Surgical management of burn injuries
Surgical management of burn injuries by Varun Harish. From #CodaZero Live, Varun Harish provides an overview of the surgical management of burn injuries. He talks us through how surgeons make decisions regarding burn management, including the importance of early assessment and intervention. Burns evolve, what you see at the beginning is going to be very different in 24 hours and different again in three days. Importantly, the management and principles of intervention differ for minor burns compared to severe burns. For smaller burns, the golden rule is two weeks. If there is a good chance that the burn will heal in two weeks, intervention is avoided. If this is not the case, intervention in the way of a skin graft or other surgical procedure is usually the best option. Varun details how the management priorities shift for larger burns. Larger burns significantly increase the chances of infection, making it important to intervene earlier rather than later. Tune in to an interesting talk on the Surgical management of burn injuries by Varun Harish.
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Surgical management of burn injuries
- 1. Surgical management of burn injuries Varun Harish Plastic & Reconstructive Surgeon Royal North Shore Hospital
- 3. Surgery for burn injuries • Acute injury • Escharotomy and fasciotomy • Burn wound excision • Wound reconstruction (skin grafting, skin substitutes) • Secondary effects • Contracture release • Functional scar corrective surgery • Ectropion repair • Commisureplasty
- 4. Escharotomy Indication • Circumferential, inelastic eschar interfering with perfusion/ventilation Consider chest escharotomy when: • Restricted movement of chest • High ventilator pressures • Hypoxaemia Consider limb escharotomy when: • Loss of circulation • Decreased oxygen saturation on pulse oximetry
- 5. Escharotomy versus fasciotomy Escharotomy • Divides eschar (full thickness burn) • Performed on limbs and torso • Can be performed at bedside • Largely prophylactic Fasciotomy • Divides deep fascia of limbs • Under GA • Prophylactic or therapeutic • Almost exclusively applies to high voltage electrical burns
- 11. Fasciotomy
- 12. Wound depth • Guides decision making about definitive treatment • Largely clinical assessment • Appearance of wound • Capillary refill • Sensation • Burns evolve • ‘2 week’ rule of healing
- 13. Epidermis Dermis - capillaries - nerves - collagen & elastin fibres Sebaceous gland Hair follicle Sweat gland Subdermal fat Epidermal Superficial Dermal Mid Dermal Deep Dermal Full Thickness Burn Wound Healing = re-epithelisation Depth of Burn
- 14. Epidermal
- 16. Mid Dermal
- 17. Deep Dermal
- 19. Surgical principles for severe burn injuries • ‘Early’ excision of eschar • Usually within 72 hours • Staged procedures • Limited by temperature and physiological reserve • Wound closure ASAP if donor sites available • Increased risk of wound sepsis longer this takes • Autografting is the ‘gold standard’
- 20. Surgical considerations • Burn depth • Burn distribution • Availability of skin graft donor sites • Patient physiology • Temperature • Haemodynamics • Transfusion requirements
- 32. Rehabilitation
- 33. Skin substitutes • Many on the market • Designed to mimic the function of skin • Various characteristics • Acellular or cellular • Component of skin replaced (epidermis, dermis, or both) • Natural or synthetic • Permanence • Multiple applications • Definitive treatment of partial thickness burns • Temporary wound coverage after burn excision • Wounds that cannot support a skin graft • Scar resurfacing
- 35. Burn evolution
- 36. Burn evolution
- 38. Silicone film 0.15mm Collagen sponge 3mm thickness Pore size 70-110m ※blood capillary about 10μm、 fibroblast about 20μm
- 50. The future
- 51. Thankyou