Other Systems_Integ_Burns

Full-thickness Burn (3rd degree)

• Zone of coagulation
• Zone of stasis
• Zone of hyperemia

• Cells are irreversibly injured
• Cell death occurs

• Less severe damage than zone of coagulation - surrounds it
• Reversible damage
• Cells may die w/o specialized tx, within 24-48 hours

• Minimal cell injury
• Surrounds zone of stasis
• Cells should fully recover within 7 days w/o any intervention or permanent damage

• % of the body's total surface area that has been burned
• Depth of burned areas

• Rule of Nines
• Lund-Browder

• Head & neck - 9% (4.5% front + 4.5% back)
• Anterior trunk - 18%
• Posterior trunk - 18%
• Arms - 9% each (4.5% front + 4.5% back)
• Legs - 18% each (9% front + 9% back)
• Perineum - 1%

• Head & neck - 17% (8.5% front + 8.5% back)
• Anterior trunk - 18%
• Posterior trunk - 18%
• Arms - 9% each (4.5% front + 4.5% back)
• Legs - 13% each (6.5% front + 6.5% back)
• Perineum - 1%

• Pneumonia
• Pulmonary edema (smoke inhalation)
• Airway obstruction (smoke inhalation)
• RLD from burns of trunk

• INC metabolic/catabolic activity
• Weight loss
• (-) nitro­gen balance
• DEC energy stores

DEC CO d/t fluid/plasma loss

Superficial

• Superficial partial thickness
• Deep partial thickness

Full thickness

Subdermal

Epidermis only

• Erythema: Pink or red appearance
• No blistering (dry surface)
• Minimal edema
• Tenderness, delayed pain

Sunburn

Spontaneous healing in 2-5 days

No scarring

• Epidermis
• Upper layers of dermis

• Bright pink or red appearance
• Blanching w/brisk capillary refill
• Blisters, moist surface, weeping
• Moderate edema
• Painful, sensitive to touch
• Temperature changes

• I - spontaneous in 2-5 days
• II superficial - spontaneous in 7-21 days
• II deep - slow 3-5 wks
• III - full thickness - removal of eschar & skin grafting

• 1st - no scarring
• 2nd superficial - no to min scarring + discoloration
• 2nd deep - hypertrophic/keloid scar + blanching
• 3rd full - Hypertrophic/keloid stays within boundaries of burn

Superficial Partial-thickness Burn (2nd degree)

Spontaneous healing in 7-21 days

Slow - 2-5 wks

• Hypertrophic/keloid scar
• Blanching

• Minimal or no scarring
• Discoloration

• Epidermis & dermis
• W/injury in nerve endings, hair follicles, & sweat glands

• Mixed red or waxy white appearance w/slow capillary refill
• Broken blisters, wet surface
• Marked edema
• Sensitive to P
• Insensitive to light touch or soft pin prick
• Severe pain

Deep Partial-thickness Burn (2nd degree)

Deep Partial-thickness Burn (2nd degree)

Healing is slow: 3 to 5 weeks

• Hypertrophic and keloid scarring are common
• Blanching

• Complete destruction of epidermis, dermis, & subcutaneous tissues
• May extend into muscle

• Tissues are white ischemic, gray, or black
• Parchment-like, dry leathery surface
• Escar formation
• No blanching; poor distal circulation
• Insensate or little pain (nerve endings ore destroyed)
• Often significant pain is experienced in the surrounding tissue, but not in the full-thickness area

Removal of eschar & skin grafting are necessary d/t destruction of dermal & epidermal tissue

• Hypertrophic scarring & wound contracture
• Keloid (raised) scar that stays within boundaries of burn wound

• Removal of eschar
• Skin grafting

• Prolonged contact with a flame
• Electrical burns

Complete destruction of epidermis, dermis, w/involvement of subcutaneous tissues & involves bone & muscle

• Skin is charred
• Dry in appearance
• Mummified

Amputation

• Flexion w/possible lateral flexion
• Splints - Soft collar; molded collar; Philadelphia collar

• ADD / IR / Extension
• Splints - axillary or airplane splint; sh ABD brace

• Flexion
• Splints - gutter splint; conforming splint; three-point splint; air splint

• Claw hand (intrinsic minus position)
• Stress wrist extension (15°)
• MP flexion (70°)
• PIP, and DIP extension
• Thumb ABD (intrinsic plus position)
• Splints - wrist splint; thumb spica splint; palmar ot dorsal extension splint

• Flexion & ADD
• Splints - anterior hip spica; ABD splint

• Flexion
• Splints - conforming splint; three-point splint; air splint

• PF
• Splints - posterior foot drop splint; posterior ankle conforming splint; anterior ankle conforming splint

• Same species, usually cadaver skin
• Temporary grafts for LARGE BURNS

• Use of skin from other species, usually pigskin
• Temporary graft

Use of patient's own skin

Contains epidermis and upper layers of dermis from donor site

Contains epidermis and dermis from donor site

Split thickness graft

Full thickness graft

• Discontinue PT for 3-5 days to allow grafts to heal
• Elastic supports to help control edema
• P garments to help prevent hypertrophic scarring or keloid formation

• Ointments - Bacitracin, Polymyxin B, Neomycin, Neosporin
• Silver sulfadiazine
• Sulfamylon

• @ term pregnancy
• <2 month="" old="" infants="" br="">W/sulfa drug allergies

• Silver impregnated
• Petrolium impregnated
• Hydrogels
• Gauze

Z-plasty (surgical incision in the form of the letter Z used to lengthen a bum scar)

Bright pink scar

Changes to a soft lavender & finally faintly pink scar

• Immature - bright pink
• Mature - soft, white, flat

• Immature - 6-12 wks
• Mature - 12-15 months

• Raised scar that extends beyond boundaries of original burn wound
• Red, raised, firm
• More common in women & w/dark skin

• Soft
• White
• Flat (takes over a year to occur)
• 12-15 months

• Bright pink
• At 6-12 weeks

• Epithelialization
• Protect w/moisturizing creams

Scar formation

Custom-made P garments - for 23 hrs/day often for 6-12 months

Sulfamylon