This is a slide show presentation on burn complications and burn rehabilitation prepared by a medical student of MCOMS Nepal.

1. Burn Complications and
Rehabilitation
Tejendra Adhikari
Roll no.-04

2. • Neurologic- delirium, seizure, peripheral nerve injury
• Psychiatric-PTSD, Anxiety,
• Genitourinary- early acute renal failure, late renal failure
• Endocrine – acute adrenal insufficiency
• Cardiovascular-endocarditis, suppurative thrombophlebitis
• Pulmonary- pneumonia, respiratory failure, CO intoxication
• Hematologic –neutropenia, thrombocytopenia, DIC
• Otolaryngologic-auricular chondritis, sinusitis, otitis media
• Enteric – gastroduodenal ulcer, pancreatitis, hepatic dysfunction
• Ophthalmologic- ectropion,
• Musculoskeletal – heterotrophic scar, heterotopic ossification ,
marjolins ulcer
Almost every system may involve

3. Burn shock
• 3 types of shock can
affect burn victim
1. neurogenic shock –due
to severe pain
• Treatment – pain killers
(IV morphine)
2. hypovolemic shock- due
to fluid loss
• Treatment- fluid
resuscitation

4. 3. septic shock -due to infections
• Treatment –iv antibiotics, oxygen and
fluid
• 50-to-60 % of burn injury deaths
• develop after
• infection of the burn wound
(Pseudomonas aeruginosa)
• pneumonia from breathing tubes
• UTI from bladder catheters
• Management-IV antibiotics , oxygen
and IV fluids with careful
monitoring

5. Burn scarring
• unavoidable complication of burn
• prevalence -32 to 72 % of burn patient
• In 3rd and 4th degree –more severe and lifelong
• Formation depends on size, depth, patients gene,
age, ethnicity etc
• 3 types
• Keloid
• Hypertrophic scar
• Scar contracture

6. Keloid scar
• thicker type of burn scar
that grow beyond the
burned area
• the result of an overgrowth
of scar tissue
• pink to red in colour
• Management-steroid
injection, excision, laser
therapy

7. Hypertrophic scar
• Hypertrophic scars are confined to the
site of the injury
• typically appear red and raised
• Mechanism- strong expression of
• tumor growth factor beta(TGHB)
• focal adhesion kinase 1 (FAK1)
• Treatment-steroid injections,
revision excision with grafting,
laser therapy
• Prevention- pressure garments,
local tissue rearrangement,
physical therapy

8. Contractures
• Abnormal shortening of tissue (muscle) resulting
in resistance of that to stretching
• Common sites- joints, eyelids, cheeks, lips, neck,
elbow, knee etc.
• It can be
• Extrinsic- pull during healing phase
• Intrinsic- loss of tissue (fibrosis)
• Treatment -Release of contracture surgically,
antihistaminic for itching
• Prevention -Physical and Occupational
therapy, Pressure garments, Topical silicon
sheeting, tissue expansion

9. Complications of contractures
Ectropion of eyelid
Marjolins ulcer Hypertrophic scar
Microstomia and
disfigurement Movement restriction

10. Marjolin's ulcer
• Very well differentiated squamous cell
carcinoma occurring in scar ulcer
• Locally malignant
• No spread to regional lymph nodes
• Painless
• Treatment –wide excision with at
least 2cm margin
• Radiotherapy is contraindicated

11. Burn Rehabilitation

12. Posioning and splinting
• Starts in the intensive care unit to prevent contracture
• The basic rule - maintaining the body part in opposite plane and
direction which it will potentially contracture (anti contracture position)
The fetal position (flexed) is position of comfort so anti
contracture position is of extension.

13. Physical
Therapy
• Gross motor skills
• Focus on lower
extremities
• Feet
• Knees
• Hips
Getting in and out of bed
Walking
Going up and down stairs
Occupational
Therapy
• Focus on upper extremities
• Arm
• Hands
• fingers
• Focus on activities of daily living
• Feeding
• Dressing
• Getting out of bed
• Going to the bathroom

14. Exercises
• Palm stretch
• Wall pushups
• Abdomen stretch
• Ankle stretch
• Knee bend

15. Scar management
• Tension release with incision- defect created is
treated with grafting such as FTSG ,STSG
• Tension release with tissue rearrangement –Z-
plasty
• Intralesional corticosteroid injection-
suppress inflammatory process of wound
,decrease collagen synthesis and increase
collagen degradation
• Cryotherapy –increases vascular damage
leading to necrosis of scar tissue
• Fat grafting into scar- recent study
• Scar massage
• Laser based therapies
• Pulse dye laser (PDL)
• Ablative CO2 laser

16. Laser based therapies
1. 585 nm pulse dye laser (PDL)
• Excellent therapeutic measure for younger
hypertrophic scar
• Induces dissociation of disulfide bond in
collagen fibers and causes realignment and
decrease fibroblast proliferation
• Repeated treatment (2 to 6)is required for better
outcome
• Side effects – erythema/purpura for 7 to 14
days, hyperpigmentation or hypopigmentation

17. 2. Ablative CO2 laser (10600nm)
• Targets water in underlying tissue
• It has greater potential depth of treatment (4mm
compared to 1.8 mm in non ablative laser)
• Works by ablating microscopic column of tissue to
flatten scars and is also believed to stimulate
matrix metalloproteinase and other signaling
pathways to collagen reorganization
• Only a portion is treated with column of energy to
create targeted area of thermal damage
(microthermal treatment zone)
• The untreated area act as reservoir of collagen and
tissue regrowth

18. Psychological therapy
• Major psychological problems
• Depression
• post traumatic stress disorder
• concerns about image
• anxiety about returning to society
• nightmares and flashbacks associated
with incident of burn
• Psychological distress occurs in as many
as 34% of burn patients and persists in
severity long after discharge
• Help the patient to develop positive mental
state

19. • Method
• Combines drug therapy and cognitive
behavioral therapy
• Beginning of therapy
• as soon as the patient is able to
understand the situation
• Goal of therapy
• To help the patient recognize thinking
that may differ physical and emotional
recovery from burn in order to return to
independent lifestyle

20. Early Burn reconstruction
• Small set of operations required in the first few year of injury
• collaboratively with the patient family and the patient's therapists
• Do not rush into these
• A balance must be drawn between repeat trauma of surgery and
patients functional and cosmetic needs
• Common procedures-
• Head and neck- lid release, neck release
• Hand- dorsal hand release, web space release
• Upper extremity- heterotopic ossification removal, axillary
contracture release
• Lower extremities- dorsal foot release, popliteal release, hip
release

21. Z plasty

22. Other techniques
• Excision and primary closure
• Simple reconstruction
• Skin grafts
• Flaps
• Dermal templates
• etc