PLASTIC

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PLASTIC RECONSTRUCTIVE SURGERY
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WOUNDS

• DEFINITION- Disruption of the normal continuity
  of bodily structure due to trauma,which may be
  penetrating or non-penetrating.
• TYPES OF WOUNDS
• Incised wounds
• Abrasions
• Crush injury
• Degloving injury
• Gunshot wounds
• Burns

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PRINCIPLES OF WOUND HEALING

• Lag phase (2-3 days)
• Incremental phase/proliferative phase (appr 3
  weeks)
• Plateau/maturation phase (appr 6 months)
• Organization of scars

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CLASSIFICTION OF WOUND HEALING

• HEALING BY 1ST INTENTION
• efficient/Incised surgical wound meticulously
  opposed/heals with minimal scarring
• HEALING BY 2ND INTENTION
• wound edges not opposed well/defect fills with
  Granulation tissue/excessive fibrosis/unsightly
  Scar
• HEALING BY 3RD INTENTION
• wound healing by 2nd intention is treated by
  excising its margin and opposing them or covering
  the area with skin graft.

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FACTORS INFLUENCING WOUND HEALING

• BLOOD SUPPLY
• AGE
• INFECTION
• SITE OF WOUND
• NUTRITIONAL STATUS
• INTERCURRENT DISEASE
• SURGICAL TECHINIQUES
• CHOICE OF SUTURE SUTURE MATERIALS

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WOUND INFECTIONS

• CLEAN PROCEDURES
• CLEAN CONTAMINATED PROCEDURES
• CONTAMINATED/DIRTY WOUNDS

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PRINCIPLES OF MANAGEMENT OF CONTAMINATED
TRAUMATIC WOUNDS

• Contaminated wounds should be debrided under
  General anaesthesia
• Contaminated wound its margins cleansed
  thoroughly
• Devitalized tissue is excised
• Avoid primary closure in gross contamination
  when treatment delayed gt6hrs
• Wound left open-suitable for delayed primary
  suture after 2-3 days or for later excision2ndry
  suture
• Appropriate protection against tetanus
• Use of antibiotics

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CRUSHING DEGLOVING INJURIES,GUNSHOT WOUNDS

• This type wounds should never be closed primarily
• - Thorough irrigation removal of dead
  tissue/foreign material
• - Wounds lightly packed dressed
• - Dressings are removed 48hrs later under
  Anaesthesia further excision
• - Wound is closed by suture, skin grafting or
  flap.

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BURNS

• CAUSED BY
• FLAMES
• HOT LIQUIS
• HOT SOLIDS
• STEAM
• IRRADIATION
• ELECTRICITY
• CHEMICALS

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EFFECTS OF BURN INJURY

• DESTRUCTION OF TISSUE(depth depends on heat of
  causative agent and
• 
  contact time)
• loss of barrier to infection
• fluid loss from surface
• red cell destruction.
• INCREASED CAPILLARY PERMEABILITY
• oedema
• loss of circulating fluid volume
• hypovolaemic shock
• INCREASED METABOLIC RATE

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CONSEQUENCES OF BURNS

• Morbiditymortality of burns depends on the
  site,extent and depth of burn and on age and
  general condition of patients
• Early Consequences
• hypovolaemia
• metabolic derangement
  (Hyponatremia,hyperkalemia
• followed by
  hypokalemia)
• sepsis
• Haemolysis with anaemia and need for
  transfusion
• Hypothermia
• Short term consequences
• Renal failure
• Respiratory failure
• Catabolism Nutritional depletion
• Venous thrombosis
• Curlings Ulcer and and erosive
  gastritis
• Long term cosequences
• Permanent disfigurement
• Prolonged hospitalisation
• Psychological problems
• Impaired function

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CLASSIFICATION

• SUPERFICIAL PARTIAL-THICKNESS BURNS
• DEEP PARTIAL-THICKNESS BURNS
• FULL-THICKNESS BURNS

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PROGNOSIS

• DEPENDS ON
• EXTENT OF THE BURN (Rule of Nine)
• DEPTH OF BURN
• SITE OF BURN
• ASSOCAITED RESPIRATORY INJURY

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MANAGEMENT

• FIRST AID
• ARREST THE BURNING PROCESS
• ENSURE AN ADEQUATE AIRWAY
• AVOID WOUND CONTAMINATION
• TRANFER TO HOSPITAL
• ADEQUATE VENTILATION
• INITIAL ASSESSMENT MANAGEMENT
• PREVENTIONTREATMENT OF BURN SHOCK
• WATER REPLACEMENT
• BLOOD TRANSFUSION
• ORGAN FAILURE BURN SHOCK
• NUTRITIONAL MANAGEMENT
• PREVENTION OF SEPTICAEMIA
• PREVENTION OF CURLINGS ULCER GASTRIC EROSIONS.
• LOCAL MANAGEMENT OF BURNS
• INITIAL CLEANSING DEBRIDEMENT
• PREVENTION OF CONTAMINATION
• RELIEF OF CONSTRICTION(ESCHAROTOMY)
• RESTORATION OF EPIDERMAL COVER

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PLASTIC RECONSTRUCTIVE SURGERY

• Discussions

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• Give the definition of a wound classified as
  clean-contaminated and provide an example of
  such?
• What aspects of the patients health and the
  condition of the wound can be corrected to
  improve the probability of wound healing?
• What are the basic differences between a gun-shot
  wound of the thigh (low velocity)which has an
  entrance and exit wound, and a large burn of the
  thigh?
• What aspects of a wound-traumatic or surgical
  cause a cosmetically poor scars?