Annals oj'the MBC - vol. 3 - n' 3 -
RELATIVE TO THE IMPROVEMENT OF BURNS MANAGEMENT
Reda Mabrouk AW.
Burns and Plastic Surgery Unit, Helipolis, Cairo, Egypt
management of burn injuries is still difficult because of a number of as yet unsolved
problems. The physician must therefore constantly bear in mind certain basic principles
concerning prevention, first aid, early management and reconstruction. These are
considered in detail and various practical advice is given.
We continue to face difficult problems in
the management of serious burn injuries. The difficulties may be due to the extent and
depth of the injury or to our negligence or ignorance of the basic principles of the type
of injury. Improving our management depends on keeping these basic principles in mind.
Examples are given in this paper.
- Prevention: a detailed analytical study of statistical
aetiological data should be the basis of our antiburn campaign and of further development
of precautions taken in dealing with the causative agents.
- First aid: this entails the study of body response to heat.
The immediate use of water is the result of basic studies on the effect of time of heat
exposure on living tissues.
- Early management: this should be based on:
- skin function: protection, fluid and electrolyte balance,
regulation of body temperature, excretion, secretion, vitamin D production, appearance and
sensation. Study of these facts shows that the skin is the most important system in the
body. Loss of pall of it will result in mortality or morbidity depending on the surface
- accurate diagnosis: extent and depth of the burn, and age
and clinical history of the patient;
- accurate knowledge of microbiology and pathology. Study of
these three basic principles requires the adoption and improvement of the following steps
- early replacement of lost fluids and elements during the
emergency period. Clinical and laboratory studies are the basic principles of difterent
formulae for replacement therapy, responsible for saving the lives of moderately and
extensively injured patients;
- to save the patient the complications of the loss of skin
functions, immediate or early excision of burned skin and skin grafting is the line of
treatment now agreed upon. In extensive burns the use of homografts as biological
dressings is mandatory in saving lives;
- study of the incidence, eftect and complication of sepsis
is our basis for improving aseptic techniques both in dealing with the patient and in the
construction and administration of burn care facilities;
- study of metabolic, endocrine and blood changes is vital to
overcome the factors known to inhibit healing. As yet we know nothing that improves
healing, but we are acquainted with factors antagonizing healing, and these should be
corrected and treated.
Metabolic studies show an increased
metabolic rate in burn patients. 40% S.A. burns maintain maximal or near maximal rates of
catecholamme synthesis and utilization. This is the basis of maintaining patients in an
ambient comfort temperature of 27-31 'C. A negative nitrogen balance indicates
hyperalimentation. Correction of anaemia is mandatory for improving healing power.
- Reconstruction: knowledge of the basic principles of
plastic reconstructive and aesthetic surgery is essential for improving our techniques of
restoring function and appearance. Detailed studies of peripheral blood vessels and nerves
are the basis of the great improvement achieved during the last decade in different types
of cutaneous, muscular, musculocutaneous and fasciocutaneous flaps. However, the basic
principle that we have to remove what is abnormal and put what is normal in its normal
position should always be borne in mind. For the correction of post-burn contractures, all
fibrous tissue should be excised and the same type of tissue, whether graft or flap,
should be replaced.
- Social, psychological and economical studies of each case
are basic to the improvement of our early and late management and to rehabilitation.
RÉSUMÉ. La gestion des brûlures continue
à être difficile à cause de divers problèmes qui ne sont pas encore résolus. Le
médecin doit donc toujours se souvenir de certains principes de base pour ce qui concerne
la prévention, les premiers secours, la gestion précoce et la reconstruction. Ces
principes sont considérés en détail et lAuteur fournit nombreux conseils.
- Artz, Moncrief & Pruitt: "Burns, a team
approach", W.B. Saunders Company, 1979.
- Feller L, Archambeault-Jones C.: -Teaching basic
burn care", The National Institute for Burn Medicine, 1975.
- Wallace A.B.: "Research in Bums", E. &
S. Livingstone, Edinburgh, 1966.