Burn

Question 1

What is the mechanism of burn healing?

Answer 1

by keratinocyte proliferation and migration

Question 2

Epitheliazation of superficial burn

Answer 2

cell migration from would PERIPHERY

Question 3

Epithelizalization from PTB

Answer 3

cell migration from wound periphery and skin appendages ( sweat glands and hair follicles )

Question 4

Epithelizalization of FTB

Answer 4

Wound contraction and fibroplasia
Excision and closure with grafting
FTB greater than 1cm diameter will not heal without surgery

Question 5

tx of superficial 1st degree burn?

Answer 5

Healing takes 10 days

Emollient and palliation

Question 6

tx of 2nd degree superficial PTB

Answer 6

healing takes 10-21 days
semi-occlusive dressing for moisture control
Palliation ( to reduce the pain without treating the underline cause like taking pain meds )
Topical

Question 7

tx of 2nd degree deep PTB

Answer 7

takes a longer time to heal ( 6wks)
loss of dermal structure and appendage slows healing
debridement and skin grafting appropriate especially with large BSA injury

Question 8

3rd degree FTB tx

Answer 8

had to be debrided
skin grafting
reginal skin plasty
Flaps: sin flap, muscle flap, fasciocutaneous flap, free tissue transfet

Question 9

4th degree burn tx

Answer 9

Excision/ amputation

Question 10

What are some appropriate graft recipient sites?

Answer 10

Will take :
granualtion 
peritenon
periosteum 
muscle

Question 11

graft recipeient sites that wont take?

Answer 11

cartilage
necrotic tissue
nerve
infected sites

Question 12

Infection prevention

Answer 12

Topical antibiotics

Systemic antibiotics prophylaxis

Question 13

Topical antibiotics

Answer 13

silver sulfdiazine
Bactroban
Sulfamylon
Anticoat

Question 14

Systemic antibiotics prophylaxis

Answer 14

not found to improve outcomes
may cause secondary infections
bacterial resistance
study in children demosnrate higher infection rates
Appropriate peri-operatively with wound excision

Question 15

what group of people have increased risk of infection with burns ?

Answer 15

Diabetics

Question 16

T/F ? Diabetes is associated with poor outcomes in burn pts

Answer 16

False!!!! Hyperglycemia is associated with poor outcomes

Question 17

what is osteochisis?

Answer 17

fracture of bones from direct splitting of bone as current passes through the bone - do x-ray

Question 18

complications of electrical burns

Answer 18

• compartment syndrome
• myonecrosis and myoglobulinemia leading to renal failure
• microvascular thrombosis resulting in prolonged tissue necrosis, progressive gangrene

Question 19

Progressive gangrene and necrosis requires

Answer 19

• staged sequential exploration
• avoid early, aggressive definitive treatment
• Best with conservative meticulous debridement than early definitive amputation
• Amputations should be left open until its clear that deep tissue necrosis is non progressive

Question 20

Partial thickness skin grafting

Answer 20

higher success of take than full thickness graft (FTSG)
renewable donor site
greater surface of coverage with fenestration
donor site healing more painful than FTSG
Graft contracture
Pigment and skin texture changes

Question 21

Full thickness skin grafting

Answer 21

more cosmetic than PTB
less graft contraction
less painful with donor site healing
-TAKE LESS READILY THAN STSG
-LESS SURFACE AREA COVERAGE 
-DONOR SITE NOT RENEWABLE

Question 22

types of split thickness skin grafting?

Answer 22

Thin
Intermediate
Thick

Question 23

Which of the split thickness skin grafting method is the best?

Answer 23

Thicker STSG preserve more reticular collagen , vascular plexus, dermal appendeges to create more cosmetic appearance

Question 24

What are some late complications burns

Answer 24

malignant degeneration ( Squamous cell carcinoma)
Dystrophic calcification
Chronic pain 
Shoe gear accomodation 
contracture and deformity

Question 25

Late challenges of burns

Answer 25

Preventing Contracture

Treating Contracture

Question 26

treating contracture

Answer 26

Scar revision
Tendon lengthening
External fixation

Question 27

How to develop a treatment plan?

Answer 27

Think in layers :)