Burns and Wound Healing Overview

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Questions and Answers

Which of the following characteristics are true for hypertrophic scars?

They typically arise within 4 weeks and grow intensely for several months. (correct)

They are characterized by a predominance of type III collagen.

They are usually larger than keloids.

They remain within the boundaries of the original wound. (correct)

What is the primary benefit of using a compression garment in scar management?

It increases blood flow to the scar.

It promotes random collagen fiber orientation.

It enhances scar pigmentation.

It decreases water content of the scar. (correct)

Which site is most commonly associated with heterotopic ossification?

Knee

Hip in children

Shoulder

Posterior elbow (correct)

Which of the following statements about peripheral neuropathies in burn patients is true?

Multiple neuropathies occur more frequently in males than females. Signup and view all the answers

What is a feature that differentiates keloids from hypertrophic scars?

Keloids may grow beyond the boundaries of the original wound. Signup and view all the answers

Which of the following is a key risk factor for developing heterotopic ossification?

Prolonged immobility Signup and view all the answers

What is an expected outcome of wearing a custom fitted compression garment?

Parallel orientation of collagen fibers Signup and view all the answers

What is the incidence rate of generalized peripheral neuropathy in burn patients?

50% Signup and view all the answers

What is the primary goal when initiating a stretching program for a pediatric patient with contractures?

To maintain normal range of motion (ROM) Signup and view all the answers

Which characteristic is essential for a good splint used in pediatric burn rehabilitation?

It should be made of moldable materials Signup and view all the answers

What distinguishing feature differentiates keloid scars from hypertrophic scars?

Keloids grow beyond the original wound borders Signup and view all the answers

Which action is advised for patients with healed burn skin to manage its sensitivity?

Utilize mild soap and avoid prolonged water exposure Signup and view all the answers

What is the recommended position for the anterior axilla to prevent contractures?

Shoulder 90-degree abduction, neutral rotation Signup and view all the answers

Which option describes a characteristic of hypertrophic scars?

They appear within several months after the initial scar Signup and view all the answers

What key aspect should be controlled during burn rehabilitation to prevent complications?

Control edema through positioning and splinting Signup and view all the answers

Which indication is not associated with the use of splints in pediatric burn therapy?

Improve overall muscle mass Signup and view all the answers

What is the primary focus during the first phase of modern burn care?

Initial evaluation and resuscitation Signup and view all the answers

Which is a significant risk factor associated with inhalational injury in burn patients?

Increased risk of pneumonia Signup and view all the answers

What is the primary objective of proper positioning during acute burn rehabilitation?

Prevent development of contractures Signup and view all the answers

Where does fluid resuscitation primarily occur within the modern burn care phases?

Initial phase of evaluation Signup and view all the answers

What is a critical respiratory complication associated with inhalational injuries?

Adult respiratory distress syndrome Signup and view all the answers

Which of the following positioning strategies is NOT useful in contracture prevention during burn rehabilitation?

Flexion of the joints Signup and view all the answers

In the context of burn injury, which statement about hemodynamic changes is accurate?

Systemic hemodynamic changes include depression of cardiac output. Signup and view all the answers

What differentiates keloid scars from hypertrophic scars?

Keloids are raised scars that do not regress over time. Signup and view all the answers

Study Notes

Burn Overview

Burns are the 4th most common type of trauma globally, following traffic accidents, falls, and interpersonal violence.
Most burns occur at home, often while cooking.
Pediatric burns happen more commonly at home, usually due to unsupervised situations.
Adults are equally likely to sustain home, outdoor, or workplace burns.
Elderly individuals are most likely to experience burns in the bathroom, followed by the kitchen.

Acute vs Chronic Wound

Acute wounds heal quickly and are typically resolved in a timely manner.
These wounds follow a clear, orderly process.
They are usually caused by isolated, non-recurring injuries.
Chronic wounds do not heal in a timely manner and can be complicated by underlying pathologies
Absence of healing may be due to minor trauma
Chronic wounds are characterized by a lack of progressive healing over a protracted period, and may be uniform in depth.

Burn Wound Zones

Zone of coagulation: The inner zone of the burn wound; characterized by cellular necrosis or death.
Zone of stasis: Surrounds the zone of coagulation; exhibits decreased blood flow, inflammation, and cellular injury. This area may be salvageable and potentially susceptible to further injury.
Zone of hyperemia: The outer zone of the burn; shows the least cellular injury and increased blood flow; full recovery is likely in this zone.

Types of Chemical Burns

Chemical burns are caused by a variety of caustic reactions.
The alterations of pH, disruption of cellular mechanisms, and direct toxic effects on metabolic processes are important factors in causing injury.
Factors determining severity include exposure duration and the nature of the chemical agent.

Types of Thermal Burns

Temperature is a key determinant for the severity of thermal burns, with protein denaturation occurring at 40°C.
The duration of contact and the thickness of the skin also influence the severity and healing potential of a thermal burn.
Depth of injury significantly impacts healing potential and the potential need for surgical intervention.

Frostbite Burns

Frostbite injuries damage skin and underlying tissues due to ice crystals puncturing cells or a hypertonic tissue environment.
This can disrupt blood flow, leading to hemoconcentration, intravascular thrombosis, and tissue hypoxia.
Frostnip manifests as whitening of exposed areas but does not frequently result in lasting damage, but it may raise the risk of frostbite with repeated exposure.

Types of Electrical Burns

Electrical burns result from the transformation of electrical energy into thermal energy because the current passes poorly through body tissues.
Electrical injury also affects cell membranes, disrupting membrane potential and function.
Determining severity of injury depends on the voltage and amperage of the current, duration of exposure, and the pathway of the current.
Cutaneous damage does not consistently reflect the extent of injury.

Burn Depth and Classification

Burn depth is a significant determinant impacting mortality and long-term function.
Deeper wounds result in more extensive tissue destruction and longer healing times and tend to result in more scarring.
Partial thickness wounds usually heal spontaneously without surgery, within 2-3 weeks, with minimal or no functional impairment.

Burn Depth Classification

Old classification systems usually use terms such as first-degree (or epidermal), second-degree, third-degree (or full-thickness), and fourth-degree burns.
Newer classifications utilize terms such as superficial, superficial partial thickness, deep partial thickness, and full thickness burns.

Burn Depth Characteristics

Superficial burns involve only the epidermis layer, healing within days with minimal scarring.
Superficial partial thickness involves the epidermis and dermis layers, resulting in blistering, pain, moisture, and reduced blanching, with healing time ranging from 7 to 21 days.
Deep partial thickness involves the epidermis and dermis layers, resulting in blisters that tend to dry, reduced or absent blanching, absent pain sensation, and significant pain with deep pressure, with variable healing time, potential for scarring.
Full thickness burns involve all skin layers impacting function. Characterized by significant pain with pressure, inelastic, waxy appearance, and the absence of blanching, with healing potentially requiring surgical procedures.

Burn Depth and Total Body Surface Area (TBSA) Calculation

The average surface area of an adult's skin is ~1.82m2
Neonates have ~0.25m2.
Calculating TBSA accurately is crucial for treatment and patient prognosis, utilizing charts tailored to specific age groups (e.g., Lund and Browder Chart).

Burn Severity

Factors such as patient age, associated injuries like inhalational injuries or head injuries, and co-morbidities are crucial in determining burn injury severity.
TBSA burned, depth of injury, and location of the burn on the body are other crucial determinants of severity.
Different severity levels (e.g., minor, moderate, major) are categorized based on these factors..

Local Response to Burn Injury

Local responses to burns include vasodilation, increased extravascular osmotic activity, impaired cell membrane function, and microvascular permeability, which lead to edema.
Decreased blood flow, ischemia, and necrosis occur within the burn wound, involving endothelial cells, platelets, and leukocytes.

General Response to Burn Injury

Hypovolemia is a major concern in burn patients.
Systemic changes in hemodynamics typically include initial cardiac output depression..
Burn victims may experience altered thermoregulation; and inhalational injuries greatly impact pulmonary function.

Inhalational Injury

Significant risk factor for morbidity due to reduced oxygen availability from exposure to toxic smoke components, particularly carbon monoxide and cyanide, which can be risk factors in some burns.
Inhalational injuries increase the risk for pneumonia, adult respiratory distress syndrome (ARDS), and multi-organ system dysfunction.

Phases of Modern Burn Care

Modern burn care is staged in phases:
Initial evaluation and resuscitation (first phase), which involves evaluation, fluid resuscitation, and assessment for other injuries and comorbidities on the first three days after the injury.
Wound excision and biologic closure (second phase), involving the serial staged operations such as debridements.
Definitive wound closure and reconstruction (third phase), characterized by skin grafting or other reconstructive surgeries, including for the face and hands.
Rehabilitation and reintegration (fourth phase), where the patient undergoes various rehabilitation and reintegration efforts to rebuild their lives and get to their normal activities.

Acute Burn Rehabilitation Positioning

Proper positioning prevents contractures and compression neuropathies, keeping tissues elongated.
Tailored positioning, including flexion, abduction, and extension, is crucial during rehabilitation.

Acute Burn Rehabilitation Splinting

Splinting is indicated to maintain joint position, prevent deformities, and manage edema.
Splints must be made of moldable materials and are compatible with dressings and topical medications
Important: Easy to don and doff

Acute Burn Rehabilitation Exercises

Maintaining normal range of motion (ROM) and strength is the initial goal of exercise programs.
Stretching is indicated when ROM is limited.
Strengthening exercises commence as soon as tolerated, with post-grafted patients requiring additional considerations.

Post-Acute Burn Rehabilitation Skin Care

Immediately after a burn, the skin is easily damaged and susceptible to sun and chemical exposure, so moisturizing with sun blocks helps.
Advise patients about using mild soaps and detergents, and not prolonged water exposure.
Massage skin frequently to stimulate blood circulation.

Post-Acute Burn Rehabilitation Scarring

Within 1-3 months, hypertrophic scars that are raised, irregular, and red, often regress spontaneously over time.
Differentiate from keloids, which persist and grow beyond the original wound boundaries.

Post-Acute Burn Rehabilitation Scar Management

Pressure techniques help align collagen fibers, thereby promoting a relatively normal scar appearance.
Custom compression garments maintain at least 25 mmHg pressure to promote proper collagen maturation and reduce scar-related edema.
Custom-fitted face masks, when applicable, can maintain facial contour and other appropriate adjustments are helpful for burn rehabilitation.

Neuromuscular Complications in Burn Injuries

Focal and multiple peripheral neuropathies can occur in burns.
Faulty positioning, improperly applied bandages, or bulky dressings can cause these complications.
Factors such as age and extent of burns correlate with the incidence of such neuropathies.

Neuromuscular Burn Complications: Heterotopic Ossification

Heterotopic ossification involves abnormal calcification in tissues surrounding joints.
Risk factors include TBSA burned, open wounds, and immobility.
The posterior elbow is frequently affected, followed by the hip or shoulder in children and adults, respectively.

Burn-Induced Amputation

Electrical burns commonly cause amputations, disproportionately affecting upper extremities.
Patients experience skin fragility, hypertrophic scarring, and burn contractures.
Altered skin sensation also increases the difficulty of the rehabilitation.
Early amputee and burn patient prosthetics result in better long-term outcomes.

Functional Training

Functional training integrates therapeutic exercises with age-appropriate activities like ADLs and play.
This approach promotes functional development.

Return to Work

Factors such as the extent of TBSA injured, presence or absence of a hand burn, and patient age correlate with the length of time required for return to work post-burn injuries.
Proper considerations of the patient's strength, range of motion, and endurance levels during work adjustment are crucial to returning to work, and this may necessitate a change in occupation in some cases.

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Description

This quiz covers key aspects of burns, including their common causes and characteristics in different age groups. It also distinguishes between acute and chronic wounds, highlighting their healing processes and underlying issues. Test your knowledge on burn wound zones and their implications for treatment.