Burns, Wound Healing

a brief introduction
Dr.Aditya Wardhana SpBP
Burn Unit RSCM
 FUNCTION OF THE SKIN

1. Thermoregulation
2. Sensoric
3. Imune respons
4. Protection
5. Control fluid loss
6. Metabolic function
7. Psycho social.
1. Siobhan Conolly MB, et al. Clinical Practice Guidelines: Burn Wound Management NSW Health. NSW Health. 2009.
 BURN SKIN DEPTH

Darke J. EMSB Course Manual; Partial Thickness Burns – Current Concepts as to Pathogenesis and Treatment. RNSH C, editor2009.
David N. Herndon. Total Burn Care 3rd Edition. Saunders E, editor2007.
Siobhan Conolly MB, et al. Clinical Practice Guidelines: Burn Wound Management NSW Health. NSW Health. 2009.
 FUNCTION OF THE SKIN

1. Thermoregulation
2. Sensoric
3. Imune respons
4. Protection
5. Control fluid loss
6. Metabolic function
7. Psycho social.
1. Siobhan Conolly MB, et al. Clinical Practice Guidelines: Burn Wound Management NSW Health. NSW Health. 2009.
Function of the skin

 Epidermal provides a vapour, bacterial layer.

 Dermis: flexibility and strngeth.

 Durable between these layers is crucial, can be

temporarily or permanent lost, TEN, EB.
 Dermal appendages prevent desiccation by
producing oils and reactive dermal
microvasculature facilitates heat dissipation and
conservation.
 PATHOPHYSIOLOGY

3. Jackson D. The diagnosis of the depth of burning. British Journal of Plastic Surgery. 1953;40:588-96.
BURN WOUND DEPTH DEGREE

Gambaran
Pembuluh Darah
Trombosis

Darke J. EMSB Course Manual; Partial Thickness Burns – Current Concepts as to Pathogenesis and Treatment. RNSH C, editor2009.
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 Airway

 Anamnesa : Trapped in closed air space

 Findings : Facial Burn, mucosal edema, stridor

 Action : Laryngoscopy -> edema or hyperemia of

upper airway -> intubate.
 When in doubt -> intubate.

 Don’t try more than twice, convert to tracheostomy

(or when difficult to intubate).
Breathing

 Mechanical of breathing : any sign of fracture?

Eschar on chest wall?
 Eschar  escharotomy.
Circulation

 Check pulse, heart rate, blood pressure, O2

saturation
 2 Large vein access -> CVC and or femoral plus
peripheral vein ( VC).
 Insert Folley catheter -> urin output.

 Circumferncial eschar -> esharotomy

 Fluid resuscitation

 Adult : > 15% TBSA

 Children : > 10% TBSA

 Parkland formula : 4 x kg x TBSA, half in 8 hrs, and half in

16 hrs.

 Target urine output : 1cc/kg/hour.

 Start from the time of injury! Don’t delay!

 Titrate, titrate, adjust hourly according urine output.

(5%)
Wound excision and closure

 Evaluation of the wound : depth, size and circumferential

components.

 Determining the time and need for operation: full thickness wound,
aggressive or staged, temporary wound closure ( allograft) or
definitive ( autograft)

 Techniques of burn wound excision…

 Techniques to minimize blood loss

 Graft fixation and postop care

 Skin substitute

 Donor site management.

 Burns….

 Is not just critical care, wound care and surgery (

excision and grafting)
 There are many issues that should be treated in
burn unit.
 Besides facilities and organization also team
work and leadership
 It should facilitate from acute care to
rehabilitation, aftercare and reconstruction.
 Symposium and Workshop

“Summary of Burn Care”

February 8- 10th 2013

Hotel Sari Pan Pacific

www.lingkarstudibedahplastik.com/burncongress

THANK YOU