In case of facial burns, consult: Otolaryngology (ENT) department: to exclude burns of the upper airway, laryngeal oedema or in case of explosion rupture of the tympanic membrane. Ophthalmology: to exclude erosion or ulceration of the cornea. Follow the same procedure as performed in the primary survey. As guided by the Advance Trauma
Life Support (ATLS), consult or re-consult if already performed: Trauma surgery, Abdominal surgery and Neurosurgery. 9. Does the patient need Emergency Surgery or not? Debridement: RAD001 manufacturer The term ”Debridement” is not merely a surgical procedure. Debridement can be performed by surgical, chemical, mechanical, or autolytic procedures. Surgical modalities 5-Fluoracil mw including early tangential excision (necrectomy) of the burned tissue and early wound closure primarily by skin grafts has led to significant improvement in mortality rates and substantially lower costs in these patients [25, 26]. Furthermore, in some circumstances, escharotomy or even fasciotomy should be performed. Indications of surgical debridement: Dermal substitutes or matrices can be used if a large burn area exists. Here are some examples: Note that in many occasions, an immediate coverage of wounds cannot be achieved. In this case, a temporary coverage is favoured. After stabilization of patient and wound bed,
a planned reconstruction takes place to close wounds permanently. In this point, some methods can be performed including: 1. Deep second degree burns. 2. Burns of any type, that are heavily contaminated 3. Third degree circumferential burns with suspected compartment the syndrome (think of: Escharotomy) 4. Circumferential burns around the wrist (think of: Carpal tunnel release) Benefits of surgical debridement: 1. To reduce the amount of necrotic tissue (beneficial for prognosis) 2. To get a sample for diagnostic purposes (if needed). Complications of debridement: 1. Pain. 2. Bleeding. 3. Infection. 4. Risk of removal of healthy tissue. Contraindications:
1. Low body core temperature below 34°C. 2. Cardiovascular and respiratory system instability. Any trainee should be aware of the following terms: Tangential excision: Tangential excision of the superficial (burned) parts of the skin Epifascial excision: This technique is reserved for burns extending at least to the subcuticular level. Subfascial excision: indicated when burns extend vey deep and reach the fascia and muscles. It is needed only in special cases. Escharotomy: Indicated for third-degree and second degree deep dermal circumferential burns. This is used to prevent a soft tissue compartment syndrome, due to swelling after deep burn. An escharotomy is performed by making an incision through the eschar to expose the fatty tissue below. This can be illustrated in Figure 3.