骨骼肌肉烧伤.pptx

Julie 王凤怡 Occupational Terapy Department of Rehabilitation Medcine Centre West China Hospital, Sichuan University2016 Burn Injury目录CONTENTStructure of skin Types of burn Incidence and prevalenceIntroduction 01Extent and DepthClassification of Burn02Hypertrophic scar and antiseptic: e.g. silver nitrate solution, – tetanus prophylaxis– partial-thickness burns will heal by re-epithelialization 上皮再生from dermal skin within 1 to 2 weeksClassification of burn: degree - When the skin is unable to heal after 17 to 21 days of local therapy → skin grafting 6. Prevent contracture by positioning & splintingMedical Management1. Operation procedures Surgical excision• Escharotomy– Surgical incision through the eschar to relieve constriction 压缩• Escharectomy– Removal of eschar to prepare for grafting• Eschar=> burned tissueMedical Management2. Local wound care: close method•Dressings– occlusive– absorption– bulky•Biological dressings & skin substitutes替代物– closing a wound / contamination污染物 / reducing pain and fluid loss. Biologic products(e.g.human amnion羊膜) may deliver growth factors – biosynthetic生物合成wound dressing sheet (Biobrane) •Topical antibiotics: most common: Silver sulfadiazine磺胺嘧啶银(Silvadene)Prevent infection, promote removal of eschar +comfortPrepare skin for graftingRestore essential function of skinMedical ManagementBurn dressing: close methodDeeper burns typically are treated with silver sulfadiazine to help prevent wound dehydration脱水 and provide antimicrobial抗菌 protectionMedical Management3. Skin grafts• When epidermal bed is so destroyed that spontaneous epithelial tissue re-growth is difficult or impossible • & where raw areas are more than 2.5 cm wide • Skin graft:– Split skin graft– Full thickness / whole skin graft– Skin FlapsMedical ManagementSplit skin grafts & whole skin/full thickness skin graftMedical ManagementTypes of graftsMedical ManagementComplicationsPART 03Hypertrophic scar & Keloid Contracture ManagementComplication of burnsComplication of burns - ScarFormation of hypertrophic scarScar formation is a natural process in wound healing (Hunter, p.1269). But problems result when wound healing has gone beyond → Hypertrophic scar, keloid → contracture (by the contractile nature of the hypertrophic scar)Complication of burns - ScarMajor factors affecting formation of hypertrophic scarComplication of burns - ScarNormal epidermis & hypertrophic scarComplication of burns - ScarCharacteristics of hypertrophic scars (early to mature phase) if untreatedComplication of burns - ScarComplication of burns - ScarComplication of burns - ScarComplications of hypertrophic scar ContractureComplication of burns - ScarComplications of hypertrophic scarPermanent deformities leading to functional problems in ADLTHANK YOU!。