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The most important property of these materials is adherence to the skin For application, the burn must be free of eschar, and hemostasis must exist (no bleeding) The surface is cleaned and rinsed with saline solution, and the skin substitute is applied Skin Substitutes
The primary goal of burn wound management is wound closure during the acute phaseEarly excision and grafting of full-thickness burns is the gold standard in burn centersSurgical debridement may begin 3 to 5 days after the burn insult, as soon as hemodynamic stability has been achieved; some physicians operate within 24 hours if the pt is stable To minimize contraction, burns over joints should be excised and grafted as soon as possible Typically, excision procedures are limited to 20% of the body surface or 2 hours of operating timeIn pts with massive burns, excision procedures are commonly staged, requiring the pt to return to the OR every 2 to 3 days until all wounds have been excised Definitive Burn Wound Closure
Sounds like we need to call on the Plastics Posse!!
Autograft:a skin graft harvested from a healthy uninjured donor site on the burn pt and then placed over the pt’s burn wound to provide permanent coverage of the woundAutografts are the only grafts that provide permanent coverage of the wound Preferred sites for obtaining these grafts are the thighs, back, and abdomen; however grafts can be harvested from almost anywhere on the bodyAutografting with the pt’s own skin is the preferred choice; however with large TBSA burns, finding donor sites can be problematicWhen an autograft is unavailable, skin substitutes can be used until the pt’s own skin is available for harvesting Previously used and healed donor sites can be used again on later return visits to the operating room Definitive Wound Closure
Autograft Surgical excision is performed to mechanically remove eschar tissue, this can be done tangentially (excising the eschar down to bleeding, viable tissue) or fasciallyFascial excision is used when the wounds are deep and the fat does not appear viable, sheets of the pt’s epidermis and a partial layer of the dermis are harvested; these grafts are referred to as split-thickness skin graftsand can be applied to the wound bed as a sheet or in a meshed form Sheet grafts are placed on the face, neck, lower portions of the arms, and hands when possible Mesh grafts can cover more area but may not produce cosmetic appearance desired; therefore they are usually placed on areas covered by clothing Definitive Wound Closure
AutograftThe grafts can be secured with sutures, fibrin glue, or staples The choice of dressing that is placed over the graft varies widely based on physician and institution preferenceOnce choice is fine mesh gauze impregnated with an emollient; it is placed over the graft, covered with a heavy gauze dressing, and secured to the pt with or without a splint