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

Dr. Sunil Keswani, National Burns Centre,
www.burns-india.com, nbcairoli@gmail.com

Dr Sunil Keswani
Plastic Surgeon
NATIONAL BURNS CENTRE
Navi Mumbai




“Pour water on
BURNS till the
burning sensation
subsides”



Relieves pain
Decreases depth of burn



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


PATIENT COMES EARLY(WITHIN 48 HRS)






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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


PRE-APPLICATION

POST-APPLICATION


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

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

nbcairoli@gmail.com

IF deeper vital structures are exposed ONLY then
 Local flaps-transposition, advancement, cross
finger, island flaps
 Abdominal, groin flaps
 Free flaps


INCISION LINES

TYPES OF RELEASE INCISIONS




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Mid axial incisions
Carpal tunnel release
Guyons canal release
Digital incisionsThumb and LF –radial
IF,MF,RF-ulnar

nbcairoli@gmail.com

8 P’S









Pain
Pallor
Pressure
Pulselessnes
Paresthesia
Paralysis
Poikilothermia
Progression of the ischemia

Timely
 Appropriate
 Adequate
-Hand compartments
-Finger compartments




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


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










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









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


Limb Physiotherapy







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

CHEMICAL BURNS






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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

TAR BURNS






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


ELECTRICAL BURNS




Compartment Syndrome
Early adequate fasciotomy
Appropriate surgical
intervention depending upon
the damage-skin graft, flap
cover, amputation.

nbcairoli@gmail.com

Re-epithelialize within 2 weeks to minimize
scarring
 Optimize epithelialisation by

Moist healing

Minimize infections

Biologic dressings

Optimize costs


nbcairoli@gmail.com






FULL THICKNESS BURNS
Autografts
Finely meshed 2:1/Sheet grafts
Medium thickness

nbcairoli@gmail.com

Exposed joints

Immobilize(K-wires)


Exposed bones, tendons, joints

Skin grafts do not suffice

Flaps required


nbcairoli@gmail.com

Pre-Op wound

Application of Homograft
Day 3

Complete healing
Day 21

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


THANK YOU
BURNS Helpline:
022 2779 3333

www.burns-india.com

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

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