiation- cancer therapy
- Cold exposure
3
Q
History in a burn patient
A
- How they got it, time, whats been done, length exposure, clothign, first aid
- Other histories - what can affect wound healing
- Pre morbid function/ADL
Exam:
- Locaiton buirn
- Extent burn (TBSA%- scales and areas, palm method (their 1 hand is 0.8%))
- Depth burn - epidermal (sun burn- no breka in skin), dermal, full thickness. Tells us how burn heals.
- Associated issues - structurla damage, infeciton, healing
4
Q
A
5
Q
Epidermal burn featuress
A
- Appearanc e- erythema, dry skin, swelling
- Assessment - blancihing, sensate, painful
- Treatment - basic first aid
- Outcome - heals in <7 days, no scarring
6
Q
Dermal burn (partial thickness)
A
- App - Blistering, exudate, swelling
- Assessment:
- Superficial dermal - blanching, sensate, painful
- Deep dermal - fixed red staining, reduced sensation, reduced CRT
- Treatment - dressings, sometimes requires surgical intervention
- Outcome - often heals in <3weeks, scars if takes longer.
7
Q
FUll thickness burn
A
- Appearance - white/brown/charred black, dry, less swelling
- Assessment - leathery, non blanching, painless/ insensate
- Treatment - usually requires surgical intervention
- Outcome - >3weeks to heal, significant scarring.
8
Q
Treatment of burns
A
- First aid - cool water 15mins
- Analgesia
- De-Roof blisters - cut top off and releases exudate fo rfaster healing
- Antibiotics in children - all <5 at RVI, anythgin dermal or bigger then flucloxacillin cos of risk of toxic shock syndrome in children.
- Dressings - use ltos honey in burns, dressings with silver in as antimicrobial. Uuslaly need reg dressing change as burns are wet.
- Review in 48hours
- Surgery
9
Q
Surgical options for burns
A
- Debridement - scrub/ versajet/ sharp debridement
- Reconstruct -
- Full thickness skin graft - epidermsi and dermis harvested for small areas only as donor site must be sutured closed. Less scar contracture, good for cosmetically and functionally sensitive areas. Higher risk of graft failure.
- Split thickness skin graft - Epidermis and part of dermis harvested. Harvested sign dermatome and often meshed. Can reconstruct large areas. Donotor sites left to heal. More late to scar contracture. Lower risk. graft failure.
10
Q
Chemical burns - acid svs alkalis
A
- Acis cause coagualiton necrosis
- Alkali cause liquefactive ncrosis - keeps liquefying so alkali get smore deeper
- Irrigate, irrigate, irrigate till pH normalised
- Monitor pH
- Check electrolytes
- Hydrofluric acid is the one of the worst and most worryign types as you can die form <1% burn as it sucks calcium out of body and arrhythmias etc
11
Q
Electricla burns
A
- Severity relates to current/voltage, pathwya through body
- Visible burn may not represent full extend of injury
- Inspect for entry and exit owunds
- Cardiac monitering
- Monitor renal function
- risk of comaprtment syndrome and rhabdomyolysis.
12
Q
Major burns
A
- Adults >/15%
- Paeds >/10%
- House fires
- Industrial accidents
- Self immolation
- Paediatric burns
13
Q
Major Burns Treatment
A
- A - Airway & C spine - airways swell so any near face then intubation straight away as u need to give ltos fluid but this makes it worse. Try with nasal tube in particular
- B - Breathing - inhalation airway. In full thickness on frint and back the chest wont expand so have to cut it in sections to allow it to like grid on body.
- C- ciruclation - big cannulas for lots of fluid, cross match etc and bloods ready for theatre.
- D-disability - AVPU as quicker and easier.
- E- Exposure/ eveyrhtign else - burns surface area, imaging (esterotomy on arms etc on limbs if needed where u cut to allow to expand), check temperature etc as hypothermia is big risk so run wamrign lines, warm fluids, blanckets etc.
FLUID:
- Parkland formula = 4ml x% burn x weight (kg)
- Give 1/2 in first 8hours, then the rest of 16hours
- Aim for UO at 0.5ml/kg/hr
- Nutritional support via NG
- Assess and clean in theatre (+/- escharotomy/escharectomy)
- Early debrdiement
- Reconstruction: eyelids, neck, line sites, face, arms, legs, trunk
- MDT
14
Q
Early complicaitosn from burns
A
- SIRS, Sepsis, ARDS, MODS, DIC
- Severe hypoproteinaemia
- Electrolyte imbalances - increased K and Na
- Anaemia
- Gastric ulceration & pancreatitis
- Infection
15
Q
Chance of mortality score in burns (Baux score)
A
Chance of mortality = Age + %TBSA (+17 for inhlaation injury).
Usually up to 130 then survival.
21
Q
Reconstructive ladder
A
- Healing by seocndary intention - leaving to heal
- Primary closure - stitching it close usign the way skin naturally folds
- grafts - need vascularised skin bed to go on to (not just tendon etc)
- Tissue expanders - under skin with salien and port in so patients come in every few weeks to have more saline injected in to create excess tissue
- Local flap - adjacent tissue used to close defects. Advancement, rotation, transposition
- Distant direct flap - donor site can be approximated to defect.
- Regional flap - rotate on a pivot point into defect that is near but not adjacent.
- Free flap - moves unit of tissue to distant site, re-anastomosing an artery and vein.
