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Round table. burns.ipras

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Participacion en la Mesa Redonda de Quemaduras. Congreso Mundial de Cirugia Plástica Reparadora y Estética IPRAS 2013

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Round table. burns.ipras

  1. 1. "Sequelae of burns,traditional and emerging issuesin a developing country” Dr. Jorge Villegas Servicio de Quemados Hospital de Urgencia Asistencia Pública Instituto Traumatológico Clínica INDISA Santiago. CHILE
  2. 2. Burn injuries and their sequelae are, in our countries, a major health problem a major social medical problem a challenge for plastic surgery
  3. 3. The incidence of burns is related to ►Life conditions ►Lifestyle The treatment of burned patiens is ►Difficult ►Long ►ExpensiveBurn frequency and severity are greaterResources are minor
  4. 4. Resources are required to Funding Facilities Human resourses ►Prevention, ►Acute phase treatment ►Rehabilitation ►Sequelae surgical treatment
  5. 5. Traditional approachSequelae Surgical treatment.After the acute phase.During rehabilitation stage. Following cases …
  6. 6. improving facial expression
  7. 7. Debridement to healthy tissue Respecting Aesthetics Units
  8. 8. Changing the skin graft of dorsum of the hands. Improving function
  9. 9. Recover the extension
  10. 10. Full thickness skin graft
  11. 11. Trunk extension limited Breast and abdomen sequelae Mastoplasty Reverse abdominoplasty
  12. 12. Improving skin coverage of thorax in a girl before puberty. Tissue Expander
  13. 13. Planning the progress
  14. 14. Complementary expansion
  15. 15. Lateral trunkextension limited Lateral Abdominoplasty Latissimus dorsi flap
  16. 16. When the repair is planned at the acute phase results are better
  17. 17. What are, for us, the issues in the treatment of sequelae today?The problem is not only surgical technique indication performance The problems are ►access, ►timeliness ►financing ►quality of care
  18. 18. A challenge for Plastic SurgeryA challenge for Health ServiceResourcesChileHealth System Public - PrivateNational Health expenditure per capita U.S. $ 670Distribution Fifty- FiftyPublic System must attend 75% of the population.The per capita expenditures in Public Service isabout 450 $ US Dollars
  19. 19. Changes produce changes
  20. 20. In Public Health System was necessary to prioritize and to optimize the use of resourcesFocusing on pathologies of greater health impact,guaranteeing by law : access, timeliness, quality of care funding
  21. 21. 2003. Intensive Care in the Burns Unit2005. Changed treatment protocols Surgical Intensive Care
  22. 22. 2007.►Serious burns patients were included in the groupof by law Guaranteed Pathologies►The treatment of severe burns was concentratedin our service as National Reference Center* *130 Severe burns a year
  23. 23. The survival of our serious burns patients is increasing % SURVIVAL
  24. 24. A.R. 1984
  25. 25. What is the best level of amputation? Colostomy. Is it necessary?
  26. 26. We had not experience in this types of patiens
  27. 27. Thesepatiens diedbefore.RehabilitationSequelae manageA new problem
  28. 28. High electrical voltage burnAbdominal wall necrosis Bowel necrosis
  29. 29. intestinal anastomosisAbdominal wall reconstruction with remaining muscles
  30. 30. Short-term Long-term
  31. 31. Self InjuryRepairing the burnt surface
  32. 32. Eyeballs savedEyelids destruction
  33. 33. Soleous muscle flap Providing new circulationtibia exposure
  34. 34. Knee arthrodesisCovering with muscle flap
  35. 35. In many cases ,These new survivors are now patients with largerand deeper burned body surface, older, and alsohave concomitant diseases They are alive but with severe sequelae a large burden of diseaseThese patients need plastic surgery techniques, already within the acute phase
  36. 36. This new situation generates a new scenario for both: ►rehabilitation and social reintegration. ►treatment of sequelae. Our Public Health System is not prepared to face that There are few plastic surgeons in the public system
  37. 37. . In summary , ►the increased survival of serious burns generates a new scenario ►That scenario demands amongst other measures: integration of plastic surgeons in the medical team from the acute stage
  38. 38. That meansFor The Public Health System►To generate conditions to get necessary infrastructure and equipment►To develop incentives for incorporating plastic surgeons to the Public Hospital networkFor plastic Surgeons►To strength their training in these areas.►To take the challenge
  39. 39. Changes produce changes That is what we are doing
  40. 40. Thanks for coming