acute burns isshcon 2013 by dr. sunil keswani, national burns centre, airoli
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Dr Sunil KeswaniPlastic Surgeon
NATIONAL BURNS CENTRE
Navi Mumbai
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
“Pour water on BURNS till the burning sensation subsides”
Relieves pain Decreases depth of
burn
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dorsal skin similar to rest of skin -much thinner (tendons easily exposed)
Palmar skin markedly different -Thicker epidermis -Less mobile -No hair -No pigment
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
PATIENT COMES EARLY(WITHIN 48 HRS)
PATIENT COMES LATE(AFTER 48 HRS)
Rupture the blister Evacuate the blister fluid by
gentle milking with saline soaked gauze
Cover with KOLLAGEN-M KOLLAGEN-M is just laid on
and covered with adequate layers of gauze to ensure there is no external soakage(“STRIKE THROUGH”)
Crepe Bandage
Gently clean with sterile saline soaked gauze
Apply a thick layer of 1% SILVER SULPHADIAZINE
Apply a non adherent lubricated dressing like Vaseline gauze or Jelonet
Cover with adequate layers of gauze
Crepe Bandage
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
PRE-APPLICATION POST-APPLICATION
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
SMALL BURN SIZE(TBSA<30%) AND DEFINITE 3RD DEGREE BURN
LARGE BURN SIZE(TBSA>30%) AND UNCERTAIN ABOUT DEPTH
Early excision and AUTOGRAFTING.
Timing-within first four days post-burn
Early excision and HOMOGRAFTING
Within first four days post- burn
Mobilisation instituted after second dressing ie 4th day
Homograft can be replaced by autograft if wound does not epithelialise under the homograft in 2 weeks time
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Allow to heal on its own-give it time RARELY does it need resurfacing IF Resurfacing needed Full thickness grafts from groin -Good function -Hyperpigmented
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
IF deeper vital structures are exposed ONLY then
Local flaps-transposition, advancement, cross finger, island flaps
Abdominal, groin flaps Free flaps
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
INCISION LINES TYPES OF RELEASE INCISIONS
Mid axial incisions Carpal tunnel release Guyons canal release Digital incisions- Thumb and LF –radial
IF,MF,RF-ulnar
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
8 P’S
Pain Pallor Pressure Pulselessnes Paresthesia Paralysis Poikilothermia Progression of the ischemia
Timely Appropriate Adequate-Hand compartments-Finger compartments
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
INTRINSIC TIGHTNESS TEST
MCP jt is passively extended and the PIP jt is passively flexed
Presence of SIGNIFICANT RESISTANCE is an indication of release of the intrinsic muscles
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
PAIN MANAGEMENT PROTOCOL
Inj Ketamine 100mg Inj Tramadol 100mg Inj Midazolam 10mg All together in a 50cc
syringe pump starting at 4cc per hour and titrating with pain relief and can go up to 40cc per hour in heavy or apprehensive patients
PAIN RELIEVED- BETTER PATIENT COMPLIANCE FOR PHYSIOTHERAPY
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Splints are given from Day 1
To be worn 24 hrs a day for a week
To be worn only at night after a week for the next 4 weeks
Light pressure bandaging
Elevation
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Mobilisation instituted after second dressing (post grafting) ie. 4th day
Passive gentle ROM exercises
Active movements Preferably every 2
hourly by hand therapist and relatives
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Limb PhysiotherapyDr. Sunil Keswani, National Burns Centre,
www.burns-india.com, [email protected]
Once the wound heals and is well epithelialised pressure garments are worn which is roughly by the 21st PBD
To be worn 23 hours a day
Should be removed four times a day for cleaning and massage and more active movements
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
CHEMICAL BURNS
FIRST AID -Wash off the offending agent with copious water for adequate time to ensure minimum contact period between corrosive and the skin
Invariably DEEP (rarely superficial)
Alkali burns are generally deeper than Acid burns
Early excision and grafting
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
TAR BURNS
Tar not to be removed on Day 1-to be left alone and
dressed with thick layer of 1% Silver sulphadiazine/ Paraffin/ Cocoa butter
Tar will start coming off spontaneously by the 4th PB day
One could damage useful epithelium and deepen the depth of burn by attempting early removal of TAR
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
ELECTRICAL BURNS
Compartment Syndrome
Early adequate fasciotomy
Appropriate surgical intervention depending upon the damage-skin graft, flap cover, amputation.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Re-epithelialize within 2 weeks to minimize scarring
Optimize epithelialisation by Moist healing Minimize infections Biologic dressings Optimize costs
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
FULL THICKNESS BURNS Autografts Finely meshed 2:1/Sheet grafts Medium thickness
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Exposed joints Immobilize(K-wires)
Exposed bones, tendons, joints Skin grafts do not suffice Flaps required
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Pre-Op wound
Application of Homograft Day 3
Complete healing Day 21
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Burns of the HAND can land up with severe dysfunction and morbidity
Simple TIMELY interventions can make a HUGE difference to outcome!!
Positioning, Early excision, Early mobilisation and TEAM APPROACH are the KEY to good outcomes in Acute HAND Burns
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
THANK YOUBURNS Helpline:
022 2779 3333
www.burns-india.com