Round table. burns.ipras
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Transcript of Round table. burns.ipras
Dr. Jorge VillegasServicio de QuemadosHospital de Urgencia Asistencia PúblicaInstituto TraumatológicoClínica INDISASantiago. CHILEwww.cirugiaplasticayquemados.cl
"Sequelae of burns,
traditional and emerging issues
in a developing country”
Burn injuries and their sequelae are, in our countries,a major health problema major social medical problema challenge for plastic surgery
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
Resources are required to
FundingFacilitiesHuman resourses
►Prevention, ►Acute phase treatment►Rehabilitation►Sequelae surgical treatment
Traditional approach
Sequelae Surgical treatment. After the acute phase.During rehabilitation stage.
Following cases …
improving facial expression
Respecting Aesthetics UnitsDebridement to healthy tissue
Changing the skin graft of dorsum of the hands. Improving function
Recover the extension
Full thickness skin graft
Reverse abdominoplasty
Mastoplasty
Trunk extension limited
Breast and abdomen sequelae
Improving skin coverage of thorax in a girl before puberty.
Tissue Expander
Planning the progress
Complementary expansion
Lateral Abdominoplasty
Latissimus dorsi flap
Lateral trunkextension limited
When the repair is planned at the acute phase results are better
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
A challenge for Plastic Surgery
A challenge for Health Service
ChileHealth 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
Resources
Changes produce changes
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
2003. Intensive Care in the Burns Unit
2005. Changed treatment protocols SurgicalIntensive Care
►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*
2007.
*130 Severe burns a year
The survival of our serious burns patients is increasing
% SURVIVAL
A.R. 1984
What is the best level of amputation?
Colostomy. Is it necessary?
We had not experience in this types of patiens
Thesepatiens diedbefore.
RehabilitationSequelae manageA new problem
High electrical voltage burn
Abdominal wall necrosis Bowel necrosis
intestinal anastomosis
Abdominal wall reconstruction with remaining muscles
Short-term Long-term
Self Injury
Repairing the burnt surface
Eyeballs savedEyelids destruction
Soleous muscle flapProviding new circulation
tibia exposure
Kneearthrodesis
Covering with muscle flap
These new survivors are now patients with larger and deeper burned body surface, older, and also have concomitant diseases
In many cases
They are alive but with severe sequelae a large burden of disease
,
These patients need plastic surgery techniques, already within the acute phase
.
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 thatThere are few plastic surgeons in the public system
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
.
For plastic Surgeons►To strength their training in these areas.►To take the challenge
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
That means
Changes produce changes
That is what we are doing
Thanks for coming