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DR SUNIL KESWANIPlastic SurgeonNATIONAL BURNS CENTRE,Mumbai
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Always early excision if patient comes early enough and facilities exist
Early enough is upto 72 hrs postburn Early excision decreases the chances of
Sepsis and facilitates early moblisation and better and more predictable functional recovery.
Delayed excision is generally at 3 weeks or later
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Within the first 3-5days After 5 days chances of Sepsis higher
and bleeding more 15% of BSA is excised at a time Coverage of excised area by Meshed
Homograft is mandatory
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Areas easy and quick to excise: trunk and legs
Joints and throats Hands and face
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Blood Loss Clear pre-operative plan Excision prior to wound hyperemia Elevation of extremities Tourniquet control Dilute Epinephrine tumescent fluid Epinephrine soaked sponges
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Procedure (En Bloc) For deeper burns Skin and fat excised in one session Less time consuming Excision down to the natural
cleavage plane Down to fat or Fascia
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Classic benefits of allograft as a physiologic and mechanical barrier:
• Reduction in water, electrolyte and protein loss
• Reduction in energy requirements secondary to the attainment of a closed wound
• Reduction in wound infection rates• Reduction in pain• Conservation of autografts• Improved general welfare and
psychological outlook of the patient
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Reduction in the number of bacteria under a biological dressing
Phagocytes within a wound use the fibrin network established between the allograft and the wound to trap and phagocytose bacteria without the production of opsonins or antibody
The effects of allografts in reducing bacteria and promoting healing have proven beneficial
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Materials that are applied for short periods then removed, to stimulate autologous healing
Cell free material that encourage colonization by autologous cells, to stimulate new skin formation
Cell containing skin substitutes: to provide immediate functional replacement
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Most widely accepted synthetic skin substitute
Bilaminar structure The median ‘take’ is 85% Two-stage procedure, with a minimum
interval of 3 weeks between the application of the Integra and the split-skin grafting
Relatively expensive
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Grown in vitro and then applied to wounds
Take of cultured epithelial autografts depends on the wound bed
Expensive Skilled labour and quality control, 3–5 weeks to produce 1.8m2 confluent
sheets of cells from a 2 cm2 biopsy Fragile sheets Blistering, infection, and contractures.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Suggested Clinical Indications for CAE burn injuries >90% broad 70-90% more limited <70% no clear indication
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Acute burns always meshed or meek micrografting for better takes
Reconstructive procedures like overgrafting and release of contractures always sheet grafting for better cosmesis
Meek micrografting gives wider coverage and more predictable takes than mesh grafting but more expensive
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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POST-PHYSICAL REHABILITATION OUTCOME
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Pre-Op wound
Application of Homograft Day 3
Complete healing Day 21
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
[email protected] YOUBURNS Helpline:
022 2779 3333
www.burns-india.com