Plastics Flashcards
Layers of the epidermis:
In order (cool lucky grammar school boys).
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale
Layers of the dermis:
Papillary and reticular
How is prognosis calculated in burn injuries?
Age + TBSA >100 = poor prognosis, especially in the presence of an inhalation injury.
In burns patients (Adult and Children) what urine output is aimed for?
0.5-1ml/kg/hr adults
1-2ml/kg/hr children
What is the common infective organism in burns patients?
Staph aureus
What is SJS?
Stevens-Johnson syndrome (SJS) is an immune-complex-mediated hypersensitivity disorder syndrome.
What causes SJS?
It is a dermatological emergency that is, in most cases caused by a reaction to medications.
Drugs that can cause SJS include sulfonamides, beta-lactams (penicillins & cephalosporins), anti-epileptics, allopurinol and NSAIDs.
It can also be caused by viral infection including herpes simplex virus, Epstein Barr virus, HIV, influenza and hepatitis.
It is more rarely caused by bacterial and fungal infections.
Features of SJS:
- SJS usually presents within a week of taking a drug with symptoms resembling an upper respiratory tract infection (cough, cold, fever, sore throat).
- After a few days, erythematous macules appear which later become target-shaped.
- Flaccid blisters develop and Nikolsky sign is positive.
- In SJS <10% of the body surface is affected whereas TEN is defined as >30% of skin involvement.
- There is mucosal ulceration affecting at least 2 of the conjunctiva, mouth, urethra, pharynx or gastrointestinal tract. SJS has a 10% mortality rate (TEN has a 30% mortality rate) due to dehydration, infection or disseminated intra-vascular coagulation.
Management of SJS:
The management is supportive of skin and eye care. An ophthalmology referral is important to prevent ocular complications.
What are the main causes of non-burn skin loss?
Necrotising fasciitis
SJS / TEN
Other dermatological conditions: Erythroderma
What organsims cause necrotising fasciitis?
Multiple organisms mainly, Group A streptococci and anaerobes.
- Strep pyogenes
What is Fournier’s gangrene?
A special type of necrotising fasciitis affecting the genitalia.
Signs of compartment syndrome:
Pain (out of proportion and exacerbated on extension)
Paraesthesia
Pallor
Pulselessness
- Urgent fasciotomy is limb saving.
Reconstructive ladder:
• Allow to heal (secondary intention)
• Primary closure
• Skin graft (split thickness or full thickness)
• Local flap
• Regional flap
• Free flap (autotransplant)
Ancillary methods: Tissue expansion, VAC dressings, skin substitutes
Factors to consider when assessing a hand injury:
• Open fractures
• Tendons and ligament injuries
• Nerve injuries
• Arteries and veins
• Soft tissues
• Amputations
• Special injuries: bites, crush injuries and nailbed repairs, burns
What is an allograft?
- example of when it’s used?
Tissue transplantation from the same species.
- commonly cadaveric skin in extensive burn injuries.
What are indications for skin grafting?
Well vascularized, non infected bed.
Large coverage defect not amenable to direct closure or local flap coverage.
What are contraindications for skin grafting?
Relative: flexion areas, constant shear and friction.
Non vascularized bed, bare-bone, cancer, infection.
Skin graft complications:
Failure, or non-take
Hyperpigmentation (Thin STSG),
Hypopigmentation (Thick STSG)
Contraction
Meshed appearance
Dryness, scaling etc
What fluids should be given for burns resus?
Crystalloid - Hartman’s or Ringer’s lactate.
What is the Parkland formula? !!
Total fluid requirement in 24 hours =
4 ml x (total burn surface area (%)) x (body weight (kg))
- 50% given in first 8 hours
- 50% given in next 16 hours
Treatment of nec fasc
- Urgent surgical referral debridement
- Intravenous antibiotics
