Burn Wound Healing

Ruby Riana A Staf Bedah FK UMM

Goals
Burn wound assessment and description

Burn injury

Burn wound healing principles

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Pathophysiology of burn
An injury to the skin or other organic tissue primarily caused by thermal or other acute trauma. It occurs when some or all of the cells in the skin or other tissues are destroyed by hot liquids (scalds), hot solids (contact burns), or flames (flame burns).
Injuries to the skin or other organic tissues due to radiation, radioactivity, electricity, friction or contact with chemicals are also identified as burns
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Causing local tissue destruction and systemic response

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Zone of Thermal Injury

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Types of burn

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contact temperature,

duration of contact

thickness of the skin.

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when ice crystals puncture the cells or when they create a hypertonic tissue environment.

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radical alteration of pH,

disruption of cellular membranes

direct toxic effects on metabolic processes.

Systemic absorption of some chemicals (such as of hydrofluoric acid) can be deadly.

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Electrical current causes damage as electrical energy is transformed into thermal energy
Injury to cell membranes (electroporation) disrupts membrane potential and function.

The magnitude of injury depends

pathway the current follows
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resistance to current flow of the tissues involved

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strength and duration of current flow.

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Pembagian Berdasarkan kedalaman Berdasarkan luas Berdasarkan keparahan

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Berdasarkan kedalaman
Tingkat

Klinis

Tusukan jarum

I II A II B III

hiperaemi basah + bulla basah + bulla + keputihan kering + putih + hitam

hiperesthesi hiperesthesi hypoesthesia anesthesia

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TIDAK DIHITUNG DALAM PERHITUNGAN LUAS LUKA BAKAR

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Berdasarkan luas

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Berdasarkan Keparahan
Parah critical.
Tingkat II 30% atau lebih Tingkat III 10% atau lebih Tingkat III pada tangan, kaki, muka Dengan adanya komplikasi pernapasan, jantung, fraktur, soft tissue yang luas.

Sedang moderate.

Tingkat II Tingkat III

15-30% 5-10%

Ringan minor.

Tingkat II Tingkat III

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kurang 15% kurang 1%

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Terapi Umum
Survai Primer : ABCDE
Survai Sekunder

Resusitasi cairan Baxter terhitung dari saat kejadian maka :

8 jam (4 cc x kg BB x % LB) RL 16 jam II (4 ccx kg BB x % LB) RL + 500-1000 cc colloid.

Pemeriksaan fisik

Selesai dalam 24 jam sejak kejadian

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Di Surabaya formula Baxter untuk anak dimodifikasi sbb : Replacement 2 c/kgBB/% luka bakar Ditambah Kebutuhan faal Umur sampai 1 tahun 100 cc/kgBB Umur 1-5 tahun 75 cc/kgBB Umur 5-15 tahun 50 cc/kgBB = Total cairan

Moncrief 17/20 Kristaloid (RL) + 3/20 Koloid (Dextran) botol yang sama dibagi 2 dalam 8 jam pertama dan 16 jam berikutnya

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FIRST AID

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Wound Healing Phases

Inflammation Proliferation Maturation

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Sequence of cell appearance

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Wound Healing Phases

Proliferative (3d-3wk)
Fibroblasts multiply Collagen production Endothelial cells proliferate
New vessels

Myofibroblasts
Wound contraction
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Wound Healing Phases

Maturation (3wk - 1yr)
Macrophages - fewer Fibroblasts - plateau Collagen content stable

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Wound maturation
Collagen content peak 3 wks = 30% original wound tensile strength Collagen crossbinding by 6 wks = 80% Wound strongest at 6 weeks
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Impaired wound healing: Local factors

Infection

Foreign bodies

Ischemia

Edema

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Impaired wound healing: Systemic factors

Age
Diabetes Smoking Nutrition Steroids Radiation

Sepsis
Chemotherapy
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Inhibition of Wound Healing

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Inhibition of Wound Healing

Poor O2 tension
Diabetes Small vessel arteriosclerosis Irradiation Infection

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Inhibition of Wound Healing

Corticosteroids inhibit
Epithelialization Vitamin A Fibroblast migration Collagen synthesis Vitamin A Angiogenesis Macrophages Wound contraction

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Signs of wound infection

Erythema
Edema Pain

Drainage
Wound dehisence

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Wound Healing
Primary
Delayed primary Secondary

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Epithelialization
Protective barrier from bacteria
Decrease fluid losses Regulate body temperature

Normalize patients physiologic state

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Optimizing wound healing

Clear infection
Debride necrotic tissue Improve blood supply

Control diabetes
Improve nutritional status

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Wound Repair
Reconstructive ladder
Free Flap

Pedicle Flap
Skin graft

Secondary closure

Primary closure

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Reconstructive Principles
Cover wound
Cover vital structures Replace like with like

Cosmesis
Complex wound requires complex reconstruction

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Reconstructive surgery: Primary goals

Preservation of life and limb
Restoration of form and function

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Reconstructive surgery: Treatment options

Secondary intention
Primary closure Skin graft

Local flap
Regional flap Distant flap
Free tissue transfer

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Wound defect analysis

Location
Size Physical components

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Physical components
Skin Mucosa Subcutaneous tissue Muscle Vessels Nerves Fascia Cartilage Bone

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Reconstructive surgery: Flap types

Skin
Random pattern blood supply Axial pattern blood supply

Muscle
Musculocutaneous

Fascia
Fasciocutaneous

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