RCS 6080 Medical and Psychosocial Aspects of Rehabilitation CounselingWoundsSkin content refresherWound HealingPhases of healingComplicationsPlastic surgeryBurn InjuriesEffectsBurn Classification - CauseBurn Classification - DepthSlide 12Burn Classification - ExtentBurn Classification – Extent Lund & BrowderBurn TreatmentPathophysiology of Burn InjuryBurn Scars - KeloidBurn Scars - HypertrophicBurn Scars - ContractureSlide 20Burn Scars - NonraisedSkin Graft ScarsFunctional LimitationsRehabilitation Burn TreatmentVocational LimitationsAdditional Resources and Information from the WebSlide 27Slide 28RCS 6080RCS 6080 Medical and Psychosocial Aspects Medical and Psychosocial Aspects of Rehabilitation Counselingof Rehabilitation CounselingWound Healing, Burn Injuries & Plastic SurgeryWoundsWoundsAny breach in the surface of the body or any tissue disruption produced by the application of energyUsually physical injuryAbrasion, degloving injuryContusion, crush injuryIncision, lacerationSkin content refresherSkin content refresherWound HealingWound HealingAs wound heals:–Fluid and cells drain from damaged tissue–Exudate may be:ClearBloody Pus-containingProper wound healing:–Cleanliness and care of lesion–Proper circulation–Good general health and nutritionPhases of healingPhases of healingInflammatory–Bleeding/clotting–Migration of WBCs–Cell swellingReparative–Laying down of collagen + migration of epith. cells–New capillary loops–Proliferation of fibroblastsstrands of collagenConsolodative–reorientation +contraction of collagen–collagen synthesisdegradation vascularityComplicationsComplicationsHypertrophic scar = continued production of collagenKeloid = ….with extension into surrounding tissuesScar contracturePlastic surgeryPlastic surgeryScar Revision–Laser resurfacing/dermabrasion–Z-plasty–Skin-grafting/flap surgery–Tissue expansionBurn InjuriesBurn InjuriesStatistics–Annually, there are approximately 1.25 million people in the US who sustain burn injuries–Of these, 5,500 do not survive and 51,000 require hospitalization–Persons whose burn injuries require hospitalization have about a 50% chance of sustaining temporary or permanent disability–The most common part of the body involved in burn injury is an upper extremity, followed by the head and neckEffectsEffectsBurn injury causes destruction of tissue, usually the skin, from exposure to thermal extremes (either hot or cold), electricity, chemicals, and/or radiation–The mucosa of the upper GI system (mouth, esophagus, stomach) can be burned with ingestion of chemicals–The respiratory system can be damaged if hot gases, smoke, or toxic chemical fumes are inhaled–Fat, muscle, bone, and peripheral nerves can be affected in electrical injuries or prolonged thermal or chemical exposure–Skin damage can result in altered ability to sense pain, touch, and temperatureBurn Classification - CauseBurn Classification - CauseThe primary cause of burn injury is exposure to temperature extremes–Heat injuries are more frequent than cold injuries–Cold injuries almost exclusively result from frostbiteElectrical and chemical injuries constitute 5-10% of burn injuries and are largely the result of occupational accidentsBurn Classification - DepthBurn Classification - DepthOld terminology–1st degree: only the epidermis–2nd degree: epidermis and dermis, excluding all the dermal appendages–3rd degree: epidermis and all of the dermis–4th degree: epidermis, dermis, and subcutaneous tissues (fat, muscle, bone, and peripheral nerves)New terminology–Superficial: only the epidermis–Superficial partial thickness: epidermis and dermis, excluding all the dermal appendages–Deep partial thickness: epidermis and most of the dermis–Full thickness: epidermis and all of the dermisBurn Classification - DepthBurn Classification - DepthBurn Classification - ExtentBurn Classification - ExtentExtent–Burn injuries are also classified in terms of the percentage of the skin surface injured (TBSA)–A relatively simple, but not totally accurate, method for determining the extent of injury is the rule of 9s–The ABA classification system describes burn injuries as mild, moderate, or majorBurn Classification – ExtentBurn Classification – ExtentLund & BrowderLund & Browder–Lund and BrowderMore accurateDivides body into small areasEstimates proportion each area contributes–Lund and BrowderMore accurateDivides body into small areasEstimates proportion each area contributesTakes more time and effort to calculate than Rule of Nines methodBurn TreatmentBurn Treatment–Respiratory care–Administration of fluids–Wound care (debridement)–Pain control–Plastic surgery (eg: skin grafts)–Monitoring for complicationsInfections CardiovascularRespiratory–Massage & Physical therapymassage video–Posttraumatic stressPathophysiology of Burn Pathophysiology of Burn InjuryInjuryPathophysiology refers to the complex chain of mechanisms that occur in the skin (local effects) and in other organ systems (systemic effects) when a burn injury occurs, as well as what happens as the skin regenerates and heals–Local Effects–Systematic Effects–Skin Regeneration and Scarring–Electrical BurnsBurn Scars - KeloidBurn Scars - KeloidBurn Scars - HypertrophicBurn Scars - HypertrophicBurn Scars - ContractureBurn Scars - ContractureBurn Scars - ContractureBurn Scars - ContractureBurn Scars - NonraisedBurn Scars - NonraisedSkin Graft ScarsSkin Graft ScarsFunctional LimitationsFunctional LimitationsAcute Limitations–Patients may experience delirium that precludes their participation in treatment–Edema, pain, bulky dressings, and immobilizing splints impair the person's ability to perform usual daily activities –Sleep is frequently disrupted–Anxiety and fear can be presentPostdischarge Limitations–The most frequent functional limitations involve scarring and joint contracture–Other functional sequelae may result in permanent impairmentRehabilitation Burn TreatmentRehabilitation Burn TreatmentPostdischarge–Wound care continues–If there is a risk of hypertrophic scarring, or it has already started, continuous pressure applied to the area will prevent its progress–Garments need to be worn 20 hours per day for up to 1 year - uncomfortable, hot, and