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Trans Cyte

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  • 1. General wound care 1.Cleaning & debridement 2.Antimicrobial Agents 3. Biological dressings 4. Biosynthetic & Synthetic dressing 5.Excision & grafting
  • 2. Excision and Grafting
  • 3. Excision & Grafting the burn wound
    • Full thickness or extensive burn-spontaneous reepithelialization is not possible.
    • Skin transplant or a graft of the patient`s own skin (autograft) is required.
    • Main area for grafting-face for cosmetic and psychologic reasons, and joint, for movement
    • If the burn is extensive, chest and abdomen is grafted to reduce surface area.
  • 4. Excision & Grafting the burn wound
    • During the procedure of excision and grafting, eschar is removed.
    • A graft is placed on clean, viable tissue.
    • With early excision, function is restore and scar tissue formation is minimized.
    • Extensive bleeding may be expected.
    • Burn wound can be cover by patient`s skin (autograft)
  • 5. Cultured epithelial autografts
    • Pt with large body surface area burns, limited unburned skin available as a donor site for grafting.
    • Cultured epithelial autograft (CEA) is one method to obtain skin tissue from a person with limited available skin for harvesting.
    • CEA is grown for biopsies obtained from the patient`s own skin.
  • 6. Cultured epithelial autografts
    • Taking one or two small (2 to 3 cm long by 1cm wide) biopsy specimens from unburned skin.( usually the groin or axilla)
    • Performed as soon as possible when the pt has been identified.
    • Specimen is sent to lab.
    • Skin specimen are cultivated in the culture medium that contain epidermal growth factor.
  • 7. Cultured epithelial autografts
    • 18 – 25 days cultivated keratinocytes expand up to 10,000 and form a sheet that can be used as skin graft.
    • The cultured skin placed on the patient`s excised burn wounds.
    • CEA grafts are only epidermal cells, good care is required to prevent injury or infection.
  • 8. Cultured epithelial autografts
    • CEA grafts generate permanent skin coverage because they generate from pt`s own cells.
    • This type of skin graft has played an important role in the survival of the pt with major burns with limited skin for donor harvesting.
    • Problems related to CEA include thin, friable skin (lack of dermal cells) and contracture development.
  • 9. Wound closure
    • Skin grafting is usually required or preferred with full-thickness or deep partial thickness.
    • After eshar removed and development of a base of granulating tissue, graft`s of patient`s own skin (autograft) are applied.
    • Blood flow is established by 3 rd or 4 th , and by 7 th and 10 th day postgrafting, vascularity continuity and wound closure have been established.
  • 10. TransCyte
    • The most recent temporary skin substitute.
    • This bioengineered substance is derived form human fibroblast cells grown within mesh.
    • This product is also a bilayer skin substitute
    • The outer epidermal analog is a thin nonporous silicone film with barrier functions comparable to skin. 
  • 11. TransCyte
    • The inner dermal analog is layered with neonatal fibroblasts which produce products mainly collagen type I, fibronectin and glycosaminoglycans.
    •   Cryo-preservation destroys the fibroblasts but preserves the activity of fibroblast.-
    • These products do stimulate the wound healing process. 
    • A thin water layer is maintained at the wound surface for epidermal cell migration.
  • 12. TransCyte
    • The nylon mesh provides flexibility and excellent adherence properties.
    • The product is peeled off after the wound has re-epithelialized.
    • TransCyte must be stored at –70 C° in order to preserve the bioactivity of the dermal matrix products.
    • TransCyte is also indicated for the temporary closure of the excised wound prior to grafting.  
  • 13. TransCyte
    • Advantages
    • Bilayer analog
    • Excellent adherence to a superficial to mid-dermal burn
    • Decreases pain
    • Provides bioactive dermal components
    • Maintains flexibility
    • Good outer barrier function
  • 14. TransCyte
    • Disadvantages
    • Need to store frozen till use
    • Relatively expensive
  • 15. The two-layer structure, the inner layer being bioactive
  • 16. Stored at -70°Centigrade TransCyte in Sealed Cassette
  • 17. TransCyte for Partial Thickness Hand Burn Cutting the sheet to fit with a small overlap followed by initial immobilization until adherent
  • 18. TransCyte on Foot Burn (3 days) Note flexibility of the dressing
  • 19. TransCyte on Leg Burn (10 days) Opaque appearance indicating re-epithelialization beneath dressing for removal
  • 20. TransCyte (Day 12) Skin substitute being removed
  • 21. Escharotomy
    • Full thickness deep dermal burns which are nearly circumferential on the limbs, neck, thorax.
    • Act like tourniquets with the development of edema.
    • All extremity burns at risk should be monitored with at least hourly vascular checks of pulse or Doppler signal.
    • Escharotomies are longitudinal or crisscross incisions through such deep burns.
    • Done without analgesia and on the ward.
    • Does not bleed much.
  • 22. Escharotomy
  • 23. General wound care 1.Cleaning & debridement 2.Antimicrobial Agents 3. Biological dressings 4. Biosynthetic & Synthetic dressing 5.Excision & grafting
  • 24. ACUTE PHASE Other medication Nutrition Relieving anxiety Wound Cleansing and debridement
  • 25. Rehabilitation PHASE
  • 26. Physical & Occupational therapy
    • Rigorous physical therapy with the physical therapist
    • To maintain optimal joint function.
    • A good time for exercise is during and after hydrotherapy
    • Skin is softer and bulky dressings are removed.
    • The patient with neck burns should sleep without pillows
    • Head hanging slightly over the top of the mattress to encourage hyperextension
  • 27. Positioning
    • During this phase, patient must be maintained in positions that prevent contractures .
    • Contracture = abnormal flexion and fixition of a join cause by muscle atrophy and shortening
    • Minimizes formation of edema.
    • Prevents tissue destruction, and maintains soft tissues to facilitate recovery.
    • Patients should be positioned in a direction of comfort, especially around joints and flexor surfaces.
  • 28. Positioning
    • Extremities should be elevated above the level of the heart using pillows, blankets, and towels.
    • Lower extremities should be elevated when the patient is sitting.
    • Patients who do not have endotracheal tubes or central lines may be placed prone to avoid pressure to posterior areas
  • 29. Position and splinting
    • Turned from side to side to prevent the development of sacral pressure sores and to minimize discomfort from pressure on burns to these areas.
    • Burns to the upper extremities or hands should be evaluated by an occupational therapist.
    • Splints immobilize body parts and prevent contracture of the joint.
  • 30. Exercises
    • Physical therapists work in conjunction with occupational therapists.
    • Assessment by the physical therapist to assist with ambulation, range of motion exercises necessary splints
    • Exercises are begun early, active and passive.
    • Range of motion (R0M), performed every 2 hours at bedside.
    • Early ambulation
  • 31.  
  • 32.  
  • 33. Pressure garment.
    • Fitting of pressure garment, can prevent or reduce hyperthropic scarring.
    • Customade elastic pressure garments for 6 months and 1 year postgraft.
    • The psychologist plays an integral part in facilitating the psychological recovery of burn patients, and should be consulted for every patient admitted to the burn unit.
  • 34. SPLINT