Quiz PhD Dissertations Add case
Burns Treatment

Procedures Procedure

Authors: Rami Mossad Ibrahim, MD, Elisabeth Lauritzen, MD, Frederik Gulmark, Hansen Med. Stud., Anne Mosebo, Med. Stud., Magnus Balslev Avnstorp, MD and Rikke Holmgaard, MD, PhD

Surgery is performed:

  • If the burns are mainly deep
  • If the chances of healing are low
  • When the patient is stabilized after the resuscitation phase

Hands and face are often left untouched during surgery at this time. However, wounds without healing in these areas will need surgery after 2-3 weeks.

Positioning

  • The optimal per-operative position of the patient allows the surgeon to harvest skin from donor sites and graft to the recipient site
  • In cases of burns on the back and flanks, the patient will be repositioned peri-operatively

Instruments

  • Zimmer Dermatome is most often used to harvest the grafts and is attached to compressed air or is battery driven
  • Watson knifes can be used both for harvesting grafts and debride necrosis
  • Rougines and Versajet can be used to debride the necrosis
  • Bandage is applied to the donor site and remaining for 2 weeks
  • Bacteriostatic dressings and compression bandages are stapled on top of the grafts to apply an even pressure supporting the adhesion to the wound bed 

Antibiotics

  • Administration of per-operative antibiotics must be evaluated individually

Transfusion

  • Due to extensive blood loss during surgery, blood transfusion should be planned pre-operatively
  • Expect approximately ½ portion of blood per % on the extremities and 1 portion of blood per % on truncus
  • Administration should be 1:1:1/2 (Sag-M:Plasma:Trombocytes) (14)

Excision technique

The chosen technique depends on the depth of the burn. Evaluation of the blood circulation of the tissue play a play when deciding excision technique and can be done in advance using Laser Doppler Imaging (15).

Tangential excision

  • Is performed with Dermatome or Watson’s knife
  • Is preferred in cases where dermis has sufficient microcirculation
  • Often gives a better cosmetic and functional result
  • Results in a greater blood loss
  • Extended time of surgery

Fascia excision

  • Indicated in very deep burns
  • Time-saving technique
  • Results in a decreased blood loss
  • Poorer aesthetic and functional result

Clinical indications of insufficient depth of excision

  • If there are coagulated vessels
  • If dermis is matt or grey
  • If the subcutis is very yellow
  • If the subcutis is reddish

Procedure and cases

Card image cap

Cleaning the burn

Card image cap

Applying bandages

Card image cap

Changing the bandage

Card image cap

Skin grafting


Want to contribute?

Add your case now

Contents
Watch video

Procedures

Procedures