Wednesday, January 22, 2014
BURN SURGERY
A majority of burns result from exposure to high temperatures,
which injures the skin. Flame, scalding, or direct contact with
a hot object may cause thermal skin injury. Similar destruction
of skin can result from contact with chemicals such as acid or
alkali or contact with an electrical current. The latter, however,
often involves extensive destruction of the underlying tissue
and physiologic systems in addition to the skin. A 2007 fact
sheet on burn statistics includes the following information:
approximately 500,000 burn injuries receive medical treatment
yearly; 40,000 patients are hospitalized in the United States for
burn injuries, with 25,000 of those admitted to the 125 hospitals
with specialized burn centers (American Burn Association
[ABA], 2007).
Intact skin provides protection against the environment for
all underlying tissues and organs. It aids in heat regulation,
prevents water loss, and is the major barrier against bacterial
invasion. The tissue injury resulting from a burn disrupts this
normal protective function, resulting in local and systemic
effects ( Box 21-2 ). Burn patients are therefore some of the most
acutely ill patients brought to the OR. The greater the degree
of injury to the skin, expressed in percentage of total body surface
area (BSA) and depth of burn, the more severe the injury.
One method of measuring BSA in adults is by use of the rule of
nines
Partial-thickness (fi rst- and second-degree) burns heal by
regeneration of skin from dermal elements that remain intact.
First-degree burns involve the epidermis, which appears pink
or red; sunburn is usually a fi rst-degree burn. Second-degree
burns, also called partial-thickness burns, involve the epidermis
and some of the dermis. Full-thickness (third-degree)
burns ( Figure 21-8 ) involve the epidermis, the entire dermis,
and the subcutaneous tissues; they require skin grafting to
heal because no dermal elements remain intact. Both partialand
full-thickness burns may require debridement of necrotic
tissue (eschar) before healing can occur by skin regeneration
or grafting. An allograft may be used to cover the burned
area during the initial healing process. However, the allograft
must be carefully tested for immunodefi ciency diseases. A
xenograft (e.g., pig skin) may also be used for covering the
burned area.
which injures the skin. Flame, scalding, or direct contact with
a hot object may cause thermal skin injury. Similar destruction
of skin can result from contact with chemicals such as acid or
alkali or contact with an electrical current. The latter, however,
often involves extensive destruction of the underlying tissue
and physiologic systems in addition to the skin. A 2007 fact
sheet on burn statistics includes the following information:
approximately 500,000 burn injuries receive medical treatment
yearly; 40,000 patients are hospitalized in the United States for
burn injuries, with 25,000 of those admitted to the 125 hospitals
with specialized burn centers (American Burn Association
[ABA], 2007).
Intact skin provides protection against the environment for
all underlying tissues and organs. It aids in heat regulation,
prevents water loss, and is the major barrier against bacterial
invasion. The tissue injury resulting from a burn disrupts this
normal protective function, resulting in local and systemic
effects ( Box 21-2 ). Burn patients are therefore some of the most
acutely ill patients brought to the OR. The greater the degree
of injury to the skin, expressed in percentage of total body surface
area (BSA) and depth of burn, the more severe the injury.
One method of measuring BSA in adults is by use of the rule of
nines
regeneration of skin from dermal elements that remain intact.
First-degree burns involve the epidermis, which appears pink
or red; sunburn is usually a fi rst-degree burn. Second-degree
burns, also called partial-thickness burns, involve the epidermis
and some of the dermis. Full-thickness (third-degree)
burns ( Figure 21-8 ) involve the epidermis, the entire dermis,
and the subcutaneous tissues; they require skin grafting to
heal because no dermal elements remain intact. Both partialand
full-thickness burns may require debridement of necrotic
tissue (eschar) before healing can occur by skin regeneration
or grafting. An allograft may be used to cover the burned
area during the initial healing process. However, the allograft
must be carefully tested for immunodefi ciency diseases. A
xenograft (e.g., pig skin) may also be used for covering the
burned area.
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