plastics

Question 1

what is classified as a complex burn

Answer 1

all electrical and chemical burns

anything affecting a critical area- these are: face, hands, feet, perineum, genitalia, crossing joint, circumferential.

any thermal burn covering more than 15% of adult body surface area
10% of child
5% if younger than 1.

Question 1

arterial ulcers

Answer 1

caused by reduction in flow- decreased perfusion and poor healing.

RF: same as PVD/CHD risk factors.- smoking, dm, htn, hyperlipidaemia etc.

S+S: small deep lesions, well defined borders, necrotic base.
occur distally- trauma and pressure areas.

concurrent intermittent claudication/ critical limb ischaemia (pain at night)

develops slowly, may be painful, no granulation tissue.

cold limbs, reduced/ absent pulses.

Ix: ABPI
normal >0.9
mild= 0.8-0.9
mod 0.5-0.8
severe= <0.5

duplex ultrasound, CT angio.

Rx: conservative rx- lifestyle
medical: statins, antiplatelet, optimise blood pressure.
surgical: angioplasty or bypass grafting.

Question 2

how to measure extent of burn- area and depth.

Answer 2

as total body surface area

palm is 1%
whole arm is 9%
whole leg is 18%.
head and neck 9%
ant and post torso are 18% each.

superficial burn- 3 sections-
epidermal- red and painful but not blistered
dermal- slow cap refill

deep dermal (partial thickness)- dry mottled skin, painful to toutch, blisters, no blanching of skin.

full thickness- painless to touch, white, brown or black skin. no blisters. dry leathery.

Question 3

treatment of burns

Answer 3

remove non-adherent clothing.
irrigate with cool water for 15-30.

keep warm
cover with cling film

admit if complex or full thickness.

severe burns cause significant systemic effects- inflammation and vasodilatory mediators released- large fluid shifts occur.

peaks at 6-8 hours post injury- lasts for 24.- can lead to burn shock.

fluid resus- 4ml X BW x %TBSA affected = first 24hours fluid reqs.

half to be given in first 8 hours

give tetanus prophylaxis

consider escharotomy- if circumferential or restricting ventilation.

6-25% of pts get DVT
significant concern over compartment syndrome- abdominal or limb.

keloids may form
anaemia is likely if more than 10% burns.

Question 4

discuss wound healing phases

Answer 4

4 phase system.

haemostasis

inflammation- wbc infiltration

proliferation- re-epitheliisation, angiogenesis, collagen synth

maturation- remodeling, vascular regression.

Question 5

complications of wound healing- delayed healing

Answer 5

risk factors assoc with CVD can cause impaired vasc flow- increaced hypoxia in the wound- poor healing.

infections- may creace a chronically inflamed state and make it not heal.

age- inc complications with age

smoking, medications, drugs- can all influence some part of the wound healing process.

Question 6

keloid scar

Answer 6

a result of unckecked fibroblastic/ proliferation healing stage

collagen synth is about 20x normal wound healing.

3x greater than a hypertrophic scar

differential vs hypertrophic scar = H scar wont go more than 4mm high, not beyond initial area of injury,

Kscar go beyond initial injury area.

Rx of Kscar:

intralesional steroids- 4-6 week apart. - injection or topical.

cryotherapy- less desirable in darker skin types.

surgery- last line rally.

radio- but not really used much, has to be fast.

lazer.

Question 7

venous ulcers

Answer 7

as a result of blood pooling in the veins- venous insufficiency

valve incompetence- pooling blood + WBC- release of mediators and formation of a fibrin cuff– hypoxia to tissues – activation and release if inflam markers– tissue injury and necrosis.

RF: age, prev vte/ venous incompetence, preg, obesity,, leg injury/ trauma.

S+S: painful (espesh at end of day), found in gaiter region, shallow, yellowey in the middle.

Ix: Duplex ultrasound
ABPI

Rx: increace activity- promote flow.

culticomponent compression bandage- change 1-2x weekly.

ABPI MUST BE BETTER THAN 0.6 FOR THIS.

treat any varicose veins concurrently.