Plastic surgery & physiotherapy in burns

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Plastic surgery & physiotherapy in burns

  1. 1. Aims Wound closure To prevent infection To recover skin function/reconsruct
  2. 2. DefinitionsGraft A skin graft is a tissue of epidermis and varying amounts of dermis that is detached from its own blood supply and placed in a new area with a new blood supply.Flap Any tissue used for reconstruction or wound closure that retains all or part of its original blood supply after the tissue has been moved to the recipient location.
  3. 3. Graft vs Flap Graft FlapDoes not maintain Maintains original bloodoriginal blood supply. supply.
  4. 4. Reconstructive ladder Free flap Distant flap Local flap Full thickness skin graft Split graft Primary closure Secondary intention
  5. 5. Skin graft Split thickness graft Composite Full thickness graft(skin+s skin ub.cut.tissue graft(epiderm ) is+dermis)
  6. 6. Type of Graft Advantages Disadvantages -Best Survival -Least resembles original skin.Thin Split -Heals Rapidly -Least resistance to trauma.Thickness -Poor Sensation -Maximal Secondary Contraction -More qualities of normal -Lower graft survivalThick Split skin. -Slower healing.Thickness -Less Contraction -Looks better -Fair Sensation -Most resembles normal -Poorest survival.Full skin. -Donor site must be closedThickness -Minimal Secondary surgically. contraction -Donor sites are limited. -Resistant to trauma -Good Sensation -Aesthetically pleasing
  7. 7. Auto graft-no rejectionHomo graft-rejected in 3 weeksHetero graftSkin cultureMeshed skin
  8. 8. Skin flap Random pattern Axial pattern flap flap specific artery andsub dermal plexus vein
  9. 9. Skin flap Local flaps transpositio Free flaps Distant flaps nal flap, blood vessels groin flap, rotation dissected and cross leg flap, anastamosed flap, to the pedicle flap z plasty, recipient area v/y plasty
  10. 10.  Musculo/myo cutaneous flap
  11. 11. Harvesting Tools Razor Blades Grafting Knives (Blair, Ferris, Smith, Humbly, Goulian) Manual Drum Dermatomes (Padgett, Reese) **Electric/Air Powered Dermatomes (Brown, Padgett, Hall)Electric & Air Powered tools are most commonly used.
  12. 12. Padgett Dermatome
  13. 13. Goulian Blade
  14. 14. Donor Sites Color Thickness Hair Texture
  15. 15. Other plastic surgeries Tissue expansion Nerve repair Nerve grafting Nerve transfer Neurolysis Tendon repair Tendon graft Tendon tranfer Tenolysis Toe to hand transfer Replantation
  16. 16. Hand burns Subjective examination Objective examination -observation/palpation edema assessment-tapes/rings/callipers&volumetric measurements Scar assessment-photography,vancouer scale(pigmentation,vascularity,pliability&height) Circulation Nails/skin Goniometry/MMT Grip strength/hand held dynamometry Sensation testing/pain/neurological tests
  17. 17. Physiotherapy Education  Pressure garments Wound care  Silicon, coban Elevation  Splints Active exercise  Thermal Passive movements modalities/US/TENS/PEME/ Stretching NMES  Strengthening/endurance CPM exercises Neural mobilization  Motor/sensory re education Massage  Desensitization Compression  Functional training/OT

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