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Burns
Fresh Burns
Old Burn scars
Post Burn Contractures, Deformities and Disfigurements
Post Burn White Patches
Burn
therapy:
The care of a patient burned by flames, a hot liquid, explosives, chemicals,
or electric current. Bums are rated according to how many layers of
skin are damaged (Classification of
Burns). Partial-thickness bums may be first or second degree.
First-degree burns involve only the top skin layer (epidermis). Second-degree
burns involve the epidermis and second layer of skin (corium), whereas
full-thickness or third degree bums involve all skin layers. Second-degree
bums covering more than 30% of the body and third-degree burns on the
face and arms and legs, or more than 10% of the body surface, are critical.
(Rule of Nine)
In the first 48 hours of a severe bum, fluid from the
vessels, salt (sodium chloride), and protein quietly pass into the burned
area causing swelling, blisters, low blood pressure, and very low urine
output. The body loses fluids, proteins, and salt, and the potassium
level is raised. The first low fluid levels are followed by a shift
of fluid in the opposite direction resulting in excess urine, high blood
volume, and low blood electrolytes. Possible other problems in serious
burns include collapse of the circulation, kidney damage, shutdown of
the stomach and bowel system, infections, shock, pneumonia, and stress
ulcer (Curling's ulcer), characterized by vomiting blood, and stomach
and bowel swelling (peritonitis).
Method:
Fluids and electrolytes, antibiotics, tetanus vaccination, and pain
drugs are given for severe burns. Often a urinary tube (catheter) and
a tube through the nose to the stomach are inserted. Treatment of the
burn may be by either the closed or open method. In the open method,
the injured area is cleaned and exposed to air, and the patient is kept
warm by a blanket or linen over a bed cradle or by a beater or lamp.
In the closed method, a cream, ointment, or solution is placed on the
burn, and the wound is covered with a dressing. A temporary skin graft
may be used to cover the wound. This prevents loss of fluid and reduces
the risk of infection, but the graft dries in 1 or 2 days and may pull
and cause pain. Newly developed artificial skin holds great promise
for treating severe burns. If fluids by mouth are allowed, juices and
carbonated drinks are offered, but not plain water and ice chips. Fluid
intake and output are measured hourly. Blood transfusions, steroid therapy,
and drugs to reduce fever may be ordered, but aspirin is not given.
Excess chilling and exposure to upper lung infections and wound infections
are carefully avoided. Burned arms and legs are raised, and using firm
supports to keep affected areas in line prevents cramps. This can be
done by using a footboard to keep the feet at a 90 degree angle to the
ankles in burns of the legs, or by having the patient grasp a ball when
the back of the hand is burned. After the first important period, a
high-calorie, high-protein diet is given, and the patient is offered
many small meals that are high in potassium. Vitamins may be needed.
The patient is helped to stand for a few minutes every hour or every
second hour and is generally able to walk in 7 to 1 0 days, but the
recovery may take a long time. A large amount of plastic surgery and
repeated skin grafts may be needed to restore function and the physical
appearance of burn patients.
Outcome:
The outcome for the severely burned patient depends greatly on the detailed,
near-constant care needed during the first phase of treatment. The extent
of body surface area burnt and the depth of burn and the respiratory
tract burns because of inhalation of fumes however remain the most important
indicators that decide the mortality and morbidity. Scarring may cause
some temporary problems, but physical therapy helps restore movement.
Pressure garments for hypertrophic scars and corrective surgeries for
contractures and depigmented scars are most helpful.
Activities:
Your normal daily activities may be limited, depending on the extent
of your injury and the recommendation of your physician. Take the following
precautions to decrease the risk of additional injury or complications:
Protect the injured area against exposure to direct sunlight by using
a sunscreen with an SPF (sun protection factor) of 15 or greater.
Protect the injured area by covering it with a loose-fitting, long-sleeve
shirt, pants, or a hat.
Prevent shearing of the skin by wearing soft, loose-fitting garments.
Avoid rough, scratchy, or abrasive fabrics, and wash all new clothing
before you wear it.
Prevent shearing of the skin by wearing soft, loose-fitting garments.
Avoid rough, scratchy, or abrasive fabrics, and wash all new clothing
before you wear it.
Use caution in resuming daily activities that involve physical exertion,
and be aware of instances when the skin may be rubbed, scraped, or damaged.
Eat a well-balanced diet; proper nourishment supplies your body with
the energy it needs to heal.
Maintain a proper fluid balance by drinking plenty of liquids (64 ounces
or more per day is recommended).
A void fluctuations in weight, because this could affect the proper
fit and comfort of your clothing.
Establish a routine of exercising the injured limbs four times a day
to maintain circulation and muscle tone. Aerobic activity should be
used to increase endurance.
Take all medications as prescribed. Side effects or adverse reactions
should be reported to your physician immediately.
Wash pressure garments daily in a mild soap solution.
Return to your physician's office or health care clinic for scheduled
follow-up appointments.
Complications:
You or your caregiver should report any of the following to the physician:
Changes in the condition of the wound such as drainage, enlargement,
blistering, swelling, or redness.
Signs of infection, including a temperature above 99° F, a foul
odor emanating from the wound, or excessive drainage.
Difficulty with dressings or pressure garments.
Post
Burn Contarctures Of Hand:
Post
Burn Contractures of the hand involving the dorsum, flexor aspect of
the fingers and thumb and the first web space are a crippling
disability. They in varying combinations render the hand totally incapable
of performing basic functions of pinch, hook and grasp. Avoiding them
in the early nursing phase of Burns by proper splintage and timely escharectomy
and skin grafting followed by physiotherapy remains the best treatment.
Once formed, release of these contractures and cover by local, distant
or free flaps and subsequent physiotherapy improves the functional capability
of these hands considerably.
172
Post Burn Contracture hands in 164 individuals were surgically treated
and 156 of them have returned to their previous vocation. The remaining
8 had to opt for a change in vocation after proper training. Presently
all patients are gainfully employed.
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Post
Burn Contarctures Of Hand |
Adduction
Contarcture Thumb
Adduction
contracture of the thumb or 1st. web space contracture effects predominantly
the movements of the trapezio-metacarpal joint, rendering the thumb
ineffective of opposition, thereby destroying the essential element
of grasp and pinch. In a study of 76 hands it was found that it was
the dominant hand of the family bread earner, which was most commonly
involved, and proper primary management could avoid the development
of this contracture. Adequate release of the contractured first web
space from hinge to hinge followed by a local skin flap cover and dynamic
abduction splintage for the subsequent six weeks gives good results
and prevents recurrences. Secondary surgeries like Flexor Pollicis Longus
lengthening and opponensplasty are sometimes added to avoid recurrences.
Fresh
Burns
Old
Burn scars
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Pre-Operation |
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After
1st Revision |
After
2nd Revision |
Post
Burn Contractures, Deformities and Disfigurements
Post
Burn White Patches
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Pre-Operation |
Post-Operation |
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