Burns. Treatment 2012

First aid Stopping action of fire, hot water, electricity, radiation, chemical substances. Stopping action of fire, hot water, electricity, radiation, chemical substances. Analgesia. Analgesia. Putting of sterile dressing. Putting of sterile dressing. Transporting to the Transporting to the nearest hospital. nearest hospital.

Medical aid Therapeutic Therapeutic Surgical Surgical Analgesia Analgesia Catheterization Catheterization Oxygen therapy Oxygen therapy Complex infusive and medicamentous therapy Complex infusive and medicamentous therapy Necrotomy Necrotomy Necrectomy Necrectomy Grafting Grafting

Necrotomy

Necrectomy Surgical Surgical Chemical Chemical Biological Biological Fermentative Fermentative

Instruments for necrectomy and for cutting of grafts Humby knife Dermatomes

Methods of local treatment of burn wounds Dry method Wet method Open methodClose method

Open method of treatment of burn wounds Open method of treatment of burn wounds Indications: burns II-IIIА st. on face,perineum, where dressings could worse physiological acts burns II-IIIА st. on face,perineum, where dressings could worse physiological acts Burns IIIB-IV st. Burns IIIB-IV st.Methods: Usage of modern drugs for local treatment (solution of K permanganat, 0,5% solution of Na nitrate, 1% solution of jodopiron, “Naksol”) Usage of modern drugs for local treatment (solution of K permanganat, 0,5% solution of Na nitrate, 1% solution of jodopiron, “Naksol”) Treatment in not bacterial environment Treatment in not bacterial environment Usage of infrared lamps Usage of infrared lamps

Open method of treatment of burns

Close method of treatment of burns The main method of local treatment The main method of local treatment Appearing of conditions for local usage of drugs Appearing of conditions for local usage of drugs Optimal treatment out of hospital Optimal treatment out of hospital The only method during transporting The only method during transporting

Wet method of treatment of burn wounds Wet method of treatment of burn wounds Indications: Non infected burns of II-IIIA st. Non infected burns of II-IIIA st. Small in size infected burns of IIIАB st. in case of little exudation Small in size infected burns of IIIАB st. in case of little exudation Auto transplants on the wounds Auto transplants on the wounds Donor wounds Donor wounds Long lasting wounds Long lasting wounds

Mechanism of action of wet environment at I stage of wound process – stimulation of autolysis and clearing of the wound at I stage of wound process – stimulation of autolysis and clearing of the wound at II stage – making of good conditions for growth of granulations at II stage – making of good conditions for growth of granulations at III stage - making of good conditions for formation of soft and elastic scars at III stage - making of good conditions for formation of soft and elastic scars

Wet method of treatment of burn wounds Wet method of treatment of burn wounds

Wet method of treatment of burns

What we can use for local treatment of burns? What we can use for local treatment of burns? Bactericidic and bacteriostatic solutions, antibiotics. Bactericidic and bacteriostatic solutions, antibiotics. Water-soluble oinments. Water-soluble oinments. Sorbs. Sorbs. Biological coverings. Biological coverings.

Usage of ointments in local treatment of burn wounds Phase of wound process DrugAction Exudation Dioxizol, Oflocain Anti inflammatory, antibiotic effect Demarcation and clearing of wound Oflocain, Miramistin, Streptonitol Clearing of wounds by necrolytic type Regeneration Pantestin, Methyluracil Providing of good formation of epithelium

Disadvantages of gauze dressings Under them good environment for development of microorganisms appear You can’t provide effective concentration of drugs There is a need to change dressings often While taking off of these dressings you can injure new epithelium Pieces of gauze you can leave on the wound Painful dressings and need in frequent anestesia

Biological substitutes of skin – Gold standard of treatment of burn wounds Gold standard of treatment of burn wounds Homo skin Xeno skin Placenta Peritoneum

Preparing of liophilized xeno dermo transplants

Producing of liophilized xeno dermo transplants Cutting of xenotransplants Equilibration in solutions Introduction into anabiosis (solutions, temperature) Being in anabiosis (“adapting to new conditions”) Pull-out the anabiosis (temperature, duration) Preparing of xeno transplants to liophilization (possible reaching by drugs) Liophilization (duration, control) Packing Preparing before usage depending on aim of usage Cutting of xeno transplants Traditional liophilization To 3 hours Laboratory “on wheels ”

The xeno transplants are packed in sterile packets ( 100,150,200,250,300 sm2). It’s thickness is 0,3-0,5 mm. The xeno transplants are packed in sterile packets ( 100,150,200,250,300 sm2). It’s thickness is 0,3-0,5 mm.

Usage of xeno grafts in case of superficial burns Their functions : decrease or stop loosing of liquid, proteins, electrolites decrease or stop loosing of liquid, proteins, electrolites improve patient’s state improve patient’s state decrease or stop pain decrease or stop pain normalize body temperature normalize body temperature prevent burn disease prevent burn disease make faster recovery make faster recovery prevent scaring. prevent scaring.

Usage of xeno transplants in case of deep burns Large area of burns Large area of burns Non stable patient’s state Non stable patient’s state Not clear wound Not clear wound In combination with autoplastic In combination with autoplastic

Morphology of liophilized xeno transplants Layers of epidermocytes are saved. Clear basal membrane. Basophilic nucleuses vacuolization of cytoplazma of some cells. Organization of epidermocytes of spinal layer. Desmosomic contacts are saved, some dilation of between cellular spaces. Small invaginations of cariolema, destruction of some organels.

Wounds of IIIB-IV stages. Third day after xeno plastic. Close fixing of xeno transplant to the wound. Vessel (capillary) is growing into the xeno transplants from injured derma.

Clear wound surface. Good granulations. Wound is ready for autotransplantation Ultra structure of active fibroblast and formation of components of between cellular substance Wounds of ІІІ B – IV stages after taking off of xenotransplant. 14 day after xenoplasty

Burn of IIIA stage

Necrectomy (2 nd day after the trauma)

Wounds are covered with xenografts

Xenografts are fixed

Epithelization under the xenografts

Child B., 1 year. Burn by hot water ІІ-ІІІ А stages of neck, back, nates, left upper limb, 50% of body area. Wounds are covered with xeno transplants.

The same child. Epithelization under xeno transplants

Burn by the flame II-IIIA stage

Xenografting of burn wounds of II- IIIA stage

Epithelization of burn wounds of II- IIIA stage under xenografts

Burn of II-IIIA st. Xenografting

Epithelization under the xenografts

Burn wounds of ІІ-ІІІАB st., 26 (18) % of body area. Early necrectomy.

Xenografting. Autografting

Child, 1 year 8 month. Burn by the fire of face, trunk, right hand 44 (32%) of body area

The same child. Wounds are covered with auto- and xeno transplants

The same child after the treatment

Burn wounds of IIIB-IV stage

Early necrectomy for wounds of IIIB-IV stage

Auto grafting of burn wounds of IIIB-IV stage

Epithelization of burn wounds of IIIB-IV stage

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