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Evolve Cosmetic » Plastic Surgery » Post Burn Reconstrution


A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation. Burns that affect only the superficial skin are known as superficial or first-degree burns. When damage penetrates into some of the underlying layers, it is a partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle or bone.

Burn Deformity Correction


Treatment


The treatment required depends on the severity of the burn. Superficial burns may be managed with little more than simple pain relievers, while major burns may require prolonged treatment in specialized burn centers. Cooling with tap water may help relieve pain and decrease damage; however, prolonged exposure may result in low body temperature. Partial-thickness burns may require cleaning with soap and water, followed by dressings. It is not clear how to manage blisters, but it is probably reasonable to leave them intact. Full-thickness burns usually require surgical treatments, such as skin grafting. Extensive burns often require large amounts of intravenous fluids because the subsequent inflammatory response will result in significant capillary fluid leakage and edema. The most common complications of burns are related to infection. While large burns can be fatal, especially in children and young adults. The long-term outcome is primarily related to the size of burn and the age of the person affected.




Burn Deformity Correction


A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation. Burns that affect only the superficial skin are known as superficial or first-degree burns. When damage penetrates into some of the underlying layers, it is a partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle or bone. The treatment required depends on the severity of the burn. Superficial burns may be managed with little more than simple pain relievers, while major burns may require prolonged treatment in specialized burn centers. Cooling with tap water may help relieve pain and decrease damage; however, prolonged exposure may result in low body temperature. Partial-thickness burns may require cleaning with soap and water, followed by dressings. It is not clear how to manage blisters, but it is probably reasonable to leave them intact. Full-thickness burns usually require surgical treatments, such as skin grafting. Extensive burns often require large amounts of intravenous fluids because the subsequent inflammatory response will result in significant capillary fluid leakage and edema. The most common complications of burns are related to infection.


Cause


Burns are caused by a variety of external sources classified as thermal (heat-related), chemical, electrical, and radiation. the most common causes of burns are: fire or flame, scalds, hot objects, electricity, and chemicals. Most burn injuries occur at home or at work & most are accidental, sometimes due to assault by another, and some result from a suicide attempt. These sources can cause inhalation injury to the airway and/or lungs. Burn injuries occur more commonly in the poor. Smoking is a risk factor, although alcohol use is not. Fire-related burns are generally more common in colder climates. Specific risk factors in the developing countries include cooking with open fires or on the floor as well as developmental disabilities in children and chronic diseases in adults
Thermal
fire and hot liquids are the common causes of burns. Of house fires that result in death, smoking causes 25% and heating devices cause 22%. Almost half of injuries are due to efforts to fight a fire. Scalding is caused by hot liquids or gases and most commonly occurs from exposure to hot drinks, high temperature tap water in baths or showers, hot cooking oil, or steam. Scald injuries are most common in children under the age of five. Generally, scalds are first- or second-degree burns, but third-degree burns may also result, especially with prolonged contact. Fireworks are a common cause of burns during holiday seasons. This is a particular risk for adolescent males.

Chemical burn
Chemicals contribute to as many as 30% of burn-related deaths. Chemical burns can be caused by over 25,000 substances,most of which are either a strong base or a strong acid. Most chemical burn deaths are secondary to ingestion.Common agents include: sulfuric acid as found in toilet cleaners, sodium hypochlorite as found in bleach, and halogenated hydrocarbons as found in paint remover, among others. Hydrofluoric acid can cause particularly deep burns which may not become symptomatic until some time after exposure. Formic acid may cause the breakdown of significant numbers of red blood cells.

Electrical burn
Electrical burns or injuries are classified as high voltage (greater than or equal to 1000 volts), low voltage (less than 1000 volts), or as flash burns secondary to an electric arc. Lightning may also result in electrical burns. while electrical injuries primarily result in burns, they may also cause fractures or dislocations secondary to blunt force trauma or muscle contractions. In high voltage injuries, most damage may occur internally and thus the extent of the injury cannot be judged by examination of the skin alone. Contact with either low voltage or high voltage may produce cardiac arrhythmias or cardiac arrest.

Radiation burn
Radiation burns may be caused by protracted exposure to ultraviolet light (such as from the sun, tanning booths or arc welding) or from ionizing radiation (such as from radiation therapy, X-rays or radioactive fallout).Sun exposure is the most common cause of radiation burns and the most common cause of superficial burns overall.



Diagnosis
Burns can be classified by depth, mechanism of injury, extent, and associated injuries. The most commonly used classification is based on the depth of injury. The depth of a burn is usually determined via examination, although a biopsy may also be used. It may be difficult to accurately determine the depth of a burn on a single examination and repeated examinations over a few days may be necessary.In those who have a headache or are dizzy and have a fire-related burn, carbon monoxide poisoning should be considered. Cyanide poisoning should also be considered.

Size
Burn severity is determined though among other things the size of the skin affected. The size of a burn is measured as a percentage of total body surface area (TBSA) affected by partial thickness or full thickness burns.First-degree burns that are only red in color and are not blistering are not included in this estimation.Most burns involve less than 10% of the TBSA.

Severity
In order to determine the need for referral to a specialized burn unit, classification system is devised. Under this system, burns can be classified as major, moderate and minor. This is assessed based on a number of factors, including total body surface area affected, the involvement of specific anatomical zones, the age of the person, and associated injuries.Minor burns can typically be managed at home, moderate burns are often managed in hospital, and major burns are managed by a burn center.

Prevention
About half of all burns are deemed to be preventable.Burn prevention programs have significantly decreased rates of serious burns. Preventive measures include: limiting hot water temperatures, smoke alarms, sprinkler systems, proper construction of buildings, and fire-resistant clothing. Experts recommend setting water heaters below 48.8 °C (119.8 °F).

Wound care
Early cooling (within 30 minutes of the burn) reduces burn depth and pain, but care must be taken as over-cooling can result in hypothermia. It should be performed with cool water 10–25 °C (50.0–77.0 °F) and not ice water as the latter can cause further injury.Chemical burns may require extensive irrigation. Cleaning with soap and water, removal of dead tissue, and application of dressings are important aspects of wound care. If intact blisters are present, it is not clear what should be done with them. Some tentative evidence supports leaving them intact. Second-degree burns should be re-evaluated after two days.in the management of first- and second-degree burns, little quality evidence exists to determine which type of dressing should be used.It is reasonable to manage first-degree burns without dressings.While topical antibiotics are often recommended, there is little evidence to support their use. ilver sulfadiazine (a type of antibiotic) is not recommended as it potentially prolongs healing time.There is insufficient evidence to support the use of dressings containing silver or negative-pressure wound therapy.

Surgery
Wounds requiring surgical closure with skin grafts or flaps (typically anything more than a small full thickness burn) should be dealt with as early as possible. Circumferential burns of the limbs or chest may need urgent surgical release of the skin, known as an escharotomy.This is done to treat or prevent problems with distal circulation, or ventilation. It is uncertain if it is useful for neck or digit burns. Fasciotomies may be required for electrical burns.



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