burn and plastic surgery

1. BURN
PRESENTED BY
SUCHISMITA SETHI
LECTURER
MSN SPECIALITY

2. DEFINITION
• A burn is the injury to the tissue of the body
caused by heat, chemicals, electrical current
or radiation. (Lewies, 2015)

3. INCIDENCE:-
• In India the incidence is quite high in young
females due to various social factors.
• The mortality rate due to burn injury is 3.5 per
100000 population.
• The highest fatality rate occur in children age
4 year & younger & adult above age 65
• Nearly 11 million people need medical
attention annually for burn injury & about
300000 die.

4. TYPES OF BURN INJURY:-
1. THERMAL BURN
2. CHEMICAL BURN
3. SMOKE & INHALATION INJURY
4. ELECTRICAL BURN
5. COLD THERMAL INJURY

5. 1. THERMAL BURN
• Thermal burn is caused by flame, flash, scald
or contact with hot object.
• The severity of injury depends on the
temperature of the burning agent & duration
of contact time.
• EX:-Scald injury are occur in during cooking.

6. 2. CHEMICAL BURNS:-
• Chemical burn are result of acids, alkalis &
organic compounds
• Acids like hydrochloric acid, oxalic acid which
are found in home for various purposes.
• Alkalis are found in oven & drain cleaner,
fertilizers.
• Alkali burn difficult to manage because it
adhere to tissue, causing protein hydrolysis.

7. 3. SMOKING & INHALATION INJURY:-
• This injury caused by breathing hot air or
noxious chemical which damage to the
respiratory tract.
• There are three type of smoke &
inhalation injuries, those are:-
• Metabolic asphyxiation
• Upper airway injury
• Lower airway injury

8. • Metabolic asphyxiation:- It is the inhalation of smoke
elements such as carbon monoxide or hydrogen
cyanide which impaired the oxygen carrying capacity of
blood & caused hypoxia. Here carboxyhemoglobin
causes hypoxia.
• Upper airway injury:- It is the injury to the mouth,
orophrynx & larynx which is caused by hot air, steam or
smoke.
• Upper air way injury is manifested by redness,
blistering & edema. Flame burn in the neck and chest
causes breathing difficulties.
• Lower airway injury:- It is the injury to the trachea,
bronchioles alveoli which is caused by breathing of
toxic chemicals or smoke.
• Clinical manifestation includes dyspnea, wheezing,
altered mental status & ARDS

9. 4. ELECTRICAL BURN:-
• Electrical burn caused by electrical current.
The electrical current damage the nerve &
blood vessels which cause tissue anoxia &
death.
• The severity of the electrical injury depend
upon the amount of voltage, surface area in
contact with current.
5. COLD THERMAL INJURY:-
• It is the tissue injury caused by intense cold to
the tissue.

10. CLASSIFICATION OF BURN INJURY
ACCORDING TO DEAPTH
• According to depth of tissue involvement the
burn injury classified in to 2 categorise
1. Partial thickness burn
2. Full thickness burn

11. 1. PARTIAL THICKNESS BURN:-
Partial thickness burn again categorised
in to 2 types
a. Superficial partial thickness burn( First degree
burn):-
• Here there is damage of epidermis, which causes
hyperaemia, pain sensation present hear.
• Ex:- sun burn or quick heat flash.
• C/F:- Erythema, pain, mild swelling, no vesicles or
blisters ( after 24 hour may blister found)
• Healing time:- About 3-6 days, the superficial skin
layer over the burn may be peel off in 1-2 days.

12. b. Deep partial thickness burn( Second degree
burn):-
• Here there is involvement of epidermis &
dermis layer.
• This type of burn may be caused by flame,
flashes, scaled, chemicals or electrical current.
• C/F:- Fluid field vesicles that are red, shiny,
wet( if vesicle rupture). Severe pain caused by
nerve injury, mild to moderate edema.
• Healing time:- It depends upon the severity of
burn. It may take 1-3 weeks to heal.

13. 3. FULL THICKNESS BURN ( THIRD &
FOURTH DEGREE BURN):-
• Here all the skin elements & local nerve endings
destroyed, coagulation necrosis present which need
surgical intervention for healing.
• It s caused by flame, scald, chemical, tar & electrical
current.
• C/F:- Dry, waxy white hard skin, visible thrombosed
vessels. Insensitive to pain due to loss of nerve.
Possible involvement of muscle, tendon & bones.
• Healing time:- Depth second & third degree burn
need to be treated with skin graft in which healthy
skin is taken from another part of body & grafted.

14. ACCORDING TO BURN SEVERITY:-
• According to burn severity burn is classified in
to 3 three categories:-
1. Minor
2. Moderate
3. Severe

15. 1. Minor:- All the first degree burn as well as
second degree burn that involves less then
10% of body surface area.
2. Moderate burn:- Burn involving the hands,
feet, face or genitals, second degree burns
involving more than 10% body surface area.
3. Severe burn:- It involves more than 25% of
TBSA. The third degree burn are classified as
moderate or more then often as severe. Deep
burn of head, hands, feet, perineum,
inhalation injury & chemicals or high voltage
electrical burn.

16. EXTENT OF BURN:-
Various methods are use to estimate
the extent of burn/ Total body surface
area(TBSA). Those are
1. Rule of nine
2. Lund & Browder method
3. Palmer method.
4. Jackson’s Burn model.

17. RULE OF NINE:-
• The rule of nine was devised by Pulaski & Tennison in 1947 & published
by Alexander Burn Wallace in 1951.
• It is the most commonly used method to estimate extent of burn in
adult.
• This system is based on dividing anatomic region, each represents
approximately 9% of TBSA.
• BODY SURFACE AREA PERCENTAGE (%)
• Head & neck 9%
• Arms(each) 18% ( anterior 4.5%, Posterior
4.5%)
• Ant. Trunk 18%
• Post. Trunk 18%
• Legs(each anterior posterior) 36%( anterior 9%, posterior 9%)
• Perineum 1%
• ________
• 100%

19. 2. LUND & BROWDER METHOD:
• It is the most accurate form of
assessment form
• BODY SURFACE AREA
PERCENTAGE
• Head 7%
• Neck 2%
• Anterior trunk 13%
• Posterior trunk 13%
• Right Buttock 2½
• Left Buttock 2½
• Genitalia 1
• Right upper arm 4
• Left upper arm 4
• Right lower arm 3
• Left lower arm 3
• R. Hand 2½
• L. Hand 2½
• R. Thigh 9 ½
• L. Thigh 9 ½
• R. Leg 7%
• L. Leg 7%
• R. foot 3 ½
• L. Foot 3 ½
• ___
100%

21. 3. PALMER METHOD

22. SYSTEMIC EFFECT DUE TO BURN/
PATHOPHYSIOLOGY:-
• FLUID & ELECTROLYTE SHIFT:-
•
• BURN
• INCREASE VASCULAR PERMIABILITY
• EDEMA INCREASE INTRAVASCULAR VOLUME
• DECREASE BLOOD VOLUME INCREASE HEMATOCRITE
• INCREASE VISCOCITY
• INCREASE PEREPHERAL RESISTANCE
• BURN SHOCK

23. CARDIOVASCULAR SYSTEM:-
• BURN
• TISSUE INJURY
• ACTIVATE SYSTEMIC INFLAMATORY MEDIATORS
• IT RELEASE OXYGEN REDICALS
• THESE CAUSES INCREASE VASCULAR PERMIABLILITY
• FLUID SHIFT FROM INTRACELLULAR SPACE TO
EXTRACELLULAR SPACE
• INTRAVASCULAR FLUID LOSS
• HYPOVOLEMIA
• SHOCK

24. CARDIOVASCULAR
• CLINICAL MANIFESTATION:-
• Angina
• Jugular venous distension
• Tachycardia
• Dysrhythmia
• Irreversible shock
• Venous thromboembolism

25. RESPIRATORY SYSTEM:-
• BURN INJURY
• ADDHERANCE OF IRRITANT TO THE UPPER
RESPIRATORY TRACT
• RELEASE INFLAMATORY MEDIATORS
• INCREASE AVASCULAR PERMIABLITY
• EDIMA FORMATION
• AIR WAY OBSTRUCTION & BRONCHOSPASM
• EXCESSIVE SECRETION
• ARDS
• DEATH

26. EDEMA IN LUNGS

27. CLINICAL MANIFESTATION:-
• Dyspnea
• Orthopnea
• Persistent hacking cough
• Crackle
• Restlessness

28. NURVOUS SYSTEM:-
• BURN INJURY
• INCREASE VASCULAR PERMIABILITY
• CEREBRAL EDEMA
• DECREASE BLOOD SUPPLY TO BRAIN
• CELLULAR HYPOXIA
• LOSS OF CONSCIOUSNESS/SHOCK

29. • CLINICAL MANIFESTATION:-
• Altered mental status
• Lethargy

30. MANAGEMENT OF BURN:-
1. Emergent
2. Acute
3. Rehabilitation

31. 1. EMERGENT PHASE:-
• This period starts from time of burn up to 42 hour.
• This phase required to resolve immediately, life threatening
problems resulting from burn injury.
• The emergent phase end when the fluid mobilization& Diuresis
begin.
• The prime goal is to prevent hypovolemic shock & prevent vital
organ dysfunction, It includes
I. Pre Hospital care
II. Airway management.
III. Fluid management
IV. Wound management
V. Analgesia & sedation
VI. Feeding Protocol
VII. Tetanus immunization
VIII. Antimicrobial agent
IX. Venous thromboemboilism prophylaxis

32. i. PRE HOSPITAL CARE:-
• Remove the person from source of burn
• For small thermal burn TBSA less then 10% cover
the burn area with clean, cool, tap water
dampened towel to minimise the injury
• Do not emerge the burn wound which more then
10% because it may cause excessive heat loss.
• If burn is larger then 10% or electrical burn or
inhalation injury then check ABC
• In case of chemical burn quickly remove the
chemical particle or powder from the skin
• If burn is due to CO poisoning treat the patient
with 100% humidified O2.

33. ii. Airway management:-
• Assess the breath sound, respiratory rate,
rhythm, symmetry of chest excursion.
• Monitor sign of hypoxia .
• Early endotracheal intubation needed in case
of burn with more then 10% TBSA or burn in
neck & chest area.
• Check ABG value frequently to know the level
of hypoxia & also know metabolic acidosis &
alkalosis.
• Extubation is indicated when edema is
resolved & usually 3-6 day after burn injury.

34. • Escharotomies of the chest wall may be needed
in case of burn in neck & trunk which may cause
respiratory distress.
• Fibro optic Bronchoscopy is needed in case of
smoke & inhalation injury after 6 to 12 hour to
know lower airway condition.
• Reposition the patient every 1-2 hours & provide
suctioning & chest physiotherapy.
• Bronchodilator provide to treat severe
bronchospasm.
• For CO poisoning administer 100% oxygen until
carboxy haemoglobin level return to normal.
• Fluid management

35. iii. Fluid management:-
• Assess the fluid need of the patient.
• Begin IV fluid replacement.
• Insert urinary catheter to monitor the urinary out put every
hour.
• If more then 15% TBSA burn insert 2 large bore IV cannula.
• If more then 30% TBSA burn maintain central line , arterial
line for fluid medication & blood assess.
• Fluid administration during the first 45 hours help to
maintain circulating fluid volume.
• There are three type fluid used to maintain body need,
those are:-
• Electrolyte such as RL
• Colloids which includes plasma & plasma expanders
• 5% dextrose.

36. Formula used for fluid calculation
are:-
a) Parkland formula
b) Brooke army formula
c) Evans formula
d) Consensus formula

37. a. PARKLAND FORMULA:-
• Parkland formula for fluid giving is:- 4ml*kg body
weight*%TBSA
• Colloid formula is:- 0.3 to 0.5 ml*kg body weight*%
TBSA
• Application of fluid:-
• ½ of total fluid in first 8 hour
• ¼ of total fluid in 2nd 8 hour.
• ¼ of total fluid in 3rd 8 hour
• After 24 hour colloid should be given when capillary
permeability return to normal.
• Ex- For a 70 kg patient with 50% TBSA BURN

38. • Ex- For a 70 kg patient with 50% TBSA BURN
• Ans:-
• Fluid need:- 4ml* kg body weight*%TBSA
• 4ML*70KG*50= 14000Ml in 24 hour
• Application of Fluid:-
• ½ in first 8 hour means =7000ml in 8 hour
• ¼ in 2nd 8 hour means=3500 ml in next 8 hour
• ¼ of total in 3rd 8 hour means= 3500 ml in next 8 hour
• Colloids Administration:- After 24 hour colloids should
be given
• Formula:- 0.3 to 0.5 ml * kg in body weight*%
TBSA
• 0.3*70*50=1050 ml= 1 lit 50 ml in 24 hour.

39. b. BROOKE ARMY FORMULA
• Electrolyte:- 1.5ml*kg body weight*% TBSA
• Colloid:- 0.5ml*kg body weight*%TBSA
• Glucose:- 2000 ml for insensible loss.
• APPLICATION:-
• DAY-1:- Half to be given in first 8 hour,
remaining half is given next 16 hour
• DAY-2:- Half of colloids half of electrolyte,
all sensible fluid replacement

40. CONT...
• EX:- For 70 kg patient with 50 % burn
• FLUID:- 1.5ml*70kg*50=5250, 5 lit 250ml
• 1st 8 hour=2,625ml
• 2nd 8 hour:-1312 ml
• 3rd 8 hour:-1312ml
• COLLOIDS:- 0.5ml*kg body weight*% TBSA
• 0.5ml*70*50= 1750ml
• In day 2nd :- half of the colloids, half of the
electrolyte, all sensible fluid replace
• 875 colloids+2625+2000ml= 5500ml

41. EVENS FORMULA:-
• Electrolyte:- 1ml* body weight*% TBSA
• Colloids:- 1ml*kg body weight*% TBSA
• Glucose:- 2000ml for insensible loss
• DAY 1:- First 24 hour:- crystalloid 1ml*kg*%
TBSA+Colloid at 1ml/kg/% TBSA+2000ML glucose in
water
• Next 24 hour:- crystalloid at 0.5ml/kg/%TBSA+ Colloids
at 0.5 ml * kg * % TBSA+2000ml of glucose in water
• Ex- 70 kg patient with 50% TBSA
• Day 1 :- Fluid:- 0.5ml*kg*%TBSA+0.5
ml*kg*%TBSA+2000ml=3500+3500+2000=9000ml
total fluid.
• Day 2:- crystalloid- 0.5ml*kg*%TBSA+Colloids
0.5ml*kg*%TBSA+2000=1750+1750+200=5500ML

42. • CONSENSUS FORMULA:-
• RL solution 2-4 ml*kg body weight*% TBSA
• Half of the fluid is given in the first 8 hour
• next half of the fluid is given in next 8 hour

43. Wound care:-
• Once the patient airway, circulation & fluid
replacement is established next priority should given
towards burn wound care.
• Wound cleaning should perform by using gentile
debridement by using scissor & forceps.
• Surgical debridement should be done in Operation
room, wound cleansing can be done on pt bed.
• A daily shower or dressing changing done in morning &
in evening dressing change should be done in patient
room.
• In case of antimicrobial dressing, dressing left for 3-14
day, no need to repeated dressing to prevent infection.

44. CONT...
Patient wound treatment in done by
two method
• Open method:- Here patient wound covered
with topical antimicrobial with no dressing
over wound.
• Multiple dressing change:- Sterile dressing
with tropical agent, dressing done every 12-24
hour.

45. Feeding Protocol:-
• Feeding Protocol:-
• Early & aggressive nutritional nutritional support
within several hour of burn injury help to decrease
mortality risk, optimizing healing of burn wound.
• Patient less then 20% TBSA are able to eat enough to
meet their nutritional need.
• For patient with ventilator provide enteral feeding
(gastric or intestinal) which help to preserve GI
function increase intestinal blood flow & promote
optimal condition for wound healing.
• Start 20-40 ml/hr & increase to the goal rate with in
24-48 hour.
• Check bowel sound every 8 hourly

46. CONT...
• High calorie, high protein , iron, multivitamin is
required.
• Dietary protein started at 1.2gm/kg/day & increase
with subsequent increase in protein marker.
• Caloric need to be meet according to Harris Benedict
formula(adult), Galveston formula (children)
• Fat 30% of calories to be provided as fat.
• Supplemental vitamin A,C,E promote wound healing
• Mineral iron, zinc promote cell integrity &
haemoglobin formation.

47. Analgesic & sedation:-
• Analgesic need to be provided for comfort. Ex-
Morphin, Fentanyl, Methadone.
• Sedative, hypnotics & antidepressant given to
control anxiety, insomenia. Ex- Lorazepam,
Midazolam.

48. Tetanus immunization
• TT should be provide to prevent anaerobic
wound contamination. If the patient not
receive TT within 10 year before burn injury
TT immunoglobin should be considered.

49. Antimicrobial Agent:-
• Systemic antibiotic are not routinely used to
control burn wound flora because the burn
eschar has little or no blood supply & may
cause multidrug resistance organism develop.
• Topical antiviral agent used. Ex- Silver
sulfadiazine & Mafenide acetate.
• Oral infection should treated with nystatin
mouth wash.

50. Venous thromboemboilism
prophylaxis:-
• Burn patient are more prone to develop DVT.
• Low molecular heparine & compression
stokins, sequencial compression device
needed to prevent DVT.

51. NURSING MANAGEMENT:-
• Impaired gas exchange related to carbon monoxide
poisoning, smoke inhalation & upper airway
obstruction.
• Goal:- To maintain the adequate tissue oxygenation
• Intervention:-
• Provide adequate 100% humidified oxygen.
• Assess the breath sound, respiratory rate, rhythm,
symmetry of chest excursion.
• Monitor sign of hypoxia .
• Observe erythma or blister in the buccal mucosa.
• Monitor ABG value
• Prepare the patient for escharotomies or
intubation.

52. Ineffective airway clearance related to
edema & effects of smoke & inhalation.
• Goal:- Maintain patient airway & adequate airway
clearance.
• Intervention:-
• Maintain patient airway through proper patient
positioning, removal of secretion & artificial airway
if needed.
• Provide humidified oxygen
• Encourage patient to turn, cough & breathing.
• Encourage the patient to use incentive spirometry.

53. Deficit fluid volume related to increase capillary permeability
& evaporative loss from the burn wound.
• Goal:- Restore the fluid & electrical balance.
• Intervention:-
• Monitor vital sign, hemodynamic monitoring,
urine output as well as strict intake output.
• Maintain IV line & regulate IV flui1d at
appropriate rate.
• Elevate head of the patient bed & elevate
extremities.
• Notify the physician immediately of decrease
urine output.

55. ACUTE PHASE:-
• It is the phase begin with mobilization of
extracellular fluid & subsequent dieresis.
• Pathophysiology:-
• Diuresis from fluid mobilization & patient is less
edematous.
• Bowel sound return
• Wound healing begin as WBC surround the burn
wound & phagocytosis occur.
• Necrotic tissue begin to slough.
• Fibroblast lay down matrices of the collagen
precursors that eventually from granulation
tissue.

56. Clinical manifestation:-
• Eschar begin separating.
• Re-epithelialisation begin separating .
• Hyponatremia CF:- Weakness, dizziness. Muscle cramps,
fatigue, headache, tachycardia.
• Hypernatremia:- Hypernatremia due to copious amount of
hypertonic solution administration.
• CF:- Lethargy, confusion, thirst.
• Hyperkalemia:- If the patient have renal failure,
adrenocortical insufficiency, with large amount of
potassium release from damaged cell.
• CF:- Muscle weakness, cramping, paralysis.
• Hypokalemia:- Due to vomiting, diarrhea, prolonged GI
suction, IV without potassium supplementation.
• CF:- Fatigue, muscle weakness, leg cramp.

57. Laboratory Value:-
• Hyponatremia develop from excessive GI
suction, diarrhea, & water intake.
• Hypernatremia
• Hypokalemia
• Hyperkalemia

58. Complication:-
• Infection:- Due to skin destruction, decrease
immunity & malpractice in wound dressing.
• Cardiovascular Respiratory complication
• Neurological:- Stress, edema, sepsis, sleep
disturbance.
• Musculoskeletal System:-
• Restricted ROM
• GI Syatem:-
• Diarrhea, paralytic ileus, curling ulcer
• Endocrine system:- increase glucose level due to
stress mediated cortisol, chatacholamine release.

59. NURSING CARE:-
• Wound care & Excision & grafting
• Pain management
• Physical & occupation therapy
• Nutritional Therapy
• Wound care & excision & grafting:-

60. Goal:-
• Prevent infection by cleaning & debriding the
area of necrotic tissue that would promote
bacterial growth, promote wound re-
epithelialisation & successful skin grafting.

61. Intervention:-
• Wound cleaning should be done with soap & water or
normal saline moisture gauze to gently remove the old
antimicrobial agent, necrotic tissue & dried blood.
• During debridement phase cover the wound with
antimicrobial agent.
• When wound is fully debride petroleum or paraffin
gauze dressing is applied to protect the re-
epithellializing keratinocytes
• In case of grafting protect the graft by applying
petroleum gauze dressing following by applying
petroleum gauze dressing followed by saline moist
middle& dry gauze outer dressing.
• In case there is formation of sero sanguineous
exudates aspiration needed by syringe or vacume to
promote graft reepithelialisation.

62. Excision & Grafting:-
• Management of full thickness burn wound involve
removal of necrotic tissue & application of split
thickness autograft skin.
• To decrease the blood loss topical application of
epinephrine, injection of saline.
• The graft is then is placed on clean, viable tissue to
achive good adherence.
• The wound is covered with autograft & stappled to
attached the wound.
• The average healing time for a donor site is 10-14 days.
• Sometimes artificial skin must replaced all function of
skin & consist of both dermal & epidermal elements.

63. Pain management:-
• Burn patient experience two kind of pain. One is
continuous back ground pain that exist through out
the day & night, Another type is treatment induced
pain which associated with dressing change,
ambulation& rehabilitation activity.
• IV infusion of morphine or hydromorphone
provide.
• Provide lorazipam or midazolam to reduce anxiety.
• Patient control analgesia used some time if patient
not able to tolerate.
• Pain also managed with by using non
pharmacologic strategies such as relaxation,
hypnosis, guided imagery, bio feed back &
medication.

64. Physical occupational therapy:-
• Physical therapy should be given in all stage of
burn to regain the muscle strength & joint
function.
• The good timing for exercise during & after
wound dressing/cleaning when skin is soft.
• Passive & active ROM exercise should be done to
promote healing.
• For patient with neck burn encourage to sleep
without pillow with hand hanging slightly over
the top of the metres to encourage hyper
extension
• Use custom feting splint to keep the joint in
functional position. More splint pressure cause
skin damage or nerve damage.

65. Nutritional therapy:-
• Adequate calories & protein is needed for
wound healing.
• Burn patient is in highly catabolic & highly
catabolic state as a result of burn injury.
• Alert patient should be encouraged to eat
high protein , high carbohydrate food to met
increased caloric needs
• Record the patient caloric intake daily using
calorie count sheet.

67. REHABILITATION:-
• The rehabilitation begins when patient burn wound have
healed & patient able to resume a level of self care activity.
• It may happen as early as 2 week or as long as 7-8 month
after burn injury.
• Goal is to Work towards resuming the functional role
towards society. Rehabilitate from any functional &
cosmetic post burn reconstructive surgery that may be
necessary.
• When patient is able to go home teach patient & family
member about wound care & dressing changing.
• Pain management & nutritional need based on the
individual status
• Water based cream used to heal the wound area.
• Low dose of histamine used at bed time if itching persist.
• Continue encourage the patient for physical & occupational
therapy.

68. • PLASTIC SURGERY

69. Plastic surgery:-
•
• The plastic derived from the Greek ward “
plastikos” which means to module or to shape.
• Plastic surgery is the medical speciality
concerned with the correction or restoration of
form & function of body structure damaged by
trauma, transformed by ageing process, changed
by disease process & malformation as a result of
congenital defect.
• Goal:-
• Correction of perceived disfigurement
• Restoration of impaired function
• Improvement of physical appearance.

70. TECHNIQUE USE FOR PLASTIC
SURGERY:-
• Incision
• Excision
• Microsurgery
• Chemosurgery
• Electro surgery
• Laser surgery
• Dermabrasion
• Liposuction

71. • Plastic surgery divided in to two major areas
• RECONSTRUCTIVE SURGERY
• COSMETIC SURGERY
• RECONSTRUCTIVE SURGERY:-
• Reconstructive surgery perform to correct functional
impairment caused by burn, traumatic injury,
congenital abnormality such as cleft lip or palate,
removal of cancer or trauma such as mastectomy.
• Common reconstructive surgeries:-
• Breast reconstruction
• Burn contracture surgery
• Cleft lip & palate.
• Injury to the limb.
• Amputation
• Pressure sore

72. RECONSTRUCTIVE MODALITIES:-
• Skin Grafting:- Here a portion of skin is detached from
its own blood supply & transferred as free tissue to a
recipient site. It provide protection underlying tissue.
• Indication:- Extensive wound, burn, surgery which
require skin graft for healing.
• Classification:-
• Autograft:- Tissue obtained from patient own skin.
• Allograft:- Obtain from donor of same species.
• Xenograft:- Obtained from donor of different species.

73. Graft application:-
• The wound is prepare for surgery . The wound is
cleaned & measured. Administration of anaesthesia.
• Donor skin harvested & prepaired with skin grafting
knive.
• The graft meshed ( multiple incision on graft ) to
removed the excessive fluid leakout from underlying
tissue.
• Then the graft hold in place in several stitches.
• Apressure bandage is applied in over the graft recipient
site.
• Then a VAC( vacuum apparatus called) placed over the
area for 3-5 days to drain fluid & easy wound healing.
• New blood vessel begin to grow within 36 hours of
grafting followed by new skin.

74. Skin Flap:-
• It is a segment of tissue that remain attached
at one end while other end is moved to
recipient area.
• Its survival depends upon functioning of
arterial & venous blood supply & lymphatic
drainage.
• Flap may consist of skin, mucous, muscle,
adipose tissue, omentum & bone.

75. POST OPERATIVE MANAGEMENT :-
• Initial pressure dressing will be left in place for 24- 48 hour.
• If wound begin to ooze apply firm pressure for 10-15 min.
• Do not give aspirin or aspirin containing medication.
• Most skin graft are hold in place by a bolster dressing(
cotton ball or foam)
• Clean site & apply ointment to the surrounding area of the
blister dressing.
• Keep the graft edge moist with antibiotic ointment.
• Protect the graft from sun because it may cause
pigmentation changes.
• Free flap:-
• It is harvested from one area of body & reconstruct a defect
area.
•

76. COSMETIC SURGERY:-
• Cosmetic surgery refers to the surgery that
design to improve appearance.
• It is perform for changes that result from
ageing, to altered inherited features or
because of client personal desire.

77. TYPES OF RECONSTRUCTIVE &
COSMETIC SURGERIES:-
• Liposuction:- Here there is removal of fat from different site
of human body.
• Tummy tuck:- It is the removal of excessive skin & excessive
fat from middle & lower abdomen in order to tighten the
muscle & facia of the abdominal wall.
• Brachioplasty:- Here the excessive fat & skin is removed
from the upper arm area in order to create a youthful look.
• Thigh lift:- It is done to remove excess skin from the thigh &
buttock area.
• Buttock augmentation surgery:- Fat grafting done to
increase the size of buttock.
• Blepharoplasty:- It is the eye lid surgery which is done in
case of droopy or saggy skin as well as bag around the eye.

78. • Endoscopic forehead & browlift :- Brow & forhead lift are perform
to raise eyebrows & reduce ridges on forehead, it gives youthful
look.
• Rhytidectomy surgery:- It involves tightening of the facial & neck
muscle as well as the removal of excessive wrinkled skin.
• Rhinoplasty:- It is the reshaping of nose.
• Cleft lip nose deformity:-
• Cleft lip
• Cleft palate
• Breast reconstruction
• Breast reduction
• Breast lift:- Reposition of breast for youth look.
• Hair transplant

79. DRUG USED IN TREATMENT OF BURN, RECONSTRUCTIVE &
COSMETIC SURGERY
• THERMAL BURN MEDICATIONS:-
• Topical antibiotics:- Ex- Noosporin
• Analgesic:- Morphine sulphate,
• NSAID:- Ex- Advil or mortin
• DRUG USED IN RECONSTRUCTIVE & COSMETIC SURGERY
• Altabax:- Bacterial protein synthesis inhibitors.
• Amevive:- Immunosuppresive
• Avita Gel:- Treatment of acne
• Bactroban cream:- Topical antibiotics
• Benzomycin:- Reduce acne infection
• Botox Cometics:- It blocking the nerve impulse to relax the
contraction of the forhead muscle which cause the wrinkle between
eyebrows.