Acute burns isshcon 2013 by Dr. Sunil Keswani, National Burns Centre, Airoli

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Acute burns isshcon 2013 by Dr. Sunil Keswani, National Burns Centre, Airoli

  1. 1. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Dr Sunil Keswani Plastic Surgeon NATIONAL BURNS CENTRE Navi Mumbai
  2. 2. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com  “Pour water on BURNS till the burning sensation subsides”  Relieves pain Decreases depth of burn 
  3. 3. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com   Dorsal skin similar to rest of skin -much thinner (tendons easily exposed) Palmar skin markedly different -Thicker epidermis -Less mobile -No hair -No pigment
  4. 4. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com PATIENT COMES EARLY(WITHIN 48 HRS)      PATIENT COMES LATE(AFTER 48 HRS)  Rupture the blister Evacuate the blister fluid by  gentle milking with saline soaked gauze  Cover with KOLLAGEN-M KOLLAGEN-M is just laid on and covered with adequate layers of gauze to ensure there  is no external soakage(“STRIKE THROUGH”)  Crepe Bandage Gently clean with sterile saline soaked gauze Apply a thick layer of 1% SILVER SULPHADIAZINE Apply a non adherent lubricated dressing like Vaseline gauze or Jelonet Cover with adequate layers of gauze Crepe Bandage
  5. 5. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com PRE-APPLICATION POST-APPLICATION
  6. 6. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com SMALL BURN SIZE(TBSA<30%) AND DEFINITE 3RD DEGREE BURN   Early excision and AUTOGRAFTING. Timing-within first four days post-burn LARGE BURN SIZE(TBSA>30%) AND UNCERTAIN ABOUT DEPTH     Early excision and HOMOGRAFTING Within first four days postburn Mobilisation instituted after second dressing ie 4th day Homograft can be replaced by autograft if wound does not epithelialise under the homograft in 2 weeks time
  7. 7. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com   Allow to heal on its own-give it time RARELY does it need resurfacing IF Resurfacing needed Full thickness grafts from groin -Good function -Hyperpigmented
  8. 8. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com IF deeper vital structures are exposed ONLY then  Local flaps-transposition, advancement, cross finger, island flaps  Abdominal, groin flaps  Free flaps
  9. 9. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com INCISION LINES TYPES OF RELEASE INCISIONS     Mid axial incisions Carpal tunnel release Guyons canal release Digital incisionsThumb and LF –radial IF,MF,RF-ulnar
  10. 10. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  11. 11. 8 P’S         Pain Pallor Pressure Pulselessnes Paresthesia Paralysis Poikilothermia Progression of the ischemia Timely  Appropriate  Adequate -Hand compartments -Finger compartments  Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  12. 12. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com INTRINSIC TIGHTNESS TEST   MCP jt is passively extended and the PIP jt is passively flexed Presence of SIGNIFICANT RESISTANCE is an indication of release of the intrinsic muscles
  13. 13. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  14. 14. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com PAIN MANAGEMENT PROTOCOL     Inj Ketamine 100mg Inj Tramadol 100mg Inj Midazolam 10mg All together in a 50cc syringe pump starting at 4cc per hour and titrating with pain relief and can go up to 40cc per hour in heavy or apprehensive patients PAIN RELIEVED- BETTER PATIENT COMPLIANCE FOR PHYSIOTHERAPY
  15. 15. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com      Splints are given from Day 1 To be worn 24 hrs a day for a week To be worn only at night after a week for the next 4 weeks Light pressure bandaging Elevation
  16. 16. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com     Mobilisation instituted after second dressing (post grafting) ie. 4th day Passive gentle ROM exercises Active movements Preferably every 2 hourly by hand therapist and relatives
  17. 17. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Limb Physiotherapy
  18. 18. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com    Once the wound heals and is well epithelialised pressure garments are worn which is roughly by the 21st PBD To be worn 23 hours a day Should be removed four times a day for cleaning and massage and more active movements
  19. 19. CHEMICAL BURNS     Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com FIRST AID -Wash off the offending agent with copious water for adequate time to ensure minimum contact period between corrosive and the skin Invariably DEEP (rarely superficial) Alkali burns are generally deeper than Acid burns Early excision and grafting
  20. 20. TAR BURNS    Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Tar not to be removed on Day 1-to be left alone and dressed with thick layer of 1% Silver sulphadiazine/ Paraffin/ Cocoa butter Tar will start coming off spontaneously by the 4th PB day One could damage useful epithelium and deepen the depth of burn by attempting early removal of TAR
  21. 21. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com ELECTRICAL BURNS    Compartment Syndrome Early adequate fasciotomy Appropriate surgical intervention depending upon the damage-skin graft, flap cover, amputation.
  22. 22. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Re-epithelialize within 2 weeks to minimize scarring  Optimize epithelialisation by  Moist healing  Minimize infections  Biologic dressings  Optimize costs 
  23. 23. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com     FULL THICKNESS BURNS Autografts Finely meshed 2:1/Sheet grafts Medium thickness
  24. 24. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Exposed joints  Immobilize(K-wires)  Exposed bones, tendons, joints  Skin grafts do not suffice  Flaps required 
  25. 25. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  26. 26. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  27. 27. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  28. 28. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  29. 29. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  30. 30. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  31. 31. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  32. 32. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  33. 33. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  34. 34. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  35. 35. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  36. 36. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  37. 37. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  38. 38. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  39. 39. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  40. 40. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com Pre-Op wound Application of Homograft Day 3 Complete healing Day 21
  41. 41. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  42. 42. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  43. 43. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  44. 44. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  45. 45. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  46. 46. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  47. 47. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  48. 48. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  49. 49. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  50. 50. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  51. 51. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  52. 52. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  53. 53. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  54. 54. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  55. 55. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  56. 56. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com
  57. 57. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com    Burns of the HAND can land up with severe dysfunction and morbidity Simple TIMELY interventions can make a HUGE difference to outcome!! Positioning, Early excision, Early mobilisation and TEAM APPROACH are the KEY to good outcomes in Acute HAND Burns
  58. 58. Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com THANK YOU BURNS Helpline: 022 2779 3333 www.burns-india.com

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