Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Burns and Plastic Surgery PPT 7 Special Burns Lecture Notes
Non Thermal injuries, Burn
Reconstruction Principles
Types of non Thermal Injuries
? 1. Electrical injuries
? 2. Chemical injuries
? 3. Cold Injuries
? 4. Ionizing radiation injuries
Electrical injuries
Contact Burns
PATHOPHYSIOLOGY
? Joule Effect:
? Passage of current through a solid conductor results in conversion of electrical
energy to heat
? Ohm's Law:
? 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:
? J = 0.24 x I sq x R x T
? J = Heat Production I = Current R = Resistance T = Time
? Resistance of body tissues
? Nerves and Blood Vessels - Good to excellent conduction
? Muscle Bone and Skin - Resistant to passage of electricity Electrical
Burns
? Extent of injury depends on
? Type of current (alternating vs direct)
? Pathway of flow
? Local tissue resistance
? Duration of contact Electrical Burns
Mortality of electrical burns
?
? Low-voltage injuries:
? Alter the cardiac cycle
? High-voltage injuries
? Cause concomitant tissue damage
? Survival of contact with voltage greater than 70,000 volts uncommon
CLASSIFICATION
? I Physical
1.Heat
2.Electrical Burn injuries
3.Lightening injuries
4.Radiation burns
5.Friction burns
? I Chemical
Acids --1.Sulphuric acid
2. Hydrochloric acid
3. Nitric acid
4.hydrofluoric acid
5.Chromic acid
Classification--contd.
Alkalies ? 1.Caustic soda
2.Caustic potash
3.Lime
4. ammonia
Organics ? 1. Phenol
2. Lysol
3.Cresol
Inorganic -- 1. Phosphorus
2. Sodium
3. Magnesium
I I Other special burns
1.Hot coal tar burns
2.Jaggery burns
3.Molten metal burns
4.Hot oil burns
CHEMICAL BURNS
?Apart from damaging skin chemical toxins may get
absorbed through skin and go into circulation in
chemical burns.Toxic effects on patients are in
1. liver--acute liver atrophy
2. renal--renal failure
3. nervous ?delerium and convulsions
Carbolic acid (Phenol) , Creselic acid (cresol),
Chromic acid and Hydrofluoric acid are known to
cause systemic toxicity
Management of chemical burns
1.Wounds to be washed with running water minimum for 15 min or till
litmus test becomes negative.
2.Proper care of eyes in facial burns with ophthalmic reference
3. Early excision and skin grafting.
Surgical
Surgical Management
Special Chemical Burns
?Hydrofluoric acid burns--HF acid is used in glass
industry . Patient presents with severe intense pain
at the site of burn. Treatment in these burns is Ca
Gluconate irrigation or local injection.
?Phenol burns--- are known for its systemic
manifestations. Treatment is irrigation with copious
water and removal of phenol.
Hydrofluoric acid burns
Tar burns
Car battery acid burns
Burns of special sites
1.Burns of face ?eye, ear
2.Burns of hand
FACIAL BURNS
? Eye burns ?
? inability to close the lids
? exposure keratitis with damage to cornea.
? managed either with tarsorraphy or early excision and skin grafting
Ear burns ?
? Ear cartilage is peculiar in nature ?
1. is a single cartilage
2. perichondrium is tightly adherent with skin on both
the sides
? Burns of ear if not properly treated may lead to
chondritis and crumpled ear deformity.
? Treatment includes ?
1. closed dressing with antibacterial cream
2. pil ows to be avoided to prevent frequent rub and
subsequent infection
3.excision and temporoparietal fascial cover in full
thickness burns of ear.
Summary of tt. For specific chemical burns
? Irrigation with water-all except sodium , lithium, potassium metals
and mustard gas
? Calcium salt inj. Or irrigation ?hydrofluoric acid
? cover with oil ? Na, K ,LITH. Etc.
? cover with water ?phosphorous metal
Radiation burns
Management
? Aloe vera cream
? Corticosteroid creams
? Systemic Amifostine
Cold injuries
Frost bite
? Rewarming of the skin
? Debridement and pain medication
? Whirl pool therapy
? Anticoagulants and antibiotics
? Surgery
? Hyperbaric oxygen
Trench foot
Below freezing
Temperature
+ moisture
Management
? Rest, warming
? Picric acid, Boric acid
? Alcohol
This post was last modified on 07 April 2022