3. BURN INJURY A.H.N MD PLASTIC AND RECONSTRUCTIVE SURGEON ALBORZ UNIVERSITY OF MEDICAL SCIENCES

8. INHALATION INJURY  PaO2/FiO2<200  CO POISONING  CYANIDE POISONING

9. NUTRITION  BMR INCREASES UP TO 200%  HARRIS BENEDICT FORMULA  <40% INACCURATE  CURRERI FORMULA  25KCAL/KG/D PLUS 40KCAL/%TBSA/D  B BLOCKER  OXANDROLONE  INSULINE  METFORMINE

10. WOUND DRESSING AND COVERAGE

11. Wound care  There are 3 factors that impair wound healing 1. Infection 2. Tissue ischemia 3. Nutritional deficit  Daily wound dressing minimizes the rate of infection

12. Wound dressing

13. Surgical treatment  For deep 2 nd degree and 3 rd degree burns  Early excision and grafting  More than 2 weeks to epithelializes

14. Topical dressings  Silver sulfadiazine:the most common agent intermediate wound peneteration good antibacteial spectrum twice a day transient leukopenia change to another agent transiently

15. Mafenide acetate  Excellent eschar penetration  Excellent bacteriostatic action  Often on ears and nose  Metabolic acidosis hypercholoremic  Very painful

16. Dakin solution  Infected and smelled skin grafts  Gram positive bacteria

17. Silver nitrate  Excellent antibacterial action  Discoloration  acticoat

18. Surgical procedures  Tangenital  Full thichness excision  Excision was done by the instrument called DERMATOM

20. tangenital  Painful  Increased blood loss  Difficult to judgement  1day to 3 weeks after injury

21. Full thichness excision  Less painful  Less blood loss  Easy to judgement  lesser cosmesis

22. excision  100 cc blood loss for 1% excision  Should limited to 10 to 20% TBSA  1 to 3days apart sessions

23. grafting  Early  Autologus skin grafts:gold standard  1 st initiate from the largest segment such as trunk  Head and neck and hands are exceptions

24. meshage  When the burned size is more than 50% of TBSA and there is less donor site  This is done by the instrument called MESHAGE  The ratio can be up to 1:9

27. Wound coverage  Fresh human cadaveric skin the most widely used viable and revascularizes rejection after 1 t0 2 weeks disease transmission

28. Wound coverage  Pig skin and freeze-dried cadaveric skin: don’t take don’t revascularize inexpensive

29. Wound coverage  Biobrane: collagen coated netting expensive works well in superficial wounds works well in skin graft donor sites

31. Wound coverage  Trancyte: human fibroblast in collagen matrix live cell expensive superficial wounds skin graft donor sites

33. Wound coverage  Alloderm:acellular human dermis expensive vascularizes slowly no antimicrobial activity

35. Wound coverage  Integra:bovine collagen in shark condroitin sulfate expensive vascularizes slowly no antibacterial activity

36. permanat coverage  Autologus skin grafts: limited the extremities are the best areas the next:trunk but contour irregularity the scalp:is the best for face wounds the donor site: can be used multiple times but bleeding is more and regrowthing is slower

37. Permanat coverage  Cultured epidermal autograft(CEA): 2 TO3 WEEKS TAKES no dermal matrix little give and are stiff little motion and function such as muscles and face and joints blisters and shears easily expensive

38. Dermal replacements  Decrease the rate of later reconstructive surgery better skin elasticity prevent extensive scarring integra alloderm engraftment takes 2 weeks after that it is covered by skin graft disadvanage:the prolonged process

39. APLIGRAF

42. Burned hand  The most important site for grafting and must be involved 1 st  Must be splinted as soon as possible whereas wrist in 30 degree extension ;mcp joints in 70-90 flexion and pip and dip joints in 180 degree extension  The most important joint in hand is PIP joint that has 95% functional capability of the hand

43. Eschar or scar

44. escharotomy  It is applied when capillary filling is impaired in extremities  When abdominal compartment syndrom was occured

45. Capillary filling  1to 3 seconds  If it is less than 1 s means vein congestion happened  If it is more than 3 s means arterial ischemia has been occured