Burn Healing

7/28/2019 Burn Healing

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Burn Wound Healing

Ruby Riana AStaf Bedah FK UMM


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Goals

Burn injuryBurn woundassessment

and description

Burn woundhealingprinciples

April 1st 20122Ruby RA


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Pathophysiology of burn

An injury to the skin or other organic tissue primarilycaused by thermal or other acute trauma. It occurs

when some or all of the cells in the skin or other

tissues are destroyed by hot liquids (scalds), hotsolids (contact burns), or flames (flame burns).

Injuries to the skin or other

organic tissues due toradiation, radioactivity,electricity, friction or contact

with chemicals are alsoidentified as burns

Causing local tissuedestruction and systemicresponse



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April 1st 2012Ruby RA 4


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Zone of Thermal Injury



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Types of burn



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contact temperature, duration of contact thickness of the skin.


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when ice crystals puncture the cells or whenthey create a hypertonic tissue environment.


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Systemic absorption of some chemicals (such as ofhydrofluoric acid) can be deadly.

radical alterationof pH,

disruption ofcellularmembranes

direct toxic effectson metabolicprocesses.


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The magnitude of injury depends

pathway thecurrent follows

resistance tocurrent flow of thetissues involved

strength andduration of

current flow.

Electrical current causes damage as electricalenergy is transformed into thermal energy

Injury to cell membranes (electroporation) disruptsmembrane potential and function.


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Pembagian

Berdasarkan kedalamanBerdasarkan luas

Berdasarkan keparahan

6/12/201313


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Berdasarkan kedalaman

Tingkat Klinis Tusukan jarum

I hiperaemi hiperesthesi

II A basah + bulla hiperesthesi

II B basah + bulla + keputihan hypoesthesia

III kering + putih + hitam anesthesia

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TIDAK DIHITUNG

DALAM PERHITUNGANLUAS LUKA BAKAR

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12/06/2013Ruby Riana A., dr., SpBP 17


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Berdasarkan luas

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Berdasarkan Keparahan

Tingkat II 30% atau lebih

Tingkat III 10% atau lebih

Tingkat III pada tangan, kaki, muka

Dengan adanya komplikasi pernapasan, jantung, fraktur, softtissue yang luas.

Parah critical.

Tingkat II 15-30%

Tingkat III 5-10%Sedang moderate.

Tingkat II kurang 15%

Tingkat III kurang 1%Ringan minor.

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Terapi Umum

Survai Primer :ABCDE

Survai Sekunder

Pemeriksaan fisik

Resusitasi cairanBaxter terhitung darisaat kejadian maka :

8 jam (4 cc x kg BBx % LB) RL

16 jam II (4 ccx kgBB x % LB) RL

+ 500-1000 cc colloid.

Selesai dalam 24 jamsejak kejadian

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Di Surabaya formula Baxteruntuk anak dimodifikasi sbb :

Replacement 2 c/kgBB/%luka bakar

Ditambah Kebutuhan faalUmur sampai 1 tahun 100

cc/kgBBUmur 1-5 tahun 75 cc/kgBB

Umur 5-15 tahun 50 cc/kgBB= Total cairan

Moncrief 17/20Kristaloid (RL) + 3/20

Koloid (Dextran) botolyang sama

dibagi 2 dalam 8 jampertama dan 16 jam

berikutnya

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FIRST AID

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Wound Healing Phases

Inflammation

Proliferation

Maturation



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Sequence of cell

appearance



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Proliferative (3d-3wk)

Fibroblasts multiply

Collagen production

Endothelial cells proliferate

New vessels

Myofibroblasts

Wound contraction



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Maturation (3wk - 1yr)

Macrophages - fewer

Fibroblasts - plateau

Collagen content stable



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Wound maturation

Collagen contentpeak 3 wks= 30%original woundtensile strength

Collagen cross-binding by 6 wks=80%

Wound strongest at6 weeks



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Impaired wound healing:

Local factors

Infection

Ischemia

Edema

Foreign bodies



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Impaired wound healing:

Systemic factors

Age

Diabetes

Smoking

Nutrition

Steroids

Radiation Sepsis

Chemotherapy



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Inhibition of Wound Healing



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Poor O2 tension

Diabetes

Small vessel arteriosclerosis

Irradiation

Infection



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Corticosteroids inhibit Epithelialization Vitamin A

Fibroblast migration

Collagen synthesis Vitamin A

Angiogenesis

Macrophages

Wound contraction



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Signs of wound infection

Erythema

Edema

Pain

Drainage

Wound dehisence



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Wound Healing

Primary

Delayed primary

Secondary



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Epithelialization

Protective barrier from bacteria

Decrease fluid losses

Regulate body temperature

Normalize patients physiologic state



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Optimizing wound healing

Clear infection

Debride necrotic tissue

Improve blood supply

Control diabetes

Improve nutritional status



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Wound Repair

Free Flap

Pedicle Flap

Skin graft

Secondary closure

Primary closure

Reconstructive ladder



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Reconstructive Principles

Cover wound

Cover vital structures

Replace like with like

Cosmesis

Complex wound requires complex reconstruction


Reconstructive surgery:


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Primary goals

Preservation of life and limb

Restoration of form and function




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Treatment options

Secondary intention

Primary closure

Skin graft

Local flap

Regional flap

Distant flap

Free tissue transfer



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Wound defect analysis

Location

Size

Physical components



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Physical components

Skin

Mucosa

Subcutaneous tissue

Muscle

Vessels

Nerves

Fascia

Cartilage

Bone




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Flap types

Skin

Random pattern blood supply

Axial pattern blood supply

Muscle

Musculocutaneous

Fascia

Fasciocutaneous

Burn Healing

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