Burn Healing
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Transcript of 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
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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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April 1st 2012Ruby RA 10
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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April 1st 2012Ruby RA 12
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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15
TIDAK DIHITUNG
DALAM PERHITUNGANLUAS LUKA BAKAR
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12/06/2013Ruby Riana A., dr., SpBP 17
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12/06/2013Ruby Riana A., dr., SpBP 18
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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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12/06/2013Ruby Riana A., dr., SpBP 26
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April 1st 2012Ruby RA 27
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Wound Healing Phases
Inflammation
Proliferation
Maturation
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Sequence of cell
appearance
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Wound Healing Phases
Proliferative (3d-3wk)
Fibroblasts multiply
Collagen production
Endothelial cells proliferate
New vessels
Myofibroblasts
Wound contraction
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Wound Healing Phases
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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Inhibition of Wound Healing
Poor O2 tension
Diabetes
Small vessel arteriosclerosis
Irradiation
Infection
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Inhibition of Wound Healing
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
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Reconstructive surgery:
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Reconstructive surgery:
Primary goals
Preservation of life and limb
Restoration of form and function
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Reconstructive surgery:
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Reconstructive surgery:
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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Reconstructive surgery:
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Reconstructive surgery:
Flap types
Skin
Random pattern blood supply
Axial pattern blood supply
Muscle
Musculocutaneous
Fascia
Fasciocutaneous