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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