PTY3051 Week 3: Burns & Plastics

Types of burns

- Thermal: flash, scald, flame

- Electrical

- Chemical

- UV radiation

- Frostbite

Referral criteria for burns

- >10% total burn surface area

- Special areas

- Electrical / chemical / inhalation burns

- Associated trauma

- Pre-existing disorders

Consequences of burns

- Loss of independence

- Financial support of family required

- Loss of productivity in society

- Financial burden to health care system

Layers & contents of dermis

- Layers: papillary (superficial) and reticular (deep)

- Contents: mechanoreceptors, sweat & sebaceous glands, lymphatic & blood vessels

Characteristics of different burns

- Pain & healing potential ↓ with ↑ burn depth

- Scarring & need for surgery ↑ with ↑ burn depth

General effects of burns

- Oedema & hypovolemia

- Immunosuppression

- GI, respiratory dysfunction, & multi-organ failure

- Muscle wasting, contractures & scarring

- Functional impairment

- Loss of independence & death

Effects of inhalation injuries

- Burns to head & neck

- Singed nasal hairs & hoarse voice

- Airway oedema, compromised airways

- Altered conscious states

- Impaired gas exchange, sputum retention & death

Surgical grafts for burn wounds

- Allografts (cadaver skins)

- Autografts (split skin / full thickness skin grafts)

- Xenografts (porcine)

- Synthetic (biobrane / integra)

Formation of scars from burns

- Around 4 - 8/52

- Inflammatory responses in the burn wound

- Formation of granulation tissues

- Epithelialisation: excessive & random collagen deposition

- Active contraction (thick, hard & raised skin) can cause formation of contractures

Features & management of contractures in burns

Features:

- Tight bands of fibrous tissues

- Typically over joints

Management:

- Prolonged stretching & exercise

- If formed: surgical release

Physiotherapy of a burns patient

- Treating existing problems

- Respiratory care

- Improving joint range & strength

- Mobilising

- Minimising contractures & scarring

Contracture & scar management in burns patient

- Splinting / positioning

- Stretching / massage

- Pressure (via tubigrip, pressure garments & contact media) to ↓ blood flow & oedema, ↑ collagen breakdown & promote fibre realignment

Mobilising burns patients

- Tilt table (for WB & orthostatic pressure mx)

- SOEOB (for trunk control & balance)

- Standing frame (for WB, LL strength & trunk control)

- Ambulating (using appropriate gait aids)

Definition & indication of flaps

Muscles / tissues relocated from one area of body to another with part/all of original blood supply intact

Indications:

- Cover vital structures

- Provide vascularised bed for nerve / tendon grafting

- Aesthetic restoration of tissue deficit

Types of flaps (anatomical composition)

- Cutaneous

- Fascial / muscle

- Bone

- Composite (myocutaneous / orthocutaneous)

Types of flaps (position)

- Pedical (attached to border of donor area)

- Rotational (rotated to cover adjacent defect)

- Advancement (moved forward with no rotation)

- Island (skin with intact vascular pedicle under skin bridge)

- Free (fully detached from donor area)

Flap assessment

- Colour (purple: venous congestion; pale/ white: arterial insufficiency

- Swelling (may indicate venous obstruction)

- Temperature (hot: infection; cold: tissue death, no perfusion)