Burns By Matthew & Ivan

Anatomy of the Skin

• The anatomy of the skin is complex, and there are many structures within the layers of the skin. There are three layers:

• 1. Epidermis, the outer layer

• 2. Dermis, made up of collagen and elastic fibres where nerves, blood vessels, sweat glands, and hair follicles reside

• 3. Hypodermis or Subcutaneous tissue, where larger blood vessels are located. This is the layer of tissue that is most important in temperature regulation.

Causes of Burns

• Burns are caused by exposure to thermal (heat), electrical, radiation, or chemical sources.

• Exposure to electrical current causes electrical burns, and contact with caustic chemicals causes chemical burns.

• Prolonged exposure to the sun's ultraviolet rays or to other sources of radiation (such as from tanning booths) can also cause burns.

• The most serious burns are usually caused by scalding hot or flammable liquids, and fires.

How are Burns Classified?

• Doctors classify burns based on the depth and extent of the injury.

• Most burns are 1st-3rd degree.

• With 4th degree burns, the tissue beneath the skin is completely destroyed. That includes the muscles, tendons, ligaments and and sometimes even bones.

1st Degree

• Skin is red, swollen, and painful

• E.g.: Sunburn

• Heal without scarring

• Skin integrity is still intact

2nd Degree

• Painful partial-thickness burns

• Damage to entire epidermis

• Blister formation

• Usually heal without scarring.

3rd Degree

• Painless full-thickness burns

• Extensive necrosis of epidermis and connective tissue

• Scarring is inevitable

• Potential for squamous cell carcinoma

Examples of 1st, 2nd, and 3rd degree burns of the hand.

1st 2nd 3rd

• Doctors determine the severity of the burn not only by its depth, but also by the percentage of the body surface that has second- or third-degree burns.

• Special charts are used to show what percentage of the body surface various body parts comprise.

• For example, in an adult, one arm constitutes about 9% of the body.

• Each leg = 18% total (front = 9%, back = 9%)

• If both legs (18% x 2 = 36%), the groin (1%) and the front chest (9%) and abdomen (9%) were burned, this would involve 55% of the body.

Rule of Nines

• For severe burns:

• Skin Grafts

• Microsurgery

• Free flap procedure

• Tissue Expansion

Management & Surgical Treatment

Skin Graft

• Skin is removed from one area of the body and transplanted to another

• A special skin-cutting instrument known as a dermatone removes the skin from an area (the donor site) usually hidden by clothing such as the buttocks or inner thigh

• The graft is placed on the area in need of covering and held in place by a dressing and a few stitches

Microsurgery

• A procedure in which the surgeon uses a microscope for surgical assistance in reconstructive procedures

• By using a microscope, the surgeon can actually sew tiny blood vessels or nerves, allowing him or her to repair damaged nerves and arteries

• This may also be a method to relieve facial paralysis or reconstruct breasts

Free-flap procedure

• During the procedure, muscle, skin or bone are transferred along with the original blood supply from one area of the body (donor site) to the surgical site in order to reconstruct the area.

• Involves the use of microsurgery

• Healing of the surgical site can be slow and require frequent wound care

Tissue Expansion

• Tissue expansion is a medical procedure that enables your body to "grow" extra skin for use in reconstructive procedures

• An instrument known as a "balloon expander" is inserted under the skin near the area in need of repair.

• Over time, this balloon will be gradually filled with saline solution (salt water), slowly causing the skin to stretch and grow,

• Once enough extra skin has been grown, it is then used to correct or reconstruct a damaged body part.

Video-Links

• http://us.cnn.com/video/?/video/health/2009/11/01/hm.growing.skin.cnn

• http://www.youtube.com/watch?v=gV7QpLBvpcc&feature=related