Download MBBS Burns and Plastic Surgery PPT 7 Special Burns Lecture Notes

Non Thermal injuries, Burn

Reconstruction Principles

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Types of non Thermal Injuries

? 1. Electrical injuries
? 2. Chemical injuries
? 3. Cold Injuries

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? 4. Ionizing radiation injuries


Electrical injuries

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Contact Burns

PATHOPHYSIOLOGY

? Joule Effect:

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? Passage of current through a solid conductor results in conversion of electrical

energy to heat

? Ohm's Law:

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? I = V / R
? Intensity of the current (amperage) is directly proportional to the potential flow

(voltage) and inversely proportional to the resistance
? Joule's Law:

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? J = 0.24 x I sq x R x T

? J = Heat Production I = Current R = Resistance T = Time

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? Resistance of body tissues

? Nerves and Blood Vessels - Good to excellent conduction

? Muscle Bone and Skin - Resistant to passage of electricity Electrical

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Burns

? Extent of injury depends on

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? Type of current (alternating vs direct)

? Pathway of flow

? Local tissue resistance

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? Duration of contact Electrical Burns

Mortality of electrical burns

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?
? Low-voltage injuries:
? Alter the cardiac cycle

? High-voltage injuries

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? Cause concomitant tissue damage
? Survival of contact with voltage greater than 70,000 volts uncommon

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CLASSIFICATION

? I Physical

1.Heat

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2.Electrical Burn injuries

3.Lightening injuries

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4.Radiation burns

5.Friction burns

? I Chemical

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Acids --1.Sulphuric acid

2. Hydrochloric acid

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3. Nitric acid

4.hydrofluoric acid

5.Chromic acid

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Classification--contd.

Alkalies ? 1.Caustic soda

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2.Caustic potash

3.Lime

4. ammonia

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Organics ? 1. Phenol

2. Lysol

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3.Cresol

Inorganic -- 1. Phosphorus

2. Sodium

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3. Magnesium

I I Other special burns

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1.Hot coal tar burns

2.Jaggery burns

3.Molten metal burns

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4.Hot oil burns


CHEMICAL BURNS

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?Apart from damaging skin chemical toxins may get

absorbed through skin and go into circulation in

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chemical burns.Toxic effects on patients are in

1. liver--acute liver atrophy
2. renal--renal failure
3. nervous ?delerium and convulsions

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Carbolic acid (Phenol) , Creselic acid (cresol),
Chromic acid and Hydrofluoric acid are known to

cause systemic toxicity

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Management of chemical burns

1.Wounds to be washed with running water minimum for 15 min or till

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litmus test becomes negative.

2.Proper care of eyes in facial burns with ophthalmic reference
3. Early excision and skin grafting.

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Surgical

Surgical Management

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Special Chemical Burns

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?Hydrofluoric acid burns--HF acid is used in glass

industry . Patient presents with severe intense pain

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at the site of burn. Treatment in these burns is Ca

Gluconate irrigation or local injection.

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?Phenol burns--- are known for its systemic

manifestations. Treatment is irrigation with copious

water and removal of phenol.

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Hydrofluoric acid burns

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Tar burns

Car battery acid burns

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Burns of special sites


1.Burns of face ?eye, ear

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2.Burns of hand



FACIAL BURNS

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? Eye burns ?
? inability to close the lids
? exposure keratitis with damage to cornea.
? managed either with tarsorraphy or early excision and skin grafting

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Ear burns ?
? Ear cartilage is peculiar in nature ?

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1. is a single cartilage

2. perichondrium is tightly adherent with skin on both

the sides

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? Burns of ear if not properly treated may lead to

chondritis and crumpled ear deformity.

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? Treatment includes ?

1. closed dressing with antibacterial cream

2. pil ows to be avoided to prevent frequent rub and

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subsequent infection

3.excision and temporoparietal fascial cover in full

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thickness burns of ear.

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Summary of tt. For specific chemical burns

? Irrigation with water-all except sodium , lithium, potassium metals

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and mustard gas

? Calcium salt inj. Or irrigation ?hydrofluoric acid
? cover with oil ? Na, K ,LITH. Etc.
? cover with water ?phosphorous metal

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Radiation burns
Management

? Aloe vera cream

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? Corticosteroid creams
? Systemic Amifostine

Cold injuries

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Frost bite

? Rewarming of the skin
? Debridement and pain medication

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? Whirl pool therapy
? Anticoagulants and antibiotics
? Surgery
? Hyperbaric oxygen

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Trench foot

Below freezing

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Temperature

+ moisture

Management

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? Rest, warming
? Picric acid, Boric acid
? Alcohol