Burns Skin Grafting And Flaps Question And Answers

Burns Skin Grafting And Flaps Important Notes

1. Depth Of Burns
   • Depth Of Burns First degree
     • Burns are confined to the epidermis
     • They are painful, erythematous, and blanch to touch with an intact epidermal barrier
   • Depth Of Burns Second Degree
     • Divided into two types- superficial and deep
     • Have some degree of dermal damage
   • Depth Of Burns Third-degree
     • Involves the epidermis and dermis
     • Characterized by a hard, leathery eschar
     • It is painless due to nerve damage
     • Black, white, or cherry red
     • Wounds heal by re-epithelization from the wound edges
     • Deep dermal and full-thickness burns require excision with skin grafting
   • Fourth degree
     • Burns involve other organs beneath the skin such as muscle, bone, and brain
2. Burns Skin Grafting And Flaps Classification
3. Rule of nine
   • Given by Wallace
   • Used to calculate the severity of burns
     • Head and neck – 9%
     • Upper limb ( right and left) – 18%
     • Thorax (front and hack) – 18%
     • A Women (front and back) – 18%
     • Lower limb ( front and back ) – 18%
     • Lower limb ( right and left) – 18%
     • Lxtemal genitalia – 1%
4. Electrical burns
   • In it, the visible areas of tissue necrosis represent only a small portion of destroyed tissue
   • Electrical current enters a part of the body through fingers or hand
   • Proceeds through tissues with lower resistance to current such as nerves, blood vessels, and muscles
   • The current then leaves the body at a grounded area typically the foot
   • The muscle is the major tissue through which the current flows and thus it sustains the most damage
   • Electrical Burns Features and Effects
     • Patients may develop cardiac dysrhythmias
     • Muscle damage results in the release of hemochromogens which are filtered in glomeruli
     • May result in obstructive nephropathy
     • Port wine-colored urine may be present
     • A large amount of blood pigment may be deposited in the collecting tubules of the kidney as a result of hemolysis
     • Hemoglobinuria will be gradually followed by oliguria ia and anuria, and the patient may die of uremia
5. Management of burns
   • Fluid replacement
     • In 10% of burns in children
     • In more than 15% of burns in adults
     • The formula to calculate fluid replacement is
       • % of burns * body weight / 2
   • Use of nasogastric tube in >35% burns
   • Blood replacement therapy in 25-50% burns
6. Effects of burns
   • Local effects
     • Cell necrosis
     • Collagen denaturation
     • Infection
     • Inflammation
   • Systemic effects
     • Hypovolaemia
     • Gastric or duodenal ulcer
     • Multiple organ transfer
     • Hypoxia
7. Types of grafts

Burns Skin Grafting And Flaps Long Essays

Question 1. Classification of burns
Answer:

Classification of buBurnauburnernurn is a wound in which there is coagulative necrosis of the tissues.

Burns Classification:

1. According to the mechanism of injury
   • Ordinary burns
     • Caused by dry heat like fire, open flame, airplane injury
   • Scalds
     • Caused by moist heat
     • Example: hot liquid or hot steam
   • Electric bums
     • Caused by low voltage electrical sources
     • Tissue damage occurs
     • The skin gradually undergoes coagulation necrosis
     • It causes minimal destruction of skin
     • The skin is involved at two points- at the point of contact and the point of exit
     • Electrical injury to the muscles is associated with the release of haemo chromogens into the bloodstream
   • Chemical burn
     • Caused by strong acid or base
     • The severity of damage is related to the concentration of the chemical and duration of contact
   • Radiation injury
     • Usually caused by x-rays or radium
     • Radiodermatitis occurs which are of two types
       • Acute radiodermatitis- exposure dose is highly excessive
       • Chronic radiodermatitis- occurs due to small doses of irradiation
   • Cold burns
     • Caused by exposure to cold like freezing injury, frostbite, trench foot
     • Causes coagulative necrosis of tissue
2. According to burn depth
   • First degree burn
     • Involves epidermis only
     • Manifests as erythema, painful, dry texture
     • Heals in a week or less
   • Second degree burn
     • The entire thickness of the epidermis is destroyed
     • Blebs or vesicles are formed between the separating epidermis and dermis
   • Third degree burns
     • Involves full thickness of the dermis
     • Appears a stiff and white or brown scar
     • Absence of pain
   • Fourth degree burn
     • Extends through skin, subcutaneous tissue, and into underlying muscle and bone
     • Result in amputation and severe functional impairment
3. According to burn severity
   • Major burns
     • Full thickness burns
     • Associated with inhalational injury, electrical burns
     • Require referral to a specialized burn treatment center
   • Moderate burns
     • Full-thickness burns involving 2-10% of total body surface area
     • Require hospitalization for burn care
   • Minor burns
     • Full-thickness burns involving less than 2% of total body surface area
     • Do not require hospitalization.

Question 2. Pathology and treatment of burns and management of 50% burns in a person aged 40 years.
Answer:

Burns Pathology:

• Local Changes
  • Severity of burn
    • First degree burn
      • Hyperemia of the skin with slight edema of the epidermis
    • Second degree burns
      • The entire thickness of the epidermis is destroyed
      • Formation of blebs and vesicles
    • Third degree burns
      • Destruction of the epidermis and dermis

Read And Learn More: General Surgery Question and Answers

• • Extent of burn
    • It is expressed as a percentage of the total surface area
    • Estimated by the rule of nines
  • Vascular changes
    • Dilatation of small vessels
    • Local liberation of histamine
    • Increased blood flow to the injured part
    • Increased capillary permeability
    • Blister formation
  • Infection
    • Due to the destruction of the epidermis, there is a loss of barrier against infection
    • This causes severe infection
  • Systemic Changes
    • Shock
    • Biochemical changes
    • Electrolyte imbalance
    • Hypoproteinaemia
    • Hyperglycaemia
    • Rise in blood urea and creatinine levels
  • Changes in blood
    • Haemoconcentration
    • Rise in hemoglobin level
    • Increase in the number of RBCs
    • Sludging of blood
    • Fall in eosinophil count
    • Aggregation of RBC, WBC, and platelets
    • Anaemia
    • Alteration in coagulation
  • Systemic lesions

Treatment of Burns:

• Treatment of shock
  • Sedation
    • As burn is very painful sedatives and analgesics are prescribed
    • Administered during first 4-5 days
    • Usually, injection of morphine is preferred
  • Fluid resuscitation
    • Started as soon as possible
    • A blood transfusion is required
    • Ringer’s lactate solution is used
  • Maintenance of airway
    • Administration of 100% oxygen with ventilation support
• General treatment
  • Tetanus prophylaxis
    • Intramuscular administration of tetanus toxoid in the dose of 0.5 ml usually provides adequate prophylaxis
  • Antibiotics
    • Microorganisms contaminate the wound
    • Thus systemic antibiotics are given on 1st or 2nd day of injury
  • Nutritional support
    • Feeding is supported by a nasogastric tube through which nutrients are delivered. 24 hours a day
  • Gastric decompression
    • Requires introduction of nasogastric suction as intestinal motility is gradually lost
    • Gastric aspirates should be regularly monitored
• Local treatment
  • First-aid measures
    • The patient is immediately removed from the source
    • Apply cool clean water to the area
  • Burn wound care
    • The wound is cleansed with a surgical detergent and all loose nonviable skin is removed
    • Blister is punctured
    • Regular dressing is carried out
  • Skin grafting
    • Excise the wound
    • The patient’s donor skin can lie meshed to increase the size of the graft
    • It is then covered with cadaveric skin

Skin Grafting And Flaps  Management: Fluid Resuscitation

• The goal is to maintain the vital organ function as soon as possible
• Several formulas are proposed
• Evans’ formula
  • 1st 24 hours
    • Normal saline- 1/2 ml/kg/% burn
    • 2000 ml of 5% dextrose
    • Colloid-containing fluid- 1 ml/kg/% burn
  • 2nd 24 hours
    • Normal saline- 1/2 of l st 24 hours
    • 2000 ml of 5% dextrose
    • Colloid containing fluid- 1/2 of 1st 24 hours
• Brooke’s formula
  • 1st 24 hours
    • Ringer’s lactate solution 1.5 ml/kg/% burn
    • Colloid containing fluid 0.5 ml/kg/% burn
    • Dextrose solution- 2000 ml
  • 2nd 24 hours
    • Ringer’s lactate solution 1/2 – 3/4 th of 1 st 24 hours
    • Colloid containing, solution 1/2 to 3/4 of 1st 24 hours
    • Dextrose solution 2000 ml

Question 3. Define burns and scalds. Discuss management of 20% burns.
Answer:

Burns and Scalds Definition:

• Burns Burn is a wound in which there is coagulative necrosis of the tissue
• Scalds It is a thermal injury or burn caused by moist heal

Burns and Scalds Management:

• First-aid measures
  • Remove the patient from the source
  • Wrap the patient in a fire blanket
  • Apply running cold water
  • Remove clothing
  • Maintain patent airway
• Airway maintenance
  • Breathing and ventilation
  • Circulation is maintained
  • Fluid resuscitation
• Wound care
  • Analgesic are preferred
  • A blood transfusion is required
  • Use of antibiotics to prevent infection
  • Nutritional support
  • Debridement of wound
  • Regular dressing
  • Excision of the devitalized tissues
  • Skin grafting

Burns Skin Grafting And Flaps Short Essays

Question 1. Burn shock
Answer:

Burn shock

• Shock is the most important effect of burns
• Burn Shock Types

Burn shock Treatment:

• Sedation
  • As the bum is very painful sedatives and analgesics are prescribed
  • Administered during first 4-5 days
  • Usually, injection of morphine is preferred
• Fluid resuscitation
  • Started as soon as possible
  • A blood transfusion is required
  • Ringer’s lactate solution is used
• Maintenance of airway
  • Administration of 100% oxygen with ventilation support

Question 2. Superficial burns
Answer:

Superficial burns

• First-degree burns are called superficial burns
  • Involves epidermis only
  • Manifests as erythema, painful, dry texture
  • Heals in a week or less

Superficial burns Management:

• First-aid measures
  • Remove the patient from the source
  • Wrap the patient in a fire blanket
  • Apply running cold water
• Wound care
  • Analgesic are preferred
  • Debridement of wound

Question 3. Rule of nine in burns
Answer:

Rule of nine in burns

• The length and width of the burn wound are expressed as a percentage of the total surface area displaying 2nd or 3rd-degree burn
• The extent is estimated by the rule of nines which is as follows:
• It applies only to adults

Question 4. Burns
Answer:

Burns

Burns: A burn is a wound in which there is coagulative necrosis of the tissues.

Burns Classification:

1. According to the mechanism of injury
   • Ordinary burns
   • Scalds
   • Electric burns
   • Chemical bums
   • Radiation burns
   • Cold burns
2. According to bum depth
   • First-degree bum
   • Second-degree bum
   • Third-degree bum
   • Fourth-degree bum
3. According to severity
   • Major bums
   • Moderate bums
   • Mild bums

Burns Management

• Treatment of shock
  • Sedation
    • As the bum is very painful sedatives and analgesics are prescribed
    • Administered during first 4-5 days
    • Usually, injection of morphine is preferred
  • Fluid resuscitation
    • Started as soon as possible
    • A blood transfusion is required
    • Ringer’s lactate solution is used
  • Maintenance of airway
    • Administration of 100% oxygen with ventilation support
• General treatment
  • Tetanus prophylaxis
    • Intramuscular administration of tetanus toxoid in the dose of 0.5 ml usually provides adequate prophylaxis
  • Antibiotics
    • Microorganisms contaminate the wound
    • Thus systemic antibiotics are given on 1st or 2nd day of injury
  • Nutritional support
    • Feeding is supported by a nasogastric tube through which nutrients are delivered 24 hours a day
  • Gastric decompression
    • Requires introduction of nasogastric suction as intestinal motility is gradually lost
    • Gastric aspirates should be regularly monitored
• Local treatment
  • First-aid measures
    • The patient is immediately removed from the source
    • Apply cold clean water to the area
• Bum wound care
  • The wound is cleansed with a surgical detergent and all loose nonviable skin is removed
  • Blister is punctured
  • Regular dressing is carried out
• Skin grafting
  • Excise the wound
  • The patient’s donor skin can be meshed to increase the size of the graft
  • It is then covered with cadaveric skin

Question 5. Skin grafting
Answer:

Skin grafting

Skin grafting is a surgical procedure involving the transplantation of skin or a skin substitute over a bum or nonhealing wound

Skin grafting Indications:

• Extensive raw wound
• Large wound due to trauma or burn
• Contracted scar
• Skin loss from surgically removed malignant growth
• In reconstructive surgeries

Skin grafting Types:

• Split thickness
  • Includes epidermis and a variable amount of dermis
  • Healing occurs by re-epithelization from the dermis and surrounding skin
• Full thickness
  • Includes epidermis and all the dermis
  • The donor site is sutured
• Composite graft
  • These are small grafts containing skin and underlying cartilage or other tissue

Question 6. PMMC flap
Answer:

PMMC flap Procedure:

• Skin below and medial to nipple over the muscle is used
• The incision is made over the skin
• Below the line or 3rd rib to retain the deltopectoral hap area
• The lower border of the muscle is raised
• Care is taken to avoid injury to thoracoacromial vessels
• The flap is raised over the medial and lateral margins of the pectoral and is the major muscle
• Skin with muscle is dissected from the deeper structures
• The flap is raised upwards upto the coracoid
• Lateral pectoral vessels are retained
• Pectoral nerves should be retained
• The defect below is usually closed primarily with sutures
• The flap is tunneled in the subcutaneous plane towards the neck or oral cavity
• Postoperatively flap is observed for color changes, seroma, and infection
• The neck is flexed towards the flap side
• A suction drain is placed
• Neck flap covers the carotids
• In the case of the oral cavity, skin can be split in half to cover both the inner and outer aspects of the oral cavity

PMMC flap uses:

• To cover the defect over the cheek/neck/pharynx/ intraoral lesions after wide excision
• Used along with deltopectoral flap.

Burns Skin Grafting And Flaps Short Answers

Question 1. Split skin grafting
Answer:

Split skin grafting

• Split skin grafting includes epidermis and variable amount of dermis
• Donor sites
  • Thigh
  • Buttock
• Healing occurs by re-epithelization from the dermis and surrounding skin

Split Skin Grafting Indications:

• Resurfacing large wound
• Lining cavities
• Resurfacing mucosal deficits
• Closure of flap donor sites
• Resurfacing muscle flaps

Split Skin Grafting Types:

• Thin- 0.005-0.012 inch
• Intermediate-0.012-0.018 inch
• Thick- 0.018-0.030 inch

Split Skin Grafting Disadvantages:

• More fragile
• Cannot withstand radiotherapy
• Contract during healing
• Gets hypo or hyperpigmented
• Less esthetic
• Lack of smooth texture

Question 2. Composite skin graft
Answer:

Composite skin graft

• Composite skin graft contains more than one tissue like skin, bone, tendons, cartilage, and muscle
• For example, it is used in the treatment of basal cell carcinoma

Composite skin graft Procedure:

• A graft is excised from the donor site
• A desired shape is obtained from it
• It is picked using a special instrument
• Placed over the injured part
• Secured in place with the help of sutures

Question 4. Plasma expanders
Answer:

Plasma expanders

Plasma expanders are high molecular weight substances which when infused IV exert osmotic pressure and remain in the body for a long time to increase the volume of circulating fluid

Plasma Expanders Ideal Properties:

• Should exert oncotic pressure comparable to plasma
• Should be long lasting
• Should be nonantigenic
• Should be pharmacologically inert

Plasma expanders Plasma Expanders Used Are:

• Dextrans
• Gelatin polymer
• Hydroxyethyl starches
• Polyvinyl pyrrolidone
• Human albumin obtained from pooled human plasma

Question 5. Burns of face
Answer:

Burns of face

• Facial burns vary from superficial to deep burns.
• Over 50% of burns involve the head and neck region.

Burns of face Causes:

• Flame
• Electric current
• Steam
• Hot substances
• Chemicals

Burns of face Treatment:

• Objectives
  • Restoration of function
    • Airway patency
    • Protection of cornea
    • Neck mobility
• Comfort
• Appearance

Question 6. Skin grafting indications
Answer:

Skin grafting indications

• Extensive raw wound
• Large wound due to trauma or bum
• Contracted scar
• Skin loss from surgically removed malignant growth
• In reconstructive surgeries

Question 7. Scalds
Answer:

Scalds

• Scald is a thermal injury or bum caused by moist heat such as boiling water, hot oil, or tar
• Injury is severe and sometimes life-threatening H Skin grafting is required
• Most thickness burn grafting results in scarring
• They result in a higher percentage of body surface area burned and longer stay in the hospital

Question 8. Third degree burns
Answer:

Third degree burns

It involves of entire depth of the epidermis and dermis

Third-degree burns Features

• It is painless due to the destruction of nerves Skin appears tough, dry, and eschar
• Thrombosed subcutaneous veins are seen
• In 3-5 weeks, eschar gets separated

Question 9. Types of skin grafting
Answer:

Types of skin grafting

1. Split thickness
   • Includes epidermis and a variable amount of dermis
   • Healing occurs by re-epithelization from the dermis and surrounding skin
2. Full thickness
   • Includes epidermis and all the dermis
   • The donor site is sutured
3. Composite graft
   • These are small grafts containing skin and underlying cartilage or other tissue

Question 10. Electric burns
Answer:

Electric burns

• Caused by low voltage electrical sources
• Tissue damage occurs
• The skin gradually undergoes coagulation necrosis
• It causes minimal destruction of skin
• The skin is involved at two points – at the point of contact and the point of exit
• Electrical injury to the muscles is associated with the release of hemochromogens into the bloodstream

Burns Skin Grafting And Flaps Viva Voce

1. Head and trunk in severely burnedpatientstaccounts for 45% of total body surface
2. Split-thickness grafts are used when the burns are extensive
3. Full-thickness grafts used to cover small areas
4. Lactated Ringer’s solution without dextrose is the fluid of choice except in children younger than 2 years
5. 5% dextrose Ringer’s lactate is used in children