Fatima Abd Al Bari
Surgery
L5
BURN Part 1))
Definition
A burn is an injury to the skin or other
organic
tissue primarily caused by thermal or
other
acute trauma.
Causes: scald(the most common),
flame(deep),flash,contact,chemical,&el
ectrical.
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Fatima Abd Al Bari
Classification
Burn Wounds Classified Based on Depth of
Penetration:
First degree:
• Epidermis only
Skin erythema, pain
Blanches with pressure
No blistering
Symptoms subside over 2-3 days,
epithelium peels at day 4.
Burn depth
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Fatima Abd Al Bari
First degree burn
Second degree
• Superficial: Papillary dermis sparing
skin appendages
Painful
Blanches with pressure
Blistering may be delayed for 12-24
hours after burn.
Most heal within 3 weeks via stem
cells from skin appendages without
hypertrophic
scarring.
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Fatima Abd Al Bari
Second degree burn
Second degree(continued)
Deep: Reticular dermis involving loss of
skin appendages
Decreased sensation
No capillary refill
Blistering
Heal in 3-9 weeks, hypertrophic
scarring common, usually treated with
excision and
Grafting.
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Fatima Abd Al Bari
Third degree burn
Entire dermis and adnexal structures
Blistering absent
Insensate, leathery consistency,thrombosed
veins.
Color varies with mechanism of burn.
If no intervention, it will demarcate and
separate over days to weeks. However, this
delays healing and risks infection.
Circumferential third-degree burns of
extremities may lead to compartment syndrome
if muscles become edematous; likewise
circumferential chest wall burns may inhibit
expansion and breathing.
Third degree burn
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PHYSIOLOGIC RESPONSE TO
BURN INJURY
# Generalized edema is usually seen in
patients with burns greater than 30% total
burned surface area (TBSA).
#Increased capillary permeabilityto
protein(last for 12-18 hours)
#Smaller burns cause localized edema only.
#Microvascular injury can interfere
with the function of various organ systems.
Indications of admission
1- Partial-thickness burns greater than 10% of TBSA
2- Third-degree burns
3- Burns involving face, hands, feet, genitalia,
perineum, or major joints
4- Chemical burns
5- Electrical burns
6- Any burn with concomitant trauma in which burn
poses greatest risk to patient
7- Inhalation injury
8- Preexisting medical disorders that could affect
mortality
9 Hospitals without qualified personnel or equipment
for care of burned children
10- Patients who will require special social, emotional,
or rehabilitative intervention
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Resuscitation
NB:Remember your A-B-C-D-Es.
#Burn shock from systemic response typically
occurs with .20% TBSA (.15% in pediatric/
geriatric patients).
# Burn shock requires resuscitation.
PARKLAND FORMULA:
4 ml X Weight (kg) X %TBSA burned.
Half of the total amount in lactated Ringer’s solution given
over the first 8 hours from the time of injury and the second
half over the next 16 hours.
Calculation of TBSA
1-Lund and Browder chart
2-rule of nines
3- palm method
NB: first degree burn is not included when
calculating TBSA.
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Fatima Abd Al Bari
Rule of nines
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Fatima Abd Al Bari
Electrical Injuries
# Most sequelae from high-voltage injury
(>1000 volts)
# Find contact points
# ECG
# Cardiac monitoring
# Renal function testing
# Tea-colored urine indicates myoglobinuria.
• Maintain urine output at 75-100 ml/hr to
minimize myoglobin precipitation. Bicarbonate
or mannitol may be needed.
#Risk of compartment syndrome in involved
extremity
Acute-Phase Burn
Reconstruction
For deep second and 3rd degree
burn :Excision Wound coverage
autograft,allograft ,xenograft
Aggressive splinting and therapy
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Fatima Abd Al Bari
Commonly Prescribed Topical
Antimicrobials for Burn Wounds
Silver sulfadiazine (Flamazine)
Mafenide acetate (Sulfamylon)
0.5% silver nitrate solution
Complications
A- Care related
• Pneumonia: Most common cause of death in burn patients
• Sepsis
• Gastrointestinal complications: Ileus and ulceration
• Renal failure: Acute tubular necrosis (ATN) from
hypoperfusion
• Shock: Inadequate end-organ perfusion
Signs of sepsis:
1. Hyperventilation
2. Fever or hypothermia
3. Hyperglycemia
4. Obtundation
5. Ileus
6. Hypotension and oliguria
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Fatima Abd Al Bari
Complications
B-Surgical:
• Graft loss
• Burn scar contracture
• Wound breakdown
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