wound burn

7/25/2019 Wound Burn

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RCS 6080RCS 6080

Medical and Psychosocial AspectsMedical and Psychosocial Aspects

of Rehabilitation Counselingof Rehabilitation Counseling

Wound Healing, Burn

Injuries & Plastic Surgery


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WoundsWounds

Any breach in the surface of the body or

any tissue disruption produced by the

application of energyUsually physical injury

Abrasion, degloving injury

ontusion, crush injury

Incision, laceration


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Skin content refresherSkin content refresher


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Wound HealingWound Healing

As !ound heals"# $luid and cells drain fro% da%aged tissue

#'udate %ay be"learBloodyPus(containing

Proper !ound healing"# leanliness and care of lesion# Proper circulation

# )ood general health and nutrition


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Phases of healingPhases of healing

Infla%%atory# Bleeding*clotting

# +igration of WBs

# ell s!elling eparative

# -aying do!n of collagen . %igration of epith/ cells

# 0e! capillary loops

# Proliferation of fibroblastsstrands of collagen

onsolodative# reorientation .contraction of collagen

# collagen synthesisdegradation

vascularity


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CoplicationsCoplications

Hypertrophic scar 1

continued production

of collagen2eloid 1 3/!ith

e'tension into

surrounding tissues

Scar contracture


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Plastic surgeryPlastic surgery

Scar evision

# -aser resurfacing*der%abrasion

# 4(plasty

# S5in(grafting*flap surgery

# 6issue e'pansion


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!urn "n#uries!urn "n#uries

Statistics# Annually, there are appro'i%ately 7/89 %illion people in the US

!ho sustain burn injuries

# :f these, 9,9;; do not survive and 97,;;; re


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$ffects$ffects

Burn injury causes destruction of tissue, usually thes5in, fro% e'posure to ther%al e'tre%es ?either hot orcold@, electricity, che%icals, and*or radiation# 6he %ucosa of the upper )I syste% ?%outh, esophagus,

sto%ach@ can be burned !ith ingestion of che%icals# 6he respiratory syste% can be da%aged if hot gases, s%o5e,

or to'ic che%ical fu%es are inhaled

# $at, %uscle, bone, and peripheral nerves can be affected inelectrical injuries or prolonged ther%al or che%ical e'posure

# S5in da%age can result in altered ability to sense pain, touch,and te%perature


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!urn Classification % Cause!urn Classification % Cause

6he pri%ary cause of burn injury is e'posure tote%perature e'tre%es

# Heat injuries are %ore fre


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!urn Classification % &epth!urn Classification % &epth

:ld ter%inology

# 7st degree" only the

epider%is

# 8nd degree" epider%is and

der%is, e'cluding all the

der%al appendages

# rd degree" epider%is and

all of the der%is

# th degree" epider%is,

der%is, and subcutaneous

tissues ?fat, %uscle, bone,

and peripheral nerves@

0e! ter%inology

# Superficial" only the

epider%is

# Superficial partial

thic5ness" epider%is and

der%is, e'cluding all the

der%al appendages

# Ceep partial thic5ness"

epider%is and %ost of theder%is

# $ull thic5ness" epider%is

and all of the der%is


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!urn Classification % &epth!urn Classification % &epth


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!urn Classification % $'tent!urn Classification % $'tent

'tent# Burn injuries are also

classified in ter%s of the

percentage of the s5insurface injured ?6BSA@

# A relatively si%ple, but nottotally accurate, %ethod fordeter%ining the e'tent ofinjury is the rule of Ds

# 6he ABA classificationsyste% describes burninjuries as %ild, %oderate,or %ajor


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!urn Classification ( $'tent!urn Classification ( $'tent

)und * !ro+der)und * !ro+der# -und and Bro!der

+ore accurate Civides body into s%all areas sti%ates proportion each

area contributes# -und and Bro!der

+ore accurate Civides body into s%all areas sti%ates proportion each

area contributes 6a5es %ore ti%e and effort to

calculate than ule of 0ines%ethod


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!urn ,reatent!urn ,reatent# espiratory care

# Ad%inistration of fluids

# Wound care ?debride%ent@

# Pain control

# Plastic surgery ?eg" s5ingrafts@

# +onitoring for

co%plications

Infections ardiovascular

espiratory

# +assage & Physical therapy

%assage video

# Posttrau%atic stress


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Pathophysiology of !urn "n#uryPathophysiology of !urn "n#ury

Pathophysiology refers to the co%ple' chain of %echanis%sthat occur in the s5in ?local effects@ and in other organsyste%s ?syste%ic effects@ !hen a burn injury occurs, as !ellas !hat happens as the s5in regenerates and heals

# -ocal ffects

# Syste%atic ffects

# S5in egeneration and Scarring

# lectrical Burns


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!urn Scars % -eloid!urn Scars % -eloid


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!urn Scars % Hypertrophic!urn Scars % Hypertrophic


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!urn Scars % Contracture!urn Scars % Contracture


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!urn Scars % Contracture!urn Scars % Contracture


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!urn Scars % .onraised!urn Scars % .onraised


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Skin /raft ScarsSkin /raft Scars


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unctional )iitationsunctional )iitationsAcute -i%itations

# Patients %ay e'perience deliriu% that precludes theirparticipation in treat%ent

# de%a, pain, bul5y dressings, and i%%obili=ing splints i%pair

the personEs ability to perfor% usual daily activities# Sleep is fre


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Rehabilitation !urn ,reatentRehabilitation !urn ,reatent

Postdischarge# Wound care continues

# If there is a ris5 of hypertrophic scarring, or it has already started,continuous pressure applied to the area !ill prevent its progress

# )ar%ents need to be !orn 8; hours per day for up to 7 year (

unco%fortable, hot, and unattractive# ontracture control continues through P6 and*or :6

# econditioning and strengthening e'ercises begin

# ounseling is a possibility to !or5 on e%otional difficulties thathave resulted fro% the burn injury

# econstructive surgery %ay be needed if the functional orcos%etic li%itations are not responsive to rehabilitation treat%ent


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1ocational )iitations1ocational )iitations

It should be e%phasi=ed that %any of the functionalli%itations that have already been discussed are notovertly apparent

If they are not recogni=ed as valid, the could veryeasily conclude that a person is %alingering, !hining, orun%otivated

Seriousness, etiology, and site of the burn injury cansignificantly affect return(to(!or5 and ho! long it ta5es

All of the studies cited in the te't suggest that si=e, depth,and location are factors that influence ti%e to return to!or5


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Additional Resources andAdditional Resources and

"nforation fro the Web"nforation fro the Web :rgani=ations

# A%erican Burn Association ?!!!/a%eriburn/org@

# Burn Survivors :nline ?!!!/burnsurvivorsonline/co%@

# Phoeni' Society for Burn Survivors, Inc/ ?

!!!/phoeni'(society/org@

# FA0Gs Webpage ?!!!/jan/!vu/edu*%edia*burninj/ht%l@
http://www.ameriburn.org/http://www.burnsurvivorsonline.com/http://www.phoenix-society.org/http://www.phoenix-society.org/http://www.burnsurvivorsonline.com/http://www.ameriburn.org/


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"nforation fro the Web"nforation fro the Web Burn Injury ehabilitation +odel Syste%s funded by

0IC

# UW*BI+S University of Washington * Harborvie!+edical enter?http"**depts/!ashington/edu*u!nidrr*inde'/ht%l@

# U6*SW+ University of 6e'as * South!est +edicalenter ?!!!/s!%ed/edu*burntrau%a@

# SBI() Shriners Hospital for hildren* Burn Institute?!!!/shrinersh


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"nforation fro the Web"nforation fro the Web elated Articles fro% Burn Survivors :nline

# 6he I%pact of econstructive Surgery?!!!/burnsurvivorsonline/co%*articles*oad6oesto

ration/asp@

# hild burns survivors report good

wound burn

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