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Monitoring of resuscitation Although fluid resuscitation has defined guidelines it is critical to understand that the process is dynamic and rigid adherence to protocols should be avoided. The key to monitoring of resuscitation is urine output. Urine output shou...

NON-THERMAL BURN INJURY Electrical injuries Electrical injuries are usually divided into low- and high-volt age injuries, the threshold being 1000 /uni00A0 V . Summary box 46.19 Electrical burns /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Low-tension...

Nursing care Burns patients require particularly intensive nursing care. Nurses are the primary e ff ectors of many decisions that directly a ff ect healing. Bandaged hands and joints that are sti ff and painful need careful coaxing. Personal hygiene, baths and ...

OTHER LIFE-THREATENING EVENTS WITH MAJOR BURNS The immune system and infection The inflammatory changes caused by the burn have an e ff ect on the patient’s immune system. Cell-mediated immunity is significantly reduced in large burns, leaving them more potential...

OTHER LIFE-THREATENING EVENTS WITH MAJOR BURNS The immune system and infection The inflammatory changes caused by the burn have an e ff ect on the patient’s immune system. Cell-mediated immunity is significantly reduced in large burns, leaving them more potential...

Physiotherapy and occupational therapy All burns cause swelling, especially burns to the hands. Elevation, splintage and exercise reduce swelling and improve the final outcome. The physiotherapy needs to be started on day /uni00A0 1, so that the message can be ...

Psychological A major burn is an overwhelming event, outside the normal experience, which stretches the patient’s coping ability , suspends the patient’s sense of safety and causes post-traumatic reactions. These are normal and usually self-limiting, receding...

RECENT ADVANCES Advanced technology , newer drugs and skin substitutes are the major advances in burn care. The next steps will focus on cultured autologous skin incorporating the patient’s own kera - tinocytes and fibroblasts. An intelligent use of these moda...

Surgical treatment Early versus staged full-thickness burn excision Opinion varies on the timing of burn eschar excision. Early total burn excision refers to excision of the entire burn on arrival at the burns unit or as soon as logistically possible. Once t...

Temperature management When undergoing burn assessment and fluid resuscitation it is vital that the patient maintains an adequate core temperature. A key function of skin is thermoregulation and in large burns t this is severely impacted. Hypothermia is a compo...

The use of skin grafts and skin substitutes Until very recently , the early definitive closure of wounds proved problematic when full-thickness burns exceeded 50% of the TBSA. The mainstay of burn wound repair has been the split-skin autograft and, at >50% T...

ABERRANT HEALING Scarring can be aberrant owing to a combination of genetic predisposition and environmental factors. The two main types of abnormal scarring are hypertrophic and keloid scars. Hypertrophic scars are elevated within the borders of the origin...

FLAP MONITORING Following microvascular free-flap reconstruction, patients may be monitored in a high-dependency unit setting as it is crucial to keep the patient physiologically optimised in order that the flap remains well perfused at all times. The traditiona...

FURTHER READING MacGregor AD, MacGregor IA. Fundamental techniques in plastic surgery , 10th edn. Edinburgh: Churchill Livingstone, 2000. Neligan PC (ed.). Plastic surgery . Philadelphia, PA: Saunders, 2012. Santoni-Rugiu P , Sykes PJ. A history of plastic su...

FUTURE DIRECTIONS Anatomical discoveries, such as a detailed understanding of the blood supply to the skin as well as technical and engineering innovations that brought about microsurgery , have enabled the field of reconstructive plastic surgery to blossom. ...

Flaps A flap is a block of tissue that contains an innate blood supply that may be transferred from a donor site to reconstruct a secondary defect; the pedicle is the ‘base’ of the flap that contains the blood supply . Unlike a graft, a flap can therefore be us...

Grafts Grafts are tissues that are transferred without their blood supply and therefore need to be revascularised through the recipient wound bed. To maximise the success of this procedure, the wound bed must be healthy with a good blood supply such - that an...

HISTORY Although the evolution of plastic surgery as a surgical specialty is comparatively recent, with the ‘masters’ of the First World War years, including Sir Harold Gillies, a New Zealand otolaryngologist working in London, considered to be the founding ...