Early excision and grafting for burns

1. Dr Muhammad Saaiq
FCPS(Surgery), FCPS(Plastic Surgery)
Assistant Professor of Plastic Surgery
ISLAMABAD.
Surgical Management
of Deep Burns Up to 40%
body surface area:
Personal Experiences and Insights

2. What are burns

3. Zone of Coagulation:
Irreversible damage
Zone of Stasis:
Impairment of blood flow
Recovery variable
Zone of Hyperemia:
Prominent vasodilation
Usually recovers
Three Zones of tissue Insult
in Deep Burns
Jackson DM: The diagnosis of the depth of burning. Br J
Surg 1953;40:588-96.

4. Alarming situation in Pakistan
Over 02 years, we had 13,295 enrolled burns
patients
1,405 patients (10.58%) were hospitalized. The
mean hospital stay was 12.16±6.07 days (range 2-
73 days).
There were 197 deaths among the hospitalized
patients (14% mortality rate for the hospitalized
patients)
Magnitude of the Problem in Pakistan

5. Types of Burns?

6. Flame burns

7. Scald burns

8. Contact burns

9. Acid burns

10. Electric burns

11. Flash burns

12. Electric contact

13. Cautery burns

14. Burns like syndromes

15. How to measure body surface
area affected

17. Degrees of Burns

18. 1st Degree burns
Sunburns

19. 2nd Degree burns

20. 3rd Degree burns

21. 4th degree burns

22. 5th degree burns(ABA)

23. Why Fluid Resuscitation during
first 2 days

24. 0%
20%
40%
60%
80%
100%
120%
12 Hours 24 Hours 36 Hours
PLASMA LOSS Vs HOURS: Greatest loss occurs during first 8-12
hours, and slow loss continues over next 12-16 hours.

25. Emergent Surgical procedures
during Fluid Resuscitation Phase

26. How Did we Surgically Manage Deep burns?

27. Objective: To analyse the Presentation and Outcome
of surgically managed deep burns.
Study Design: Case series.
Duration of the Study: Two Years
Inclusion criteria: All burn injury victims of either
gender who underwent early surgical excision and
resurfacing for deep burns during the study period.
Exclusion criteria:
1. Burns >40 %TBSA
2. Burns <5 %TBSA
3. Suicidal burns
Data Collection: Continually updated computer data
base and Ongoing photo-archiving of Patients.

28. Gender Distribution (n=169)
Females
61%
Males
39%

29. Age Distribution (n=169)
32
21
66
28
22
0
10
20
30
40
50
60
70
No. of
patients
0-10 11..20 21-30 31-40 41-50
Age (Years)

30. Age Distribution (n=169)
Upto 12
Years
22%
> 12 Years
78%

31. Distribution of the Causes (n=169)
12 7
1 7
13
7
4
1
0 50 1 00 1 50
N o . o f P atie n ts
F lam e bu rn s
C o nta c t bu rn s
F las h/ ele c tric
S c ald s
C hem ic al
B la s t injury
CausesofburnInjury

32. 7 7
5 2
2 4
9
7
0 2 0 4 0 6 0 8 0
N o . o f Pa tie n ts
Kitch e n
Ho m e
R o o fto p /p la yg ro u n d
Stre e t
R o a d
Place of acquisition of the burn
injury (n=169)

33. T B S A a ffe c te d (n =1 6 9 )
0-10%
T B S A
10% 11-20%
T B S A
21%
21-30%
T B S A
52%
31-40%
T B S A
17%
Total body surface area involved
(n=169)

34. Procedure Numbers
1 Mean TBSA burnt (%) 30.1±8.3%
2 Mean Operating time (Min) 130±16.76 min
3 Mean blood transfusions(Units) 3.4±1.25
4 Mean hospital stay
(days)
12.16±6.07
( range 7-39)
5 Mortality Nil
Outcome measures observed
(n=169)

35. Few Representative Cases of the
Series

56. Deep Burns
>15-20%TBSA
What if Timely Surgery for deep burns
is NOT instituted?
INEVITABLE
MORTALITY

57. What if Timely Surgery for deep burns
is NOT instituted? (When <15-20%)
A stitch in time Saves nine.