BurnsBurns. . TreatmentTreatment

Doc. Doc. Guda N.V.Guda N.V.

First aidFirst aid Stopping action of fire, hot Stopping action of fire, hot

water, electricity, radiation, water, electricity, radiation, chemical substances.chemical substances.

Analgesia.Analgesia. Putting of sterile dressing.Putting of sterile dressing. Transporting to the Transporting to the

nearest hospital.nearest hospital.

Medical aidMedical aid

TherapeuticTherapeutic

SurgicalSurgical AnalgesiaAnalgesia CatheterizationCatheterization Oxygen therapyOxygen therapy Complex infusive and Complex infusive and

medicamentous therapymedicamentous therapy NecrotomyNecrotomy NecrectomyNecrectomy GraftingGrafting

Necrotomy

NecrectomyNecrectomy

SurgicalSurgical ChemicalChemical

BiologicalBiological FermentativeFermentative

Instruments for necrectomyInstruments for necrectomy and forand for cutting of graftscutting of grafts

Humby knifeHumby knife

DermatomesDermatomes

Methods of local treatment of burn Methods of local treatment of burn woundswounds

Dry method Wet method

Open method Close method

Open method of treatment of Open method of treatment of burn woundsburn wounds

IndicationsIndications:: burnsburns II II st.st. on faceon face,,perineumperineum, , where dressings where dressings

could worse physiological actscould worse physiological acts BurnsBurns IIIIII--IVIV st.st.

Methods:Methods: Usage of modern drugs for local treatmentUsage of modern drugs for local treatment

((solutionsolution of K permanganatof K permanganat, 0,5% , 0,5% solution of solution of Na nitrateNa nitrate, 1% , 1% solutionsolution of jodopironof jodopiron, , ““NaksolNaksol”)”)

Treatment in notTreatment in not bacterial environmentbacterial environment Usage of infrared lampsUsage of infrared lamps

Open method of treatmentOpen method of treatment of burnsof burns

Close method of treatment of burnsClose method of treatment of burns

The main method of local treatmentThe main method of local treatment Appearing of conditions for local Appearing of conditions for local

usage of drugsusage of drugs Optimal treatment out of hospitalOptimal treatment out of hospital The only method during transportingThe only method during transporting

What we can use for local What we can use for local treatment of burns?treatment of burns?

Bactericidic and bacteriostatic solutionsBactericidic and bacteriostatic solutions ((hlorhexidinhlorhexidin,, furacilin furacilin, , jodobakjodobak,,jodopironjodopiron), ), antibioticsantibiotics..

Water-solubleWater-soluble oinments oinments – – dermasindermasin, , oflokainoflokain, , miramistinmiramistin, , levosinlevosin, , pantestinpantestin).).

SorbsSorbs -- polimethylsiloksanpolimethylsiloksan.. Biological coveringsBiological coverings..

Disadvantages of gauze dressings

• Under them good environment for development of microorganisms appear

• You can’t provide effective concentration of drugs• There is a need to change dressings often• While taking off of these dressings you can injure new

epithelium• Pieces of gauze you can leave on the wound• Painful dressings and need in frequent anestesia

Dressings with water-soluble Dressings with water-soluble ointmentsointments

AdvantagesAdvantages Method is simple and Method is simple and

widely usedwidely used It could be used in It could be used in

case of wounds of case of wounds of different formdifferent form

Dressings could be Dressings could be made made ex temporeex tempore

Method is used on Method is used on each stage of wound each stage of wound processprocess

It has a lot of points of It has a lot of points of influence influence

Effect of dehydrationEffect of dehydration

DisadvantagesDisadvantages Over drying of the Over drying of the

woundwound Small influence on Small influence on

regenerationregeneration Allergy on Allergy on

components of components of ointmentointment

Action is provided Action is provided only by only by monomolecular layer monomolecular layer of ointment that is of ointment that is on the wound surfaceon the wound surface

Wet method of treatment Wet method of treatment of burn woundsof burn wounds

Indications:Indications: Non infected Non infected burnsburns of II-IIIAof II-IIIA st.st. Small in size infected burns ofSmall in size infected burns of

IIIIIIААBB st. in case of little st. in case of little exudationexudation

Auto transplants on the woundsAuto transplants on the wounds Donor woundsDonor wounds Long lasting woundsLong lasting wounds

Mechanism of action of wet Mechanism of action of wet environmentenvironment

at at II stage of wound processstage of wound process – – stimulation of autolysis and clearing stimulation of autolysis and clearing of the woundof the wound

at II stageat II stage – – making of good making of good conditions for growth of granulationsconditions for growth of granulations

atat III stageIII stage - - making of good making of good conditions for formation of soft and conditions for formation of soft and elastic scarselastic scars

Wet method of treatment Wet method of treatment of burn woundsof burn wounds

Wet method of treatment of Wet method of treatment of burnsburns

Usage of ointments in local treatment of burn wounds

Phase of wound process

Drug Action

Exudation Dioxizol, Oflocain

Anti inflammatory, antibiotic effect

Demarcation and clearing of wound

Oflocain, Miramistin, Streptonitol

Clearing of wounds by necrolytic type

Regeneration Pantestin, Methyluracil

Providing of good formation of epithelium

Biological substitutes of skinBiological substitutes of skin – – Gold standard of treatment of burn woundsGold standard of treatment of burn wounds

• Homo skin

• Xeno skin

• Placenta

• Peritoneum

Preparing of liophilized Preparing of liophilized xeno dermo transplantsxeno dermo transplants

Producing of liophilized xeno dermo Producing of liophilized xeno dermo

transplantstransplants Cutting of xenotransplants Equilibration in solutions

Introduction into anabiosis (solutions, temperature)

Being in anabiosis (“adapting to new conditions”)

Pull-out the anabiosis (temperature, duration)

Preparing of xeno transplants to liophilization (possible reaching by drugs)

Liophilization (duration, control)

Packing

Preparing before usage depending on aim of usage

Cutting of xeno transplants

Traditional liophilization

To 3 hours

Laboratory “on wheels ”

The xeno transplants are packed in sterileThe xeno transplants are packed in sterilepackets packets

( 100,150,200,250,300 sm2). ( 100,150,200,250,300 sm2). It’s thickness is 0,3-0,5 mm.It’s thickness is 0,3-0,5 mm.

Usage of xeno grafts in case of Usage of xeno grafts in case of superficial burnssuperficial burns

Their functions :Their functions : decrease or stop loosing of liquid, proteins, decrease or stop loosing of liquid, proteins,

electrolites electrolites improve patient’s stateimprove patient’s state decrease or stop pain decrease or stop pain normalize body temperaturenormalize body temperature prevent burn diseaseprevent burn disease make faster recoverymake faster recovery prevent scaring.prevent scaring.

Usage of xeno transplants in Usage of xeno transplants in case of deep burnscase of deep burns

Large area of burnsLarge area of burns Non stable patient’s stateNon stable patient’s state Not clear woundNot clear wound In combination with autoplasticIn combination with autoplastic

Morphology of liophilized xeno Morphology of liophilized xeno transplantstransplants

Layers of epidermocytes are saved. Clear basal membrane. Basophilic nucleuses vacuolization of cytoplazma of some

cells.

Organization of epidermocytes of spinal layer. Desmosomic contacts are saved,

some dilation of between cellular spaces. Small invaginations of cariolema,

destruction of some organels.

Wounds of IIIB-IV Wounds of IIIB-IV stagesstages. . Third day Third day

after xeno plasticafter xeno plastic. . Close fixing of Close fixing of

xeno transplant to xeno transplant to the woundthe wound . . Vessel Vessel

(capillary) is (capillary) is growing into the growing into the xeno transplants xeno transplants

from injured from injured dermaderma..

Clear wound surface. Good granulations. Wound is ready for

autotransplantation

Ultra structure of active fibroblast and formation of components of

between cellular substance

Wounds ofWounds of ІІІ ІІІ BB – – IVIV stagesstages after taking after taking off of xenotransplant. 14 day after off of xenotransplant. 14 day after

xenoplastyxenoplasty

Burn of II-III stageBurn of II-III stage

NecrectomyNecrectomy ((22ndnd day after the trauma)day after the trauma)

Wounds are covered with Wounds are covered with xenograftsxenografts

Xenografts are fixedXenografts are fixed

Epithelization under the Epithelization under the xenograftsxenografts

ChildChild BB., 1 ., 1 yearyear. . Burn by hot waterBurn by hot water ІІ-ІІІ ІІ-ІІІ stages of neckstages of neck, , backback,, nates nates, , left upper limbleft upper limb, ,

50% 50% of body areaof body area. . Wounds are covered Wounds are covered with xeno transplantswith xeno transplants..

The same The same child. child.

Epithelization Epithelization under xeno under xeno transplantstransplants

Burn by the flame II stageBurn by the flame II stage

Xenografting of burn wounds of Xenografting of burn wounds of II stageII stage

Epithelization of burn wounds Epithelization of burn wounds of II stage under xenograftsof II stage under xenografts

BurnBurn of II stof II st. . XenograftingXenografting

Epithelization under the Epithelization under the xenograftsxenografts

Burn wounds ofBurn wounds of ІІ-ІІІ ІІ-ІІІ stst., 26 (18) % ., 26 (18) % of of

body areabody area. . Early necrectomyEarly necrectomy..

Xenografting.Xenografting. AutograftingAutografting

ChildChild, 1 , 1 yearyear 8 8 monthmonth. . Burn Burn by the fire of face, trunk, by the fire of face, trunk,

right handright hand 44 (32%) 44 (32%) of body of body areaarea

The same The same child. child.

Wounds Wounds are are

covered covered with auto- with auto- and xenoand xeno

transplants transplants

The same The same child after the child after the

treatmenttreatment

Burn wounds of III-IV stageBurn wounds of III-IV stage

Early necrectomy for wounds Early necrectomy for wounds of III-IV stageof III-IV stage

Auto grafting of burn wounds Auto grafting of burn wounds of III-IV stageof III-IV stage

EpithelizatiEpithelization of burn on of burn wounds of wounds of III-IV stageIII-IV stage

Xenoderm Xenoderm powderpowder

Thank Thank you you

for your for your attentioattentio

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