surgery - PLASTICS burns + wounds Flashcards
(82 cards)
what are systemic complications of burns?
arise secondary to the large inflammatory response
SIRS and MODS
what is SIRS?
Systemic Inflammatory Response Syndrome (SIRS), an exaggerated and dysregulated inflammatory response to injury occurs, leading to third space losses, hypotension, and organ dysfunction.
what is MODS?
further deterioration = multiple organ dysfunction syndrome (MODS), whereby the dysregulated systemic inflammatory following the injury leads to end-organ failure.
what determines risk of developing MODS?
degree and severity of burn
increasing patient age
treatment of systemic complication of burns?
adequate and careful fluid resuscitation is performed.
what specific organ injuries can occur as a result of burns?
what is curlings ulcer?
how is it managed?
A Curling’s ulcer is a gastric ulcer that can occur following severe burns. The significant reduction in plasma volume following the injury can lead to gastric mucosa ischaemia, leading to ulcer formation
Patients admitted with severe burns who subsequently develop features of upper GI bleeding or perforation should be suspected to have a Curling’s ulcer. Indeed, any patient with significant burn injury should be started on PPI-therapy at admission to reduce this risk.
what are local complications of burns?
Adverse scarring (including hypertrophy or keloid growth) and contractures (Fig.2) can result from healing of deep burns.
Contractures are abnormal contraction or stiffening of tissues, resulting in decreased movement and range of motion; they can be intrinsic (from scarring within the affected area) or extrinsic (scarring outside the affected area).
describe reconstruction after burns?
Prospective scar management begins with early excision and grafting to prevent post-burn hypertrophic scarring and contracture
how is prospective scar management carried out?
Thick sheet grafts can be used for important areas, such as the face, hands, and neck; pressure garments, including face masks, are applied as soon as scars are stable*.
how are formed scars and contractures reconstructed?
not attempted until such scars have matured
excision and grafting, scar release and joint release, local and regional flaps, skin substitutes, and tissue expansion.
what are non-surgical recosntruction techniques for burns?
intralesional corticosteroid injection, cryotherapy, laser treatment, radiotherapy and 5-fluorouracil.
Physiotherapy has a key role in maintaining range of motion, preventing abnormal positioning, and preventing predictable contractures. Regular chest physiotherapy is used to minimise pulmonary complications and nutritional support is provided to maintain bodyweight and prevent loss of lean muscle mass.
what are chemical burns?
occur from acids, alkalis, and other substances
cause continuous tissue destruction through mechanisms such as oxidation, reduction, and desiccation, until the chemical is neutralised
what is the initial management of chemical burns?
immediate irrigation of the affected area, using warm water for at least 30 minutes
Clothes, including shoes and any accessories, that have been contaminated must be removed.
what are electrical burns?
causes
Large electrical burns are most commonly caused by lightning strikes or contact with high-voltage power lines
All such entries will have an entry and exit wounds, albeit often small, and the damage caused is often more serious than it visually appears.
how are electrical burns classified?
low voltage (<1000V – household supply) or high voltage (>1000V – industrial)
what are the main concerns with electrical burns?
arrhythmia and myoglobinuria, which can occur even with low voltage burns.
Electricity will travel through the path of least resistance, which can include the cardiac conduction system (resulting in arrhythmias), soft tissues (causing extensive rhabomyolysis), or the brain (resulting in seizures or respiratory arrest)
ix for electrical burns?
A to E assessment
ECG for conductor abnormalities
renal function + CK to assess rhabdomyolysis
how do you mx electrical burns?
Contractures of the extremity may occur long term, if there was extensive soft tissue damage resulting in scarring and fibrosis of the affected area. Early fasciotomies may be required.
what are cold injuries?
freezing (frostbite) or non-freezing (trench foot)
wat is frostbite?
tissues are injured due to cellular and microvascular damage, secondary to the formation of ice crystals within the cells and the extracellular space
how do you manage cold injury?
tissues are injured due to cellular and microvascular damage, secondary to the formation of ice crystals within the cells and the extracellular space
Rewarming needs to be gradual in order to avoid reperfusion injury
how do you manage cold injury if patient has hypothermia?
rewarming needs to happen at a systemic level.
<32 degree = warmed IV fluids
what should you keep in mind about the reperfusion process?
Reperfusion is a very painful process; therefore, the patient must have intravenous analgesia administered. The affected area should be demarcated to determine injury progression (dead tissue might need surgical debridement) and tetanus prophylaxis should be given if required.
