BURN

COMBUSTIO
Dr.Dian Syahputra

Division of Plastic Surgery, School of Medicine North Sumatra University

 Superficial Soft Tissue damage
due to :
- Dry and moist heat
- Electrical current
- Chemical fluid
 PROBLEMS

4 stages acute management

1. Anticipation of shock/fluid resuscitation
and respiratory function disorder.
2. Prevention of secondary infection.
3. Proper management of burned tissue
with early grafting of deep burn skin loss.
4. Prevention of complication including late
complication contracture and keloid.
 Mass catastrophe :
-Bomb blast
-Bali 2002
-Marriot 2003
-Polonia Airplane
crash 1987
Sumatra :
Prognosis : NO BURN UNIT
100 Age + % BSA
Mental Psychosocial support
 DIAGNOSE

1. Ethiology Grade

2. GRAde Deep : I, II, & III

3. SUrface area % BSA

4. LOcation Specific areas

{ D : e-burn gr@sulo }
 ETHIOLOGY

Anamnesis : Grade/Severity
SCALD I & II
FLAME II & III
ELECTRICAL III
CHEMICAL III
INHALATION respiratory
Time of injury fluid resusitation first 8 hours
GRADE
Erythema

Blister

Pinprick ( - )
 ESTIMATION OF
BODY SURFACE AREA

% BSA
9

9 9
9 9
9 9

9 9 9 9
1%

Rule of Nine Hands Palm = 1%

Lund & Browder Chart
 LOCALIZATION

Special Area : JOINT HANDS

FACE AURICLE
PERINEUM PALM & SOLE
Woman Breasts
 PATHOPHYSIOLOGY
Fluid Electrolit Protein
Fluid Electrolit Protein

Increase
permeability

Interstitial tissue
Interstitial tissue

Haemoconsentration HYPOVOLUMIC SHOCK

SEVERITY OF BURN

Severe Moderate Mild

 MANAGEMENT

1. General/Medical Treatment :
Fluid Resusitation
Prevention infection
2. Local : Topical Antibiotic
3. Surgery :
a. Debridement
b. Excharatomy
c. Excicion + Grafting
d. Granulating Tissue + Grafting
 ESTIMATION OF
FLUID RESUSCITATION
Parkland Hospital Formula :
24 hours
4 ml Lact. Ringers x % BSA x Kg BW = X ml
X ml in first 24 hours
x ml in first 8 hours
24 48 Koloid

Foley catheter : urine out put / hours 1 ml / kg BW/ hours

Renal function
Serum electrolite level (K+)
Albumin / Globulin ratio
ATTENTION

Inhalation burn
face neck

Respiratory distress
first 24 hours & 1-5 days
 Sistemic Antibiotic
Tetanus Prophylactic
Analgesic & Sedatives
Nutritional support :
Formula Curreri (24 hours caloric requirment)
Adult : 25 kilocal/kg BW + 40 kilocal % BSA
Child : 60-90 kilocal/kg BW + 35 kilocal % BSA
 TOPICAL ANTIBIOTIC
Silver Sulfadiazine
Cream in consentration of 1 %
Applied twice daily : open or
close
Effective Gram + & Gram

Silver Nitrat (0,5 % solution)

Sulfanylon
 Debridement
SURGERY
Escharatomy

Prevention :
Position arm & leg

Thin

Grafting : STSG
Moderate

Prompt
Large : Electro Dermatome
1 2 weeks Granulating
MESH Graft
Scald Burn
Scald Burn with Pregnancy
Scald Burn in specific area
Flame Burn Suicide 40%
Flame Burn 30%
Cemical Burn
Electrical Burn
Flame Burn Escharatomy
Upper Arm
Granulating Tissue Grafting
1-2 weeks
 COMPLICATION

Pulmonary Oedema
Gastrointestinal
33% Curling Ulcer
Infection : - Septichemi
- UTI
- Auricular chondritis
Late Complication
6 months 2 years
1. Contracture
2. Keloid
Late complication Keloid
Finger contracture
 Diagnose e-burn gr@sulo
Emergency
life saving Mortality

live saving Morbidity

Prevent infection & deformity

Ed Sept 2003