Burn
- 1. BURN PRESENTED BY SUCHISMITA SETHI LECTURER MSN SPECIALITY
- 2. DEFINITION • A burn is the injury to the tissue of the body caused by heat, chemicals, electrical current or radiation. (Lewies, 2015)
- 3. INCIDENCE:- • In India the incidence is quite high in young females due to various social factors. • The mortality rate due to burn injury is 3.5 per 100000 population. • The highest fatality rate occur in children age 4 year & younger & adult above age 65 • Nearly 11 million people need medical attention annually for burn injury & about 300000 die.
- 4. TYPES OF BURN INJURY:- 1. THERMAL BURN 2. CHEMICAL BURN 3. SMOKE & INHALATION INJURY 4. ELECTRICAL BURN 5. COLD THERMAL INJURY
- 5. 1. THERMAL BURN • Thermal burn is caused by flame, flash, scald or contact with hot object. • The severity of injury depends on the temperature of the burning agent & duration of contact time. • EX:-Scald injury are occur in during cooking.
- 6. 2. CHEMICAL BURNS:- • Chemical burn are result of acids, alkalis & organic compounds • Acids like hydrochloric acid, oxalic acid which are found in home for various purposes. • Alkalis are found in oven & drain cleaner, fertilizers. • Alkali burn difficult to manage because it adhere to tissue, causing protein hydrolysis.
- 7. 3. SMOKING & INHALATION INJURY:- • This injury caused by breathing hot air or noxious chemical which damage to the respiratory tract. • There are three type of smoke & inhalation injuries, those are:- • Metabolic asphyxiation • Upper airway injury • Lower airway injury
- 8. • Metabolic asphyxiation:- It is the inhalation of smoke elements such as carbon monoxide or hydrogen cyanide which impaired the oxygen carrying capacity of blood & caused hypoxia. Here carboxyhemoglobin causes hypoxia. • Upper airway injury:- It is the injury to the mouth, orophrynx & larynx which is caused by hot air, steam or smoke. • Upper air way injury is manifested by redness, blistering & edema. Flame burn in the neck and chest causes breathing difficulties. • Lower airway injury:- It is the injury to the trachea, bronchioles alveoli which is caused by breathing of toxic chemicals or smoke. • Clinical manifestation includes dyspnea, wheezing, altered mental status & ARDS
- 9. 4. ELECTRICAL BURN:- • Electrical burn caused by electrical current. The electrical current damage the nerve & blood vessels which cause tissue anoxia & death. • The severity of the electrical injury depend upon the amount of voltage, surface area in contact with current. 5. COLD THERMAL INJURY:- • It is the tissue injury caused by intense cold to the tissue.
- 10. CLASSIFICATION OF BURN INJURY ACCORDING TO DEAPTH • According to depth of tissue involvement the burn injury classified in to 2 categorise 1. Partial thickness burn 2. Full thickness burn
- 11. 1. PARTIAL THICKNESS BURN:- Partial thickness burn again categorised in to 2 types a. Superficial partial thickness burn( First degree burn):- • Here there is damage of epidermis, which causes hyperaemia, pain sensation present hear. • Ex:- sun burn or quick heat flash. • C/F:- Erythema, pain, mild swelling, no vesicles or blisters ( after 24 hour may blister found) • Healing time:- About 3-6 days, the superficial skin layer over the burn may be peel off in 1-2 days.
- 12. b. Deep partial thickness burn( Second degree burn):- • Here there is involvement of epidermis & dermis layer. • This type of burn may be caused by flame, flashes, scaled, chemicals or electrical current. • C/F:- Fluid field vesicles that are red, shiny, wet( if vesicle rupture). Severe pain caused by nerve injury, mild to moderate edema. • Healing time:- It depends upon the severity of burn. It may take 1-3 weeks to heal.
- 13. 3. FULL THICKNESS BURN ( THIRD & FOURTH DEGREE BURN):- • Here all the skin elements & local nerve endings destroyed, coagulation necrosis present which need surgical intervention for healing. • It s caused by flame, scald, chemical, tar & electrical current. • C/F:- Dry, waxy white hard skin, visible thrombosed vessels. Insensitive to pain due to loss of nerve. Possible involvement of muscle, tendon & bones. • Healing time:- Depth second & third degree burn need to be treated with skin graft in which healthy skin is taken from another part of body & grafted.
- 14. ACCORDING TO BURN SEVERITY:- • According to burn severity burn is classified in to 3 three categories:- 1. Minor 2. Moderate 3. Severe
- 15. 1. Minor:- All the first degree burn as well as second degree burn that involves less then 10% of body surface area. 2. Moderate burn:- Burn involving the hands, feet, face or genitals, second degree burns involving more than 10% body surface area. 3. Severe burn:- It involves more than 25% of TBSA. The third degree burn are classified as moderate or more then often as severe. Deep burn of head, hands, feet, perineum, inhalation injury & chemicals or high voltage electrical burn.
- 16. EXTENT OF BURN:- Various methods are use to estimate the extent of burn/ Total body surface area(TBSA). Those are 1. Rule of nine 2. Lund & Browder method 3. Palmer method. 4. Jackson’s Burn model.
- 17. RULE OF NINE:- • The rule of nine was devised by Pulaski & Tennison in 1947 & published by Alexander Burn Wallace in 1951. • It is the most commonly used method to estimate extent of burn in adult. • This system is based on dividing anatomic region, each represents approximately 9% of TBSA. • BODY SURFACE AREA PERCENTAGE (%) • Head & neck 9% • Arms(each) 18% ( anterior 4.5%, Posterior 4.5%) • Ant. Trunk 18% • Post. Trunk 18% • Legs(each anterior posterior) 36%( anterior 9%, posterior 9%) • Perineum 1% • ________ • 100%
- 19. 2. LUND & BROWDER METHOD: • It is the most accurate form of assessment form • BODY SURFACE AREA PERCENTAGE • Head 7% • Neck 2% • Anterior trunk 13% • Posterior trunk 13% • Right Buttock 2½ • Left Buttock 2½ • Genitalia 1 • Right upper arm 4 • Left upper arm 4 • Right lower arm 3 • Left lower arm 3 • R. Hand 2½ • L. Hand 2½ • R. Thigh 9 ½ • L. Thigh 9 ½ • R. Leg 7% • L. Leg 7% • R. foot 3 ½ • L. Foot 3 ½ • ___ 100%
- 21. 3. PALMER METHOD
- 22. SYSTEMIC EFFECT DUE TO BURN/ PATHOPHYSIOLOGY:- • FLUID & ELECTROLYTE SHIFT:- • • BURN • INCREASE VASCULAR PERMIABILITY • EDEMA INCREASE INTRAVASCULAR VOLUME • DECREASE BLOOD VOLUME INCREASE HEMATOCRITE • INCREASE VISCOCITY • INCREASE PEREPHERAL RESISTANCE • BURN SHOCK
- 23. CARDIOVASCULAR SYSTEM:- • BURN • TISSUE INJURY • ACTIVATE SYSTEMIC INFLAMATORY MEDIATORS • IT RELEASE OXYGEN REDICALS • THESE CAUSES INCREASE VASCULAR PERMIABLILITY • FLUID SHIFT FROM INTRACELLULAR SPACE TO EXTRACELLULAR SPACE • INTRAVASCULAR FLUID LOSS • HYPOVOLEMIA • SHOCK
- 24. CARDIOVASCULAR • CLINICAL MANIFESTATION:- • Angina • Jugular venous distension • Tachycardia • Dysrhythmia • Irreversible shock • Venous thromboembolism
- 25. RESPIRATORY SYSTEM:- • BURN INJURY • ADDHERANCE OF IRRITANT TO THE UPPER RESPIRATORY TRACT • RELEASE INFLAMATORY MEDIATORS • INCREASE AVASCULAR PERMIABLITY • EDIMA FORMATION • AIR WAY OBSTRUCTION & BRONCHOSPASM • EXCESSIVE SECRETION • ARDS • DEATH
- 26. EDEMA IN LUNGS
- 27. CLINICAL MANIFESTATION:- • Dyspnea • Orthopnea • Persistent hacking cough • Crackle • Restlessness
- 28. NURVOUS SYSTEM:- • BURN INJURY • INCREASE VASCULAR PERMIABILITY • CEREBRAL EDEMA • DECREASE BLOOD SUPPLY TO BRAIN • CELLULAR HYPOXIA • LOSS OF CONSCIOUSNESS/SHOCK
- 29. • CLINICAL MANIFESTATION:- • Altered mental status • Lethargy
- 30. MANAGEMENT OF BURN:- 1. Emergent 2. Acute 3. Rehabilitation
- 31. 1. EMERGENT PHASE:- • This period starts from time of burn up to 42 hour. • This phase required to resolve immediately, life threatening problems resulting from burn injury. • The emergent phase end when the fluid mobilization& Diuresis begin. • The prime goal is to prevent hypovolemic shock & prevent vital organ dysfunction, It includes I. Pre Hospital care II. Airway management. III. Fluid management IV. Wound management V. Analgesia & sedation VI. Feeding Protocol VII. Tetanus immunization VIII. Antimicrobial agent IX. Venous thromboemboilism prophylaxis
- 32. i. PRE HOSPITAL CARE:- • Remove the person from source of burn • For small thermal burn TBSA less then 10% cover the burn area with clean, cool, tap water dampened towel to minimise the injury • Do not emerge the burn wound which more then 10% because it may cause excessive heat loss. • If burn is larger then 10% or electrical burn or inhalation injury then check ABC • In case of chemical burn quickly remove the chemical particle or powder from the skin • If burn is due to CO poisoning treat the patient with 100% humidified O2.
- 33. ii. Airway management:- • Assess the breath sound, respiratory rate, rhythm, symmetry of chest excursion. • Monitor sign of hypoxia . • Early endotracheal intubation needed in case of burn with more then 10% TBSA or burn in neck & chest area. • Check ABG value frequently to know the level of hypoxia & also know metabolic acidosis & alkalosis. • Extubation is indicated when edema is resolved & usually 3-6 day after burn injury.
- 34. • Escharotomies of the chest wall may be needed in case of burn in neck & trunk which may cause respiratory distress. • Fibro optic Bronchoscopy is needed in case of smoke & inhalation injury after 6 to 12 hour to know lower airway condition. • Reposition the patient every 1-2 hours & provide suctioning & chest physiotherapy. • Bronchodilator provide to treat severe bronchospasm. • For CO poisoning administer 100% oxygen until carboxy haemoglobin level return to normal. • Fluid management
- 35. iii. Fluid management:- • Assess the fluid need of the patient. • Begin IV fluid replacement. • Insert urinary catheter to monitor the urinary out put every hour. • If more then 15% TBSA burn insert 2 large bore IV cannula. • If more then 30% TBSA burn maintain central line , arterial line for fluid medication & blood assess. • Fluid administration during the first 45 hours help to maintain circulating fluid volume. • There are three type fluid used to maintain body need, those are:- • Electrolyte such as RL • Colloids which includes plasma & plasma expanders • 5% dextrose.
- 36. Formula used for fluid calculation are:- a) Parkland formula b) Brooke army formula c) Evans formula d) Consensus formula
- 37. a. PARKLAND FORMULA:- • Parkland formula for fluid giving is:- 4ml*kg body weight*%TBSA • Colloid formula is:- 0.3 to 0.5 ml*kg body weight*% TBSA • Application of fluid:- • ½ of total fluid in first 8 hour • ¼ of total fluid in 2nd 8 hour. • ¼ of total fluid in 3rd 8 hour • After 24 hour colloid should be given when capillary permeability return to normal. • Ex- For a 70 kg patient with 50% TBSA BURN
- 38. • Ex- For a 70 kg patient with 50% TBSA BURN • Ans:- • Fluid need:- 4ml* kg body weight*%TBSA • 4ML*70KG*50= 14000Ml in 24 hour • Application of Fluid:- • ½ in first 8 hour means =7000ml in 8 hour • ¼ in 2nd 8 hour means=3500 ml in next 8 hour • ¼ of total in 3rd 8 hour means= 3500 ml in next 8 hour • Colloids Administration:- After 24 hour colloids should be given • Formula:- 0.3 to 0.5 ml * kg in body weight*% TBSA • 0.3*70*50=1050 ml= 1 lit 50 ml in 24 hour.
- 39. b. BROOKE ARMY FORMULA • Electrolyte:- 1.5ml*kg body weight*% TBSA • Colloid:- 0.5ml*kg body weight*%TBSA • Glucose:- 2000 ml for insensible loss. • APPLICATION:- • DAY-1:- Half to be given in first 8 hour, remaining half is given next 16 hour • DAY-2:- Half of colloids half of electrolyte, all sensible fluid replacement
- 40. CONT... • EX:- For 70 kg patient with 50 % burn • FLUID:- 1.5ml*70kg*50=5250, 5 lit 250ml • 1st 8 hour=2,625ml • 2nd 8 hour:-1312 ml • 3rd 8 hour:-1312ml • COLLOIDS:- 0.5ml*kg body weight*% TBSA • 0.5ml*70*50= 1750ml • In day 2nd :- half of the colloids, half of the electrolyte, all sensible fluid replace • 875 colloids+2625+2000ml= 5500ml
- 41. EVENS FORMULA:- • Electrolyte:- 1ml* body weight*% TBSA • Colloids:- 1ml*kg body weight*% TBSA • Glucose:- 2000ml for insensible loss • DAY 1:- First 24 hour:- crystalloid 1ml*kg*% TBSA+Colloid at 1ml/kg/% TBSA+2000ML glucose in water • Next 24 hour:- crystalloid at 0.5ml/kg/%TBSA+ Colloids at 0.5 ml * kg * % TBSA+2000ml of glucose in water • Ex- 70 kg patient with 50% TBSA • Day 1 :- Fluid:- 0.5ml*kg*%TBSA+0.5 ml*kg*%TBSA+2000ml=3500+3500+2000=9000ml total fluid. • Day 2:- crystalloid- 0.5ml*kg*%TBSA+Colloids 0.5ml*kg*%TBSA+2000=1750+1750+200=5500ML
- 42. • CONSENSUS FORMULA:- • RL solution 2-4 ml*kg body weight*% TBSA • Half of the fluid is given in the first 8 hour • next half of the fluid is given in next 8 hour
- 43. Wound care:- • Once the patient airway, circulation & fluid replacement is established next priority should given towards burn wound care. • Wound cleaning should perform by using gentile debridement by using scissor & forceps. • Surgical debridement should be done in Operation room, wound cleansing can be done on pt bed. • A daily shower or dressing changing done in morning & in evening dressing change should be done in patient room. • In case of antimicrobial dressing, dressing left for 3-14 day, no need to repeated dressing to prevent infection.
- 44. CONT... Patient wound treatment in done by two method • Open method:- Here patient wound covered with topical antimicrobial with no dressing over wound. • Multiple dressing change:- Sterile dressing with tropical agent, dressing done every 12-24 hour.
- 45. Feeding Protocol:- • Feeding Protocol:- • Early & aggressive nutritional nutritional support within several hour of burn injury help to decrease mortality risk, optimizing healing of burn wound. • Patient less then 20% TBSA are able to eat enough to meet their nutritional need. • For patient with ventilator provide enteral feeding (gastric or intestinal) which help to preserve GI function increase intestinal blood flow & promote optimal condition for wound healing. • Start 20-40 ml/hr & increase to the goal rate with in 24-48 hour. • Check bowel sound every 8 hourly
- 46. CONT... • High calorie, high protein , iron, multivitamin is required. • Dietary protein started at 1.2gm/kg/day & increase with subsequent increase in protein marker. • Caloric need to be meet according to Harris Benedict formula(adult), Galveston formula (children) • Fat 30% of calories to be provided as fat. • Supplemental vitamin A,C,E promote wound healing • Mineral iron, zinc promote cell integrity & haemoglobin formation.
- 47. Analgesic & sedation:- • Analgesic need to be provided for comfort. Ex- Morphin, Fentanyl, Methadone. • Sedative, hypnotics & antidepressant given to control anxiety, insomenia. Ex- Lorazepam, Midazolam.
- 48. Tetanus immunization • TT should be provide to prevent anaerobic wound contamination. If the patient not receive TT within 10 year before burn injury TT immunoglobin should be considered.
- 49. Antimicrobial Agent:- • Systemic antibiotic are not routinely used to control burn wound flora because the burn eschar has little or no blood supply & may cause multidrug resistance organism develop. • Topical antiviral agent used. Ex- Silver sulfadiazine & Mafenide acetate. • Oral infection should treated with nystatin mouth wash.
- 50. Venous thromboemboilism prophylaxis:- • Burn patient are more prone to develop DVT. • Low molecular heparine & compression stokins, sequencial compression device needed to prevent DVT.
- 51. NURSING MANAGEMENT:- • Impaired gas exchange related to carbon monoxide poisoning, smoke inhalation & upper airway obstruction. • Goal:- To maintain the adequate tissue oxygenation • Intervention:- • Provide adequate 100% humidified oxygen. • Assess the breath sound, respiratory rate, rhythm, symmetry of chest excursion. • Monitor sign of hypoxia . • Observe erythma or blister in the buccal mucosa. • Monitor ABG value • Prepare the patient for escharotomies or intubation.
- 52. Ineffective airway clearance related to edema & effects of smoke & inhalation. • Goal:- Maintain patient airway & adequate airway clearance. • Intervention:- • Maintain patient airway through proper patient positioning, removal of secretion & artificial airway if needed. • Provide humidified oxygen • Encourage patient to turn, cough & breathing. • Encourage the patient to use incentive spirometry.
- 53. Deficit fluid volume related to increase capillary permeability & evaporative loss from the burn wound. • Goal:- Restore the fluid & electrical balance. • Intervention:- • Monitor vital sign, hemodynamic monitoring, urine output as well as strict intake output. • Maintain IV line & regulate IV flui1d at appropriate rate. • Elevate head of the patient bed & elevate extremities. • Notify the physician immediately of decrease urine output.
- 55. ACUTE PHASE:- • It is the phase begin with mobilization of extracellular fluid & subsequent dieresis. • Pathophysiology:- • Diuresis from fluid mobilization & patient is less edematous. • Bowel sound return • Wound healing begin as WBC surround the burn wound & phagocytosis occur. • Necrotic tissue begin to slough. • Fibroblast lay down matrices of the collagen precursors that eventually from granulation tissue.
- 56. Clinical manifestation:- • Eschar begin separating. • Re-epithelialisation begin separating . • Hyponatremia CF:- Weakness, dizziness. Muscle cramps, fatigue, headache, tachycardia. • Hypernatremia:- Hypernatremia due to copious amount of hypertonic solution administration. • CF:- Lethargy, confusion, thirst. • Hyperkalemia:- If the patient have renal failure, adrenocortical insufficiency, with large amount of potassium release from damaged cell. • CF:- Muscle weakness, cramping, paralysis. • Hypokalemia:- Due to vomiting, diarrhea, prolonged GI suction, IV without potassium supplementation. • CF:- Fatigue, muscle weakness, leg cramp.
- 57. Laboratory Value:- • Hyponatremia develop from excessive GI suction, diarrhea, & water intake. • Hypernatremia • Hypokalemia • Hyperkalemia
- 58. Complication:- • Infection:- Due to skin destruction, decrease immunity & malpractice in wound dressing. • Cardiovascular Respiratory complication • Neurological:- Stress, edema, sepsis, sleep disturbance. • Musculoskeletal System:- • Restricted ROM • GI Syatem:- • Diarrhea, paralytic ileus, curling ulcer • Endocrine system:- increase glucose level due to stress mediated cortisol, chatacholamine release.
- 59. NURSING CARE:- • Wound care & Excision & grafting • Pain management • Physical & occupation therapy • Nutritional Therapy • Wound care & excision & grafting:-
- 60. Goal:- • Prevent infection by cleaning & debriding the area of necrotic tissue that would promote bacterial growth, promote wound re- epithelialisation & successful skin grafting.
- 61. Intervention:- • Wound cleaning should be done with soap & water or normal saline moisture gauze to gently remove the old antimicrobial agent, necrotic tissue & dried blood. • During debridement phase cover the wound with antimicrobial agent. • When wound is fully debride petroleum or paraffin gauze dressing is applied to protect the re- epithellializing keratinocytes • In case of grafting protect the graft by applying petroleum gauze dressing following by applying petroleum gauze dressing followed by saline moist middle& dry gauze outer dressing. • In case there is formation of sero sanguineous exudates aspiration needed by syringe or vacume to promote graft reepithelialisation.
- 62. Excision & Grafting:- • Management of full thickness burn wound involve removal of necrotic tissue & application of split thickness autograft skin. • To decrease the blood loss topical application of epinephrine, injection of saline. • The graft is then is placed on clean, viable tissue to achive good adherence. • The wound is covered with autograft & stappled to attached the wound. • The average healing time for a donor site is 10-14 days. • Sometimes artificial skin must replaced all function of skin & consist of both dermal & epidermal elements.
- 63. Pain management:- • Burn patient experience two kind of pain. One is continuous back ground pain that exist through out the day & night, Another type is treatment induced pain which associated with dressing change, ambulation& rehabilitation activity. • IV infusion of morphine or hydromorphone provide. • Provide lorazipam or midazolam to reduce anxiety. • Patient control analgesia used some time if patient not able to tolerate. • Pain also managed with by using non pharmacologic strategies such as relaxation, hypnosis, guided imagery, bio feed back & medication.
- 64. Physical occupational therapy:- • Physical therapy should be given in all stage of burn to regain the muscle strength & joint function. • The good timing for exercise during & after wound dressing/cleaning when skin is soft. • Passive & active ROM exercise should be done to promote healing. • For patient with neck burn encourage to sleep without pillow with hand hanging slightly over the top of the metres to encourage hyper extension • Use custom feting splint to keep the joint in functional position. More splint pressure cause skin damage or nerve damage.
- 65. Nutritional therapy:- • Adequate calories & protein is needed for wound healing. • Burn patient is in highly catabolic & highly catabolic state as a result of burn injury. • Alert patient should be encouraged to eat high protein , high carbohydrate food to met increased caloric needs • Record the patient caloric intake daily using calorie count sheet.
- 67. REHABILITATION:- • The rehabilitation begins when patient burn wound have healed & patient able to resume a level of self care activity. • It may happen as early as 2 week or as long as 7-8 month after burn injury. • Goal is to Work towards resuming the functional role towards society. Rehabilitate from any functional & cosmetic post burn reconstructive surgery that may be necessary. • When patient is able to go home teach patient & family member about wound care & dressing changing. • Pain management & nutritional need based on the individual status • Water based cream used to heal the wound area. • Low dose of histamine used at bed time if itching persist. • Continue encourage the patient for physical & occupational therapy.
- 69. Plastic surgery:- • • The plastic derived from the Greek ward “ plastikos” which means to module or to shape. • Plastic surgery is the medical speciality concerned with the correction or restoration of form & function of body structure damaged by trauma, transformed by ageing process, changed by disease process & malformation as a result of congenital defect. • Goal:- • Correction of perceived disfigurement • Restoration of impaired function • Improvement of physical appearance.
- 70. TECHNIQUE USE FOR PLASTIC SURGERY:- • Incision • Excision • Microsurgery • Chemosurgery • Electro surgery • Laser surgery • Dermabrasion • Liposuction
- 71. • Plastic surgery divided in to two major areas • RECONSTRUCTIVE SURGERY • COSMETIC SURGERY • RECONSTRUCTIVE SURGERY:- • Reconstructive surgery perform to correct functional impairment caused by burn, traumatic injury, congenital abnormality such as cleft lip or palate, removal of cancer or trauma such as mastectomy. • Common reconstructive surgeries:- • Breast reconstruction • Burn contracture surgery • Cleft lip & palate. • Injury to the limb. • Amputation • Pressure sore
- 72. RECONSTRUCTIVE MODALITIES:- • Skin Grafting:- Here a portion of skin is detached from its own blood supply & transferred as free tissue to a recipient site. It provide protection underlying tissue. • Indication:- Extensive wound, burn, surgery which require skin graft for healing. • Classification:- • Autograft:- Tissue obtained from patient own skin. • Allograft:- Obtain from donor of same species. • Xenograft:- Obtained from donor of different species.
- 73. Graft application:- • The wound is prepare for surgery . The wound is cleaned & measured. Administration of anaesthesia. • Donor skin harvested & prepaired with skin grafting knive. • The graft meshed ( multiple incision on graft ) to removed the excessive fluid leakout from underlying tissue. • Then the graft hold in place in several stitches. • Apressure bandage is applied in over the graft recipient site. • Then a VAC( vacuum apparatus called) placed over the area for 3-5 days to drain fluid & easy wound healing. • New blood vessel begin to grow within 36 hours of grafting followed by new skin.
- 74. Skin Flap:- • It is a segment of tissue that remain attached at one end while other end is moved to recipient area. • Its survival depends upon functioning of arterial & venous blood supply & lymphatic drainage. • Flap may consist of skin, mucous, muscle, adipose tissue, omentum & bone.
- 75. POST OPERATIVE MANAGEMENT :- • Initial pressure dressing will be left in place for 24- 48 hour. • If wound begin to ooze apply firm pressure for 10-15 min. • Do not give aspirin or aspirin containing medication. • Most skin graft are hold in place by a bolster dressing( cotton ball or foam) • Clean site & apply ointment to the surrounding area of the blister dressing. • Keep the graft edge moist with antibiotic ointment. • Protect the graft from sun because it may cause pigmentation changes. • Free flap:- • It is harvested from one area of body & reconstruct a defect area. •
- 76. COSMETIC SURGERY:- • Cosmetic surgery refers to the surgery that design to improve appearance. • It is perform for changes that result from ageing, to altered inherited features or because of client personal desire.
- 77. TYPES OF RECONSTRUCTIVE & COSMETIC SURGERIES:- • Liposuction:- Here there is removal of fat from different site of human body. • Tummy tuck:- It is the removal of excessive skin & excessive fat from middle & lower abdomen in order to tighten the muscle & facia of the abdominal wall. • Brachioplasty:- Here the excessive fat & skin is removed from the upper arm area in order to create a youthful look. • Thigh lift:- It is done to remove excess skin from the thigh & buttock area. • Buttock augmentation surgery:- Fat grafting done to increase the size of buttock. • Blepharoplasty:- It is the eye lid surgery which is done in case of droopy or saggy skin as well as bag around the eye.
- 78. • Endoscopic forehead & browlift :- Brow & forhead lift are perform to raise eyebrows & reduce ridges on forehead, it gives youthful look. • Rhytidectomy surgery:- It involves tightening of the facial & neck muscle as well as the removal of excessive wrinkled skin. • Rhinoplasty:- It is the reshaping of nose. • Cleft lip nose deformity:- • Cleft lip • Cleft palate • Breast reconstruction • Breast reduction • Breast lift:- Reposition of breast for youth look. • Hair transplant
- 79. DRUG USED IN TREATMENT OF BURN, RECONSTRUCTIVE & COSMETIC SURGERY • THERMAL BURN MEDICATIONS:- • Topical antibiotics:- Ex- Noosporin • Analgesic:- Morphine sulphate, • NSAID:- Ex- Advil or mortin • DRUG USED IN RECONSTRUCTIVE & COSMETIC SURGERY • Altabax:- Bacterial protein synthesis inhibitors. • Amevive:- Immunosuppresive • Avita Gel:- Treatment of acne • Bactroban cream:- Topical antibiotics • Benzomycin:- Reduce acne infection • Botox Cometics:- It blocking the nerve impulse to relax the contraction of the forhead muscle which cause the wrinkle between eyebrows.