Acute Burn Management and Rehabilitation
Comprehensive burn management has direct implications on long-term function, including the development of contractures, scarring, and Marjolin’s ulcers. Burn patients require lifelong surveillance and management. An understanding of the acute and chronic
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Azra Ashraf
The Acute Burn
nurses, psychosocial support, and nutritionists. This typically occurs in the United States in Epidemiology the context of a “burn unit.” Some burns may reflect pediatric abuse and neglect, such as scald According to the American Burn Association, burns on the buttocks, and require the care proin 2013 there were 450,000 burn cases requir- vider reports the burn to appropriate authoriing medical attention and 3,400 deaths, including ties. Globally, burns are most common outside fire/smoke/inhalation injury [1]. Approximately the United States, specifically in the developing 69 % were male and 31 % female. Ethnic break- world. Burns such as acid violence burns comdown includes 59 % Caucasian, 20 % African- monly reflect domestic violence and are more American, and 14 % Hispanic. In terms of common in South Asia, in areas like India and location, 72 % occurred while the patient was Pakistan. Unfortunately, many of these counat home, 9 % at work, 5 % in the street or high- tries have limited resources in terms of expertise, way, and 5 % while participating in recreation intensive care management, and appropriate folor sport. The breakdown of type of burn was low-up to best rehabilitate their patients [3]. 43 % fire/flame, 34 % scald, 4 % electrical, 3 % Rehabilitating patients may take up to several chemical, and 7 % other [1]. In the early 1990s, years and multiple operations. It is imperative the LA50 (burn size lethal to 50 % of population) that health-care providers have a basic underwas 81 % total body surface area (TBSA) [2]. standing of the natural history of burns and techCurrent trends suggest a decreased incidence of niques in their armamentarium. This chapter will burn deaths due to improved prevention protocols present an overview of burn management and such as early excision and grafting, improved strategic reconstructive options. Details of speICU care, ventilation, nutrition, and a “team cific procedures exceed the goals and purview of approach.” According to several studies, each this chapter [3]. 1 % of burn corresponded with two-day hospital stay and an overall mean cost of $39,533 [2]. Successful surgical outcomes require a multi- The Burn Wound and Triage disciplinary team approach, including therapists, An acute wound is comprised of three zones: coagulation, stasis, and hyperemia [4] (Fig. 15.1). A. Ashraf, MD Each zone exhibits specific characteristics. The Private Practice, zone of coagulation tends to be the central area, Shrewsbury, NJ, USA comprised of necrotic and nonviable tissue. The e-mail: [email protected] © Springer International Publishing Switzerland 2017 A.I. Elkwood et al. (eds.), Rehabilitative Surgery, DOI 10.1007/978-3-319-41406-5_15
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Fig. 15.1 These images depict the zones of injury in a burn wound: stasis, hyperemia and coagulation
zone of stasis surrounds the zone of c oagulation and is most vulnerable to ischemia. In this zone, initially blood flow is present. However, if the patient is not appropriately resu
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