Burn Injury Resource Center

Skin flap is a surgical procedure in which a healthy skin and its underlying subcutaneous tissue is taken from an area very close to the wound to be covered, the flap remains partly connected to its original site via its blood supply.

Skin graft is the surgical procedure in which a non healing wound or a burn wound is covered by a piece of healthy skin taken either from the patient or from a cadaver or an animal; the graft taken does not have its own blood supply and is completely separated from its original site . Skin graft is either used a temporary wound cover or a permanent one. Some wounds such as third degree burns if left to heal on their own can lead to scarring and contractions.

As the skin is the largest organ in the body and among its functions is playing a major role in protecting the body from fluid loss and help in preventing harmful micro organisims such as bacteria and viruses from entering the body and causing infections therefore its important to cover third degree burns with skin graft as soon as possible as uncovered third degree burns are more liable for wound infections and fluid loss from the burn area .

The incidence of burns during pregnancy are more common in developing countries then developed countries. Treatment of burns during pregnency may not be easy as during treatment both the wellbeing of the mother and the baby has to be taken into consideration. Topical and systemic treatment of burns in pregnant women may cause serious effects on the health of the fetus including fetal malformations.

Treatment of burns in pregnant women may include:

• Monitoring of the mother and the fetus by frequent ultrasounds, fetal heart monitoring, measuring blood clotting factors on a daily bases and other tests as needed.

Anyone is susceptible for burn injuries including pregnant women. The incidence of burns during pregnancy is higher in developing countries compared to developed countries. Most of the burns happening in pregnant women are accidental and are caused by different causes. The most common causes are scalding followed by flame injury. Other causes my include chemical, flash, electrical and friction burns.

The management of burns in pregnant women is not easy, it requires a multidisciplinary approach with close monitoring of fetal and maternal well being. For the mother the aim of the treatment is to restore full range of function and to minimize damages as much as possible. For the fetus the aim of treatment is reach full term being healthy without any congenital abnormalities. Treatment is more difficult in the first trimester of pregnancy because of thr risk of abortion. When the mother is at or near term, delivery should be done as soon as possible.

Minor burns may have no effect on the course of pregnancy but burns of at least 35% of total body surface area can induce early delivery and/or fetal loss. When a burn injury happen in a pregnant lady and depending on the severity of the burn there will be multiple body reactions among which are the following:

Diagnosis:

The diagnosis of DVT is made by physical examination and testing, the tests may include:

• Doppler ultrasound exam of the suspected limb.

Patients with burns especially those with second and third degree burns may need to be hospitalized as part of the healing process;  immobilization for an extended period of time may increase the risk of developing DVT . Infection of the burn wound and burn on the limbs affected by the DVT may also be among the risk factors for DVT (Wahl and Brandt, 2001). High total body surface area burn percentage and patients needing central venous line or multiple surgeries and/or blood transfusions are also at risk (Mullins et al., 2013).

DVT is a medical condition in which a blood clot forms in a deep vein in the body. Most of the blood clots happen in the large veins in the lower legs and thigh. These clots can block the veins leading to restricted blood flow or may break off and move through the circulatory system leading to serious problems depending on which organ is affected. A DVT may cause pulmonary embolism if it goes to the lung, it may cause heart attack if it goes to the heart or it may cause a stroke if it goes to the brain.

Deep venous thrombosis may be caused by:

When the skin is burned, the affected tissue will die depending on the severity of the injury. The dead tissue will naturally fall of as part of the healing process of the skin. However, in some cases where burns are severe (second and third degree burns), wound debridement is necessary. This dead tissue if not removed, will be a good medium for bacteria to grow and flourish, predisposing the wound for infection and other complications. Debridement is defined as the process of removing dead tissue and contaminated material from and around a wound to expose the healthy tissue.

There are four debridement methods which are : Surgical, Chemical, Mechanical and Autolytic debridement. The wound will be assessed to determine the best debridement method by examining the depth, extent and location of the wound; whether it lies close to other structures like bones, the risk of infection and antibiotic use, and the type of pain management that will be used during and after the procedure.

• Surgical debridement:

Dermabrasion is a surgical procedure involving the removal (sanding) of the damaged top layer of the skin using a specialized instrument called a dermabrader. This procedure is used for scars as well as other skin conditions such as wrinkles and tattoos.

Dermabrasion improves the appearance of the scar or other skin abnormality as a new layer of skin will replace the skin that has been treated. This procedure won’t entirely remove the scar or other abnormality but it will improve its appearance by softening the edges of the scar or other lesions.

The procedure can be done in a surgeon’s office or in an outpatient surgical facility. After the procedure the skin will be swollen, red and tender. Swelling gradually subsides within 2-3 weeks. You may feel some burning, itching, aching or discomfort for a while after the surgery. Pain medication, antibiotics and anti-swelling medications can be prescribed. Ointment and special dressing will help speed the healing process and your physician will give you instructions on how to care for the wound. Healing usually occurs within seven to ten days.

In difficult circumstances, not only the person who has been exposed to a trauma, but the caregivers as well, need all the help and support they can get and will appreciate the presence of friends and family beside them at that critical time period. By being there even for a few minutes, this will bring comfort and support for that person and your help will not be forgotten as suffering a burn injury can be one of the most traumatic experience a person can go through both physically and psychological.

If you are visiting a patient who is still in the hospital, there are certain things to keep in mind including visiting hours, number of visitors allowed and infection control as burn centers have strict guidelines regarding infection control. Visitors may be required to wear a gown, mask, cap and gloves when visiting the patient. The nurse will give you instructions on the protective clothing to decrease the risk of infection.

Look for any signs outside the patient’s door that will tell you if you have to wear these protective garments when entering the patient’s room, it’s important to follow these instructions. You have to wash your hands prior to entering and after leaving the patient. Avoid visiting the patient if you have an active cold or an infection and inform the nurse about it if you do visit.

Origin of hospital acquired infection:

Hospital acquired infection can be external (from outside the body) or internal (from the inside of the body).

External (Exogenous) infection: examples of external sources of infection may include