Clinics in plastic surgery
-
Because patients assume a position of comfort during acute burn management, affected joints or regions must be splinted in positions of function to avoid contractures. Particularly with the increasing trend towards ambulatory burn care, close monitoring by the burn team and patient education is required to achieve the best functional result. ⋯ Although the physiologic mechanism is incompletely defined, pressure therapy to prevent and treat hypertrophic burn scars is an integral component of burn care. Multiple materials and methods are available with treatment, starting soon after burn wound closure, and modified as needed until scar maturation has occurred.
-
Early excision of burn eschar and wound closure significantly improves survival following major burn injury. Immediate primary excision performed by burn-experienced surgeons in dedicated burn care facilities can reduce further morbidity and mortality, length of hospital stay and medical costs. Burn care at the millennium is evolving rapidly into a subcategory of trauma surgery, with burn patients increasingly being viewed as victims of major trauma who benefit most from immediate and definitive surgical correction of their injuries.
-
Rapid assessment and management of airway and breathing problems are required in the patient with severe burns complicated by significant facial burns and inhalation injury. A policy that results in intubation of all patients at potential risk for airway compromise can be both foolish and dangerous. At the same time, it is recognized that intubation of patients who are likely to develop unstable airways is necessary if transport times to burn centers are long and if i.v. resuscitation is initiated during transport. ⋯ The goal is to maintain urine outputs in the range of 0.5 to 1 mL/kg/hr for adults and 1 to 1.5 mL/kg/hr in children. In patients with fluid requirements greater than 150% of that predicted by formula, the addition of colloid at 12 hours can reduce total fluid requirements and burn edema. Early placement of pulmonary artery catheters can be useful in patients with known myocardial dysfunction, age greater than 65 years, severe inhalation injury, or fluid requirements greater than 150% of that predicted by formula.
-
Healing is a continuum that can be unpredictable. Despite many advances and understanding of the multiple cellular processes and molecules involved in burn wound healing, physicians and patients have yet to reap the full benefit of this knowledge. The advances have occurred in a very short period, and with the exponential growth of molecular biology techniques and transgenic animal models, our understanding and treatment of burn wound healing could change exponentially over the next 10 years. The goal must be to continue to improve functional outcomes for burn survivors just as we have conquered critical care management for acutely injured burn patients.