burn rehabilitation

Burn Rehabilitation

Braddom Chapter 58

Alireza PishgahiDecember 2012

Burn Wound Subtypes

TBSA

Lund & Browder

The rule of 9.

Every one’s palm is equal to 1% of TBSA.

Acute Surgical Procedures Avoid compartment syndrome Wounds have to remain open after escharotomy. Extremities should be elevated and in neutral position for 24

hrs before ROM exercise.

Debridement & autologus skin grafting

Reduce infection Increase survival

Nutrition in Burns

Daily calorie need: (25 kcal/kg) + (40kcal plus TBSA)

Serum pre-albumin

Dysphagia More TBSA More days with tracheostomy More days under ventilator

Catabolism

TBSA >30%Increase insulin resistanceReduce bone mineral densityReduce lean body mass

catabolism Increase pneumoniaPoor wound healing

Beta-blockers(Propranolol)

Anabolics (Oxandrolone)

ExercisePassive(spilnting/

positioning)Active ASAP

Dressing & Hydrotherapy More trends toward

hydrocollid,biosynthetic, antimicrobial dressings for superficial and partial-thickness wounds.

Hydrotherapy increase G-negative infections such as Psudomonas.

Positioning

Splinting

To reduce intrinsic-minus deformity

Functional position

Complications- inhalation injury

Increase mortality in children/ elderly.

Susceptible to ARDS/pneumonia/MOF

Early tracheostomyDo not affect pulmonary outcomeIncrease oral hygiene level

Complications- inhalation injury

EtiologyThermal injury/ electrical injury/ compression/ metabolic

imbalance

More TBSA & deeper burnAxonal lesion is more frequent than demyelinating injury

Most commonMedian sensory neuropathy

Complications- inhalation injury

Complications- Hypertropic Ossification

TBSA>30% Most common site is below elbow

Best treatment or prevention is not yet clear.

Bisphophonat agents(Etidronate)Recurrence is common even after surgery and postoperative

passive mobilization.

Complications- Hypertropic Ossification

Complications- Hypertrophic Scarring

Most common complication in burn injury

Raised/ red/ painful/ pruritic/ contractileDoes not cross injury line(in apposition with Keloid)

Most susceptible groupAdolescent/ darker skins/ inflammatory wounds with

prolonged healing/ open wound more than 3 weeks

TGF-β

Complications- Hypertrophic Scarring

Prevention is the best treatment.

First line treatmentMoisturizing creamsReduce mechanical insultsAvoid heat and sunburn

Complications- Contractures

Most common in shoulder/elbow/knee

Massage/splint/stretch/proper positioning /ROM exercise will reduce contractures

To reduce pruritus in scarsTopical: Diphenhydramine/ Doxepin/ GabapentineOral: Diphenhydramine/ Doxepin/ Gabapentine/ NaltroxeneNon-pharmacologic: Massage/ TENS/ LASER

Inpatient Rehabilitation

Functional Independence Measure<110

مشاوره بخش سوختگی مردان

% اندام های تحتانی 30 ساله ایW با سوختگی حدود 43آقای در این بخش بستری می باشدو لطفا جهت انجام

فیزیوتراپی بیمار را ویزیت نمایید.Proper positioningActive ROM of all joints of lower limbsStretch for hamstring and calf muscles

TENS?Massage?