BURN CENTER PHOTO GALLERY

 Prof. Dr. Mustafa TURAN CV

IN OUR BURN CENTER WE PERFORM THE MODERN BURN MANAGEMENT PROTOCOLS MANAGEMENT OF THE BURN PATIENT

Outcomes for burn patients have improved dramatically over the past 20 years, yet burns still cause substantial morbidity and mortality.Proper evaluation and management, coupled with appropriate early referral to a specialist, greatly help in minimizing suffering and optimizing results.

Burn patients should be systematically evaluated with emphasis on support of the airway, gas exchange, and circulatory stability. After evaluation of the burn wound, begin fluid resuscitation and make decisions concerning outpatient or inpatient management or transfer to a burn center.

Major burns

These include injuries covering more than 20% of the total body surface area, and represent a real challenge to burn surgeons. Survival depends on accurate assessment and prompt resuscitation initially, as well as on patients' premorbid conditions and associated injuries such as smoke inhalation. Subsequently, constant attention to wound cleanliness and to nutritional, respiratory, cardiovascular, and renal support is necessary.

Fluid resuscitation

Most formulas recommend that all crystalloid be isotonic during the first 24 hours, generally Ringer lactate solution. In smaller children, whose gluconeogenetic capacity is immature, hypoglycemia is a threat and Ringer lactate solution with 5% dextrose should be added at a maintenance rate.  Electrolyte levels should be carefully monitored and corrected.

Burn center transfer criteria are as follows:

·         Second- or third-degree burns greater than 10% total body surface area (TBSA) in patients younger than 10 years or older than 50 years.

·         Second- or third-degree burns greater than 20% TBSA in persons of other age groups

·         Second- or third-degree burns that involve the face, hands, feet, genitalia, perineum, or major joints

·         Third-degree burns greater than 5% TBSA in persons of any age group

·         Electrical burns,

·         Chemical burns 

·         Inhalational injury 

·         Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality

·         Any patients with burns or concomitant trauma (eg, fracture) in which the burn injury poses the greatest risk of morbidity or mortality: In such cases, if the trauma poses the greater immediate risk, the patient may be treated initially in a trauma center until stable before being transferred to a burn center.

Burn depth is classified as first, second, or third degree, as follows:

·         First-degree burns are usually red, dry, and painful. Burns initially termed first-degree are often actually superficial second-degree burns, with sloughing occurring the next day.

·         Second-degree burns are often red, wet, and very painful. Their depth, ability to heal, and propensity to form hypertrophic scars vary enormously.

Initial evaluation and management of the burn patient. Second-degree burns are often red, wet, and very painful.

·         Third-degree burns are generally leathery in consistency, dry, insensate, and waxy. These wounds will not heal, except by contraction and limited epithelial migration, with resulting hypertrophic and unstable cover.

Note circumferential, or near-circumferential, burn wounds because they may cause progressive extremity ischemia or interfere with ventilation as burn wound swelling increases. In such situations, timely escharotomy is essential.

Burn Wound Management

Gently we clean the wound of debris and exudate on a regular basis. This usually requires daily removal of accumulated exudate and topical medications.  Most topical dressings have a viscous carrier that prevents wound desiccation and a broader antibacterial spectrum that reduces wound colonization.

Excision and grafting

Early excision and closure of full-thickness wounds changes the natural history of burn injury, avoiding the otherwise common occurrence of wound sepsis. Wound size and depth are the important factors in determining the need for early operation because this correlates with the physiologic threat represented by the injury.

Small (less than 20 per cent TBSA) full-thickness burns and indeterminate (deep partial-thickness versus full-thickness) burns, if treated by an experienced surgeon, can be excised safely and grafted.  If wounds cover more than 30% TBSA, this may require staged procedures. If the wounds involve more than 50% of the body surface, achieving immediate autograft closure is often impossible.

When autograft material is exhausted, temporary biologic closure is achieved with temporary wound closure or human allograft. Wounds are later resurfaced with autograft when donor sites have healed.

Most major centers treating severe burns believe early and staged excision is the treatment of choice. Advances in intensive care and the development of skin substitutes have facilitated this.

MEDICATIONS AND MEMBRANES

A wide range of topical medications is available, including simple petrolatum, various antibiotic-containing ointments and aqueous solutions, and debriding enzymes.

Medications

·         Silver sulfadiazine - Broad antibacterial spectrum; painless application 

·         Various debriding enzymes - Useful in selected partial-thickness wounds

·         Various antibiotic ointments - Useful in many superficial partial-thickness wounds

Membranes

·         Various impregnated gauzes - Provide vapor and bacteria barrier while allowing drainage

·         Various hydrocolloid dressings - Provide vapor and bacteria barrier while absorbing wound exudate

·         Various semipermeable membranes - Provide vapor and bacteria barrier

·         Split-thickness allograft - Vascularizes and provides durable temporary closure of wounds

Chamical burns

·         Can result from exposure to acidic, alkaline or petroleum products.

·         Alkali burns tend to be deeper and more serious than acid burns.

·         Immediately flush away the chemical with large amounts of water for at least 20 to 30 minutes (longer for alkali burns). Alkali burns to the eye require continuous irrigation during the first eight hours after the burn.

Electrical burns

·         Are often more serious than they appear on the surface.

·         Rhabdomyolysis results in myoglobin release, which can cause acute kidney injury. If the urine is dark, start therapy for myoglobinuria immediately.

·         Fluid administration should be increased to ensure a urinary output of at least 100 ml/hour in the adult.

·         Metabolic acidosis should be corrected by maintaining adequate perfusion and adding sodium bicarbonate.

Complications

·         Respiratory distress from smoke inhalation or a severe chest burn.

·         Fluid loss, hypovolaemia and shock.

·         Infection.

·         Increased metabolic rate leading to acute weight loss.

·         Increased plasma viscosity and thrombosis.

·         Vascular insufficiency and distal ischaemia from a circumferential burn of limb or digit.

·         Muscle damage from an electrical burn may be severe even with minimal skin injury; rhabdomyolysis may cause acute kidney failure.

·         Poisoning from inhalation of noxious gases released by burning

·         Haemoglobinuria and renal damage.

·         Scarring and possible psychological consequences.