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

1. "Sequelae of burns,
traditional and emerging issues
in a developing country”
Dr. Jorge Villegas
Servicio de Quemados
Hospital de Urgencia Asistencia Pública
Instituto Traumatológico
Clínica INDISA
Santiago. CHILE
www.cirugiaplasticayquemados.cl

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. 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. Resources are required to
Funding
Facilities
Human resourses
►Prevention,
►Acute phase treatment
►Rehabilitation
►Sequelae surgical treatment

5. Traditional approach
Sequelae Surgical treatment.
After the acute phase.
During rehabilitation stage.
Following cases …

6. improving facial expression

7. Debridement to healthy tissue Respecting Aesthetics Units

10. Changing the skin graft of dorsum of the hands. Improving function

11. Recover the extension

12. Full thickness skin graft

13. Trunk extension limited
Breast and abdomen sequelae Mastoplasty
Reverse abdominoplasty

14. Improving skin coverage of thorax in a girl before puberty.
Tissue Expander

15. Planning the progress

16. Complementary expansion

17. Lateral trunk
extension limited
Lateral
Abdominoplasty
Latissimus dorsi flap

18. When the repair is planned at the acute phase results are better

19. 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

20. A challenge for Plastic Surgery
A challenge for Health Service
Resources
Chile
Health System Public - Private
National Health expenditure per capita U.S. $ 670
Distribution Fifty- Fifty
Public System must attend 75% of the population.
The per capita expenditures in Public Service is
about 450 $ US Dollars

21. Changes produce changes

22. In Public Health System was necessary
to prioritize and
to optimize the use of resources
Focusing on pathologies of greater health impact,
guaranteeing by law :
access,
timeliness,
quality of care
funding

23. 2003. Intensive Care in the Burns Unit
2005. Changed treatment protocols
Surgical
Intensive Care

24. 2007.
►Serious burns patients were included in the group
of by law Guaranteed Pathologies
►The treatment of severe burns was concentrated
in our service as National Reference Center*
*130 Severe burns a year

25. The survival of our serious burns patients is increasing
% SURVIVAL

26. A.R. 1984

27. What is the best level of amputation?
Colostomy. Is it necessary?

28. We had not experience in this types of patiens

29. These
patiens died
before.
Rehabilitation
Sequelae manage
A new problem

30. High electrical voltage burn
Abdominal wall necrosis Bowel necrosis

31. intestinal anastomosis
Abdominal wall reconstruction with remaining muscles

32. Short-term Long-term

33. Self Injury
Repairing the burnt surface

34. Eyeballs saved
Eyelids destruction

35. Soleous muscle flap
Providing new circulation
tibia exposure

36. Knee
arthrodesis
Covering with muscle flap

37. In many cases
,
These new survivors are now patients with larger
and deeper burned body surface, older, and also
have concomitant diseases
They are alive but
with severe sequelae
a large burden of disease
These patients need plastic surgery techniques, already
within the acute phase

38. 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

39. .
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

40. That means
For The Public Health System
►To generate conditions to get necessary
infrastructure and equipment
►To develop incentives for incorporating plastic
surgeons to the Public Hospital network
For plastic Surgeons
►To strength their training in these areas.
►To take the challenge

41. Changes produce changes
That is what we are doing

42. Thanks for coming