November 20, 2014

Tap Water and Scald Burns (part I)

One of the most common causes of burn injuries is scald injury. Hot water scalds is a common cause of scald injury in which a short exposure time can result in severe burns depending on the water temperature. Most scald burns happen in the home from exposure to hot water in the sink, showers or bathtubs. Scald burns can also happen at restaurants and other places. Scald burns can happen to anyone, the severity depends on the temperature of the liquid and the duration of exposure.

Scald burns can happen to anyone but there is a vulnerable population which can be affected that includes young children, elderly people and people with disabilities. Many people are unaware that it needs a short exposure period to hot tap water to cause serious burns. People at high risk of developing scald burns are:

  • Young children have thinner skin, this results in deeper and more severe burns. Children have greater body proportion that is exposed to a scalding substance.
  • Elderly people have thinner skin leading to deeper and more severe burns. Elderly people may also have other medical conditions that make them more liable to fall in the bathtub as well as decreased sensation of heat and poor microcirculation leading to slow release of heat from the burned tissue.
  • People with physical and cognitive disabilities
  • Crowded families and families with low socioeconomic status
  • Single parent and parents with poor education.
As a standard, the maximum temperature of water delivered to the tap by residential water heaters is 120 degree Fahrenheit (48 degree Celsius).

Temperature/scald burn:

113°F (45°C) lead to second degree burn in 2 hours and third degree burn in 3 hours
116.6°F (47°C) lead to second degree burn in 20 minutes and third degree burn in 45 minutes
118.4°F (48°C) lead to second degree burn in 15 minutes and third degree burn in 20 minutes
120°F (49°C) lead to second degree burn in 8 minutes and third degree burn in 10 minutes
124°F (51°C) lead to second degree burn in 2 minutes and third degree burn in 4.2 minutes
131°F (55°C) lead to second degree burn in 17 seconds and third degree burn in 30 seconds
140°F (60°C) lead to second degree burn in 3 seconds and third degree burn in 5 seconds

Hot beverages like coffee and tea are usually served at 160-180°F (71-82°C) and can cause instant burns when falling on the skin, these burns will require surgery.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.


November 18, 2014

Severe Burns and Cellulitis (Part II)

Predisposing factors:

  • Burns (second degree and third degree burns).
  • Skin diseases such as boils, eczema and psoriasis.
  • Weak immune system such as in AIDS and patients using immunosuppressive drugs.
  • Diabetes. (feet burns in diabetic patients)
  • Old age.
  • Diseases affecting the circulation of blood to the lower limbs such as varicose veins.
  • I.V drug abusers.
  • Varicella.
  • Dense populations who share hygiene facilities and common living quarters such as nursing homes, homeless shelters and college dormitories.
Clinical features:
  • The area affected is red, tender and swollen.
  • Increased warmth in the affected area.
  • Regional enlargement of lymph nodes may be present.
  • Fever, headache, nausea and chills may be present.
  • Red streaking visible in the skin proximal to the area of cellulitis may be seen.
  • Abscess.
  • Ulceration.
Diagnosis:
  • No work up is needed in uncomplicated cellulitis and the diagnosis is based on the clinical features.
  • In complicated cases, cases with generalized sepsis and when any of the predisposing factors are present, the following tests may be done: Complete blood count, Blood culture, Blood urea nitrogen and creatinine level, US and others.
Treatment:

Cellulitis is potentially serious as it spreads quickly and can lead to more serious complications. If it is not treated, the infection can spread to the blood or lymph nodes and in rare cases the infection can spread to the fascia which is the deep layer of tissue causing a disease called Necrotizing Fasciitis (flesh eating bacteria) which is a medical emergency that can lead to death. Treatment of cellulitis include:

  • Rest of the affected area.
  • Antibiotics: either oral or intravenous depending on the severity of cellulitis, the presence of risk factors and presence of complications.
  • Pain killers.
  • Debridement of the dead tissue.
  • Hyperbaric oxygen therapy may be used in some cases.
Prevention:

Prevention is done by taking a good care of cuts, wounds and burns, if you develop signs and symptoms of cellulitis, seek medical help quickly to avoid complications. (see burn wound care at home)

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

November 13, 2014

Severe Burns and Cellulitis (Part I)

The skin is the first line of defense against infection, it is composed of three layers, the epidermis, the dermis and the subcutaneous tissue layer (see the skin). Infection is the leading cause of death among hospitalized patients with burns. Normally the surface of the skin contains a mixture of microorganisms called normal skin flora, these flora live on the surface of skin and cause no disease unless the skin is damaged and/or the immune system is compromised. (see wound infection)

Cellulitis is an infection of the dermis and the subcutaneous tissue layer of the skin, cellulitis can be caused by normal skin flora or by exogenous bacteria, where in most cases the skin has previously been broken such as:

  • Second degree and third degree burns which lead to blister formation that can open and become infected.
  • Cracks in the skin.
  • Cuts in the skin.
  • Sites of intravenous catheter insertion.
  • Surgical wounds.
Cellulitis can affect any part of the skin but it commonly affects the skin on the face or the lower legs.

Causes:
The most common bacteria causing cellulitis is Group A Streptococcus and Staphylococcus aureus, both of them are part of the normal flora of the skin and are harmless when they are on the outer surface of the skin but cause infection when they enter the skin. Group A Streptococcus is found on the skin and the throat while Staphylococcus aureus is found on the skin and the mucosa (lining) of the nose and mouth. Other exogenous bacteria can cause cellulitis and in some cases people get cellulitis without a break in the skin.

Kramer and Pollack, LLP; are VERY well versed in all aspects of representing burn injury victims. They have handled a multitude of burn injury cases ranging from hot water scald burns, to stove tipping cases to explosion cases. They are competent, experienced and very thorough

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.


November 11, 2014

Physical Therapy and Third Degree Burns

The aim of physical therapy is to improve the movement and function of the affected area and to prevent and minimize scarring (hypertrophic, Keloid) as much as possible. Once the patient has sustained a burn injury such as a second or a third degree burn, the rehabilitation phase should begin as soon as possible.

Physical therapy usually starts at the time of admission; the patient will be assessed by a team of therapists who are part of the burn care team and rehabilitation will start accordingly.

Physical therapy may include:

  • Body and limb positioning.
  • Exercises: they are either active exercises done by the patient himself or passive exercises done by the physical therapist moving the area involved.
  • Splints: splint will be fitted by your therapist and need to be worn as instructed, if you develop an allergic reaction such as redness, blistering, itching, numbness or abnormal sensation when wearing the splint than you have to remove it and contact your therapist immediately.
  • Orthotic devices: some patients may need to use orthotic devices.
Physical therapy may be hard in the beginning because of the pain that is associated with the burn and surgeries, the sensitivity of the skin and the fear that the patient have. In children doing physical therapy may be harder; parents play an important role with the team in encouraging the child, helping him/her with their therapy and praising them.

Some patients will be transferred to a rehabilitation center after discharge from the burn center to continue their rehabilitation, the duration and type of therapy will depend on the condition of the patient and the severity of the burn.

Patients may be discharged home with instruction to continue physical therapy at home; compression garments may be given and used with exercising.

For some a physical therapist will be assigned to them making home visits, if exercises are given to you by your therapist, it is important to do these exercises and increase your home activities as advised by your therapist.

Make sure to follow all the orders and instructions given to you, it may be hard in the beginning, you may get tired and frustrated but you have to remember that it is for your benefit and will become easier with time, the aim of the therapy is to restore the normal daily activities as much and as soon as possible and to prevent any deformities.

Make sure to attend all outpatient follow up appointments with the burn clinic as your physicians and therapists will monitor your progress and adjust what needs to be adjusted for you.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

October 2, 2014

Carbon Monoxide Detectors

Carbon monoxide (CO) is a colorless, odorless and tasteless gas. It is quite toxic to humans and other oxygen-breathing organisms. Carbon monoxide poisoning happens when enough carbon monoxide is inhaled. (See carbon monoxide poisoning)

Low levels of carbon monoxide are always present in air. It can also be produced from incomplete combustion of flame fueled devices such as fireplaces, furnaces, stoves, vehicles, space heaters and others.

Breathing carbon monoxide fumes decreases the blood's ability to carry oxygen. Low levels of oxygen can lead to cell death, including cells in vital organs such as the brain and heart.

A carbon monoxide detector is a device with an alarm that is designed to detect elevated levels of carbon monoxide, the detectors can be AC powered, battery operated or hardwired. The AC powered unit may have a battery backup. As the weight of CO is almost identical to the weight of normal air, the detector can be installed near the ceiling or on a wall. The detector shouldn't be placed near a fireplace and shouldn't be installed near a smoke detector so that you are able to distinguish between a CO and a smoke detector alarm when there is an emergency situation.

CO detectors should be present in every home and each level needs a separate detector. If you have one CO detector it should be installed near the sleeping area and make sure that the alarm is loud enough so that you can wake up when it sounds.

When the alarm sounds, don't panic, try to stay calm because the alarm is intended to sounds before you experience symptoms. Evacuate the house, gather all the members of household out to a safe area where there is fresh air. Check if anyone is experiencing symptoms of carbon monoxide poisoning (see CO poisoning), if yes than call 911. Ventilate the area and identify the source of the carbon monoxide and make sure that your appliances are checked by a professional as soon as possible.

Prevention of CO poisoning:

  • Install a carbon monoxide detector on each floor of your home. Test and replace the detector according to the instructions of the manufacture, check the batteries according to the manufacture instruction.
  • Check the battery once per year.
  • Inspect and properly maintain heating system, chimneys and appliances.
  • Use non electrical space heaters only in well ventilated areas.
  • Don't use a gas oven or stove to heat your house.
  • Don't burn charcoal inside your home, garage, tent or camper.
  • Don't leave cars running inside the garage.
  • If you are using a kerosene heater indoors, make sure there is good ventilation

When buying a CO detector consider the location you want to install the detector in, the power source and the installation ease.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

September 17, 2014

Pressure Ulcers (Part II)

Treatment:

  • Treatment of pressure ulcer starts by identifying and managing the underlying cause.
  • Relieving pressure by changing position and using pressure relieving mattresses or cushion is important for healing.
  • The treatment of a pressure ulcer depends on the stage of the ulcer. When the skin is intact, removing the pressure will allow the pressure ulcer to heal.
  • Pain medication may be used when the pressure ulcer is painful.
  • When the skin is broken, the protective barrier is no longer present leading to an increased risk of infection; antibiotics may be used when there are signs of infection (see wound infection).
  • When dead tissue is present, it should be removed by debridement as dead tissue increases the risk of infection and interferes with healing.
  • Cleansing the wound and dressing changes are important in decreasing infection.
  • Special dressings can be used to promote healing of pressure ulcers.
  • Deep ulcers especially those beyond stage 2 may be difficult to treat and if they are deep, they may require surgical repair.
  • Transplanting healthy skin to the affect area may be needed in some cases (see skin graft).
  • Topical negative pressure therapy (suction) may be used in some cases.
  • Your health care provider will decide what the best treatment options for you are and will assess the healing progress.
  • Healing time varies from days to months and some may not heal especially when there is an associated illness.
Prevention:
  • Frequent changes in the patient's position, turning them every 2 hours in bed and every 30 to 60 minutes in a chair.
  • Checking the skin every day for redness, bruises and blisters and documenting the findings.
  • Keep the skin clean and avoiding dryness by using moisturizers.
  • Adequate fluids, protein, vitamins and minerals should be encouraged and correction of malnutrition when present.
  • Using foam cushions or pads or other supporting devices on the beds and chairs, ask your healthcare provider about the one that is suitable for you. Donut shaped cushions are not recommended as they may interfere with the flow of blood.

Complications of pressure ulcers:

  • Septicemia which is spread of infection from an infected ulcer to the blood.
  • Bone infection (osteomyelitis) from an infected ulcer.
  • Amputation of the limb in severe cases.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.
September 11, 2014

Pressure Ulcers (Part I)

Also knows as bedsores, pressure sores and decubitus ulcers. Are areas of skin and underlying tissue damage that happens when the skin and underlying tissue over a bony prominence is compressed between that bony prominence and an external surface for a prolonged period of time, the unrelieved pressure on the skin and underlying tissue will lead to compression of the blood supply to that area, as a result of the decreased blood supply and oxygen the skin begins to die forming an ulcer. Friction of the skin created by the body sliding over a bed sheet, etc contributes also to the skin injury and the formation of ulcer, too much moister such as sweat and urine may also contribute to the formation of an ulcer. Although pressure ulcers can happen anywhere in the body, the hip, heal and buttocks are common sites.

Risk factors for pressure ulcers:

  • Persons at a high risk of developing pressure ulcers are those who are immobile due to an injury or an illness. Any injury or illness that leads to immobility or causes the patient to be bedridden for a long time will increase the risk of pressure ulcers.
  • Persons who have decreased or absence sensation due an injury or illness are also at risk.
  • Older persons have a higher risk because of their increased incidence of debilitating diseases and the thinning and fragility of their skin.
Signs and symptoms of pressure ulcers:

Depending on the severity, pressure ulcers are classified into four stages:

Stage 1: The skin is intact with pink or red coloration that doesn't blanch with pressure; skin may be itchy, painful and may feel worm to the touch.
Stage 2: Partial thickness skin loss. There will be blistering or an open sore (ulcer), the area is red, painful and swollen, dead tissue may be present.
Stage 3: Full thickness skin loss, crater like ulcers are present that extends to the subcutaneous tissue.
Stage 4: Full thickness skin loss with the involvement of muscle, tendon, bone or joint.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

September 10, 2014

Burn Wound Care at Home

Wound care at home is an important factor in the continuation of wound healing. A patient may come home with unhealed areas that still require wound care.
Dressing change and bathing:


  1. It is important to wash the hands with soap and water before and after dressing changes.

  2. Put surgical gloves on both hands.

  3. If dressing change is painful, pain medications might be needed (consult with your doctor), pain medications if needed have to be taken 30 minutes before changing the dressings to give them time to work.

  4. Dressing change may be done during bathing (ask your doctor if you can shower or bathe).

  5. Remove the old dressings carefully. Taking care not to disturb scabs on healing process.

  6. Look for any signs and symptoms of infection.

  7. Use lukewarm water, wash the wound gently with soap and water, use mild non deodorant soap (such as Dove), if you have used creams or ointments, make sure that you have removed all of it by using a clean white wash cloth (avoid using any cloth that contain dyes as it may be irritating to the skin).

  8. Dry the skin, apply creams, ointments, if they were given to you (consult your doctor for the type of creams and ointments).

  9. Cover the wound with a clean, dry dressing (consult your doctor for the type of dressing)


When Bathing a Child:

  1. Make sure that the hot water tank temperature is set below 120 degree F so that very hot water cannot be turned on accidentally.

  2. Make sure that the area where bathing is taking place (shower or tub) is clean.

  3. Fill the tub BEFORE placing child in the water, make sure the water is not too hot.

  4. Have a specific clean area where you will always perform the dressing change, make sure you have all the supplies needed for dressing change and have a place where you store them.

  5. Always look for signs and symptoms of infection especially in children as they may not be able to express what they feel.

  6. Contact your doctor immediately if there are any signs and symptoms of infection.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

August 15, 2014

Smoke Inhalation Injury

Smoke inhalation injuries are caused by inhalation or exposure to hot gaseous products of combustion, this can cause serious respiratory complications, and it is the primary cause of death in victims with indoor fires.
In these injuries diagnosis is not always easy and symptoms may not appear until 24-48 hours after the exposure, that's why it is important to immediately evaluate any person with suspected smoke inhalation.
Children under the age of 11 and adults over the age of 70 are most vulnerable to the effect of smoke inhalation; firefighters are at a great risk for smoke inhalation because of their occupation.

Smoke inhalation injuries are related to three causes:


  • Inhalation of carbon monoxide or cyanide (used in construction material) will impair or reduce the level of oxygen at the tissue level. This will manifest as shortness of breath and blue-gray or cherry-red skin color, carbon monoxide poisoning can appear symptomless up until the point where the patient becomes comatose. It is an immediate threat to life and is treated with 100% oxygen.

  • Hot gases cause heat injury by causing burns to the upper airways. Signs of heat damage are singed nasal hears, burns around and inside the nose and mouth, and internal swelling of the throat.

  • Inhalation of toxic gases and the products of combustion may cause irritation and chemical injury to the throat and lungs. This will manifest as noisy breathing, coughing, hoarseness of the voice, black or gray sputum, and fluids in the lungs.


Treatment:

  • Contact your doctor immediately whenever smoke is inhaled for more than a few minutes.

  • Treatment varies depending on the severity of the damage. The first step in the treatment is to maintain an open airway and supply adequate oxygen. The patient may be given 100% humidified oxygen through a mask if the airways are patent (intact) and the victim is stable. Oxygen is often the only treatment necessary. However other modes of treatment may be needed such as bronchodilators, suction, endotracheal intubation, chest physiotherapy, adequate fluid and antibiotics if there is infection.


Prognosis:
The prognosis for recovery is usually good with adequate medical treatment however the outcome depends on the severity of the smoke inhalation, if there were accompanying burns, injuries or medical conditions.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

August 13, 2014

Burns And Itching

Most patients who suffer from burn injuries usually experience itching at some point during the healing process. Itching is one of the most problematic and distressing issues that the patient's experience. It can vary in severity from one patient to the other and it can be severe that it interferes with sleeping, eating, moving and quality of life.

Itching usually starts during the healing process. It is usually worse at night, probably due to decreased movement and pain. It is increased with anything that increases the temperature of the body, for example activity on hot weather (because of the increase of histamine release which is one of the mediators for itching).

Itching can be decreased by:


  1. Keeping the burned area moist using skin moisturizers (check with your doctor first).

  2. Cool baths or cold compresses.

  3. Antihistamines like Benadryl.

Avoid the following:

  1. Dryness of the skin.

  2. Creams and moisturizers that contain perfumes as they may irritate the skin.

  3. Excessive heat as it may aggravate itching.


Itching may last for several months or even longer and usually diminishes with time.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

July 24, 2014

Global View of Burned Patients

Burns are one of the most devastating and serious injuries that can happen in a person's life, not for the victim only but for the relatives as well. Depending on the severity of burns, some of them may need to be referred to the hospital for treatment such as second and third degree burns
The initial contact of the victim with the burn service starts usually with the Emergency Department, and perhaps it's the only injury that need specialist treatment by a team of medical, surgical and nursing personnel who have a specific specialization. The Emergency department may be confusing for both the patient and the relatives; on the other hand the arrival of the patient to the emergency department is one of most dramatic events in the surgical practice.

Sometimes an atmosphere of tension is created in the emergency department due to the pain and fear of the patient and his/her relatives, the magnitude of the injury and the visibility of the damage therefore it's important for the patient and the relatives to stay calm as much as they can and to interact with the medical and surgical team treating the patient as they play an important role in the healing process of their patient.

The duration that the patient needs to stay in the Emergency Department varies from one patient to another, some patients stay for a short period of time while others may need to stay for a long time (several hours) for the evaluation during which the staff will provide the patient's relatives with updates on the patient's condition. The family of the patient should not hesitate or feel intimidated to ask any question they have regarding their patient as for some of them this is a new experience they haven't gone through before.

Following the evaluation and depending on the patient's condition, some patients are discharged home while others are admitted to the hospital or transferred to a specialized burn center for further treatment.

The criteria for transferring a patient to a burn center may include:

  • Burns involving the face, eyes, hands, feet, genitalia, perineum or major joints.
  • Third degree burns regardless size of burn and age of the patient.
  • Partial thickness burn 5-10% total body surface area.
  • Chemical burns.
  • Electrical burns including lightning injury.
  • Patients with burns who suffer inhalation injury.
  • Patients with preexisting medical condition that can complicate the burn injury and prolong the recovery process.
  • Burns in children in whom the hospital is without qualified equipment or personal to care for the child.
Family members are encouraged to ask questions and seek explanations regarding the condition of their loved ones. Family members are also encouraged to take care of themselves by getting enough nutrition and rest besides leaving the hospital when possible. The team caring for the patient gives frequent reports to immediate family members regarding the condition of the patient.

The burn is not a superficial and localized injury affecting only the skin; it's systemic and affects most systems in the body therefore there are 2 teams involved in the treatment of burned patient. The Surgical and the medical teams. The surgical team is responsible for caring of the burn injury in all its aspects. The medical team is responsible for the general condition of the patient not only the burn. Victims of burn injuries may be eligible to receive legal compensation for their pain, suffering, medical bills, and physical damage.

Kramer and Pollack, LLP: are VERY well versed in all aspects of representing burn injury victims. They have handled a multitude of burn injury cases ranging from hot water scald burns, to stove tipping cases to explosion cases. They are competent, experienced and very thorough. Your initial consultation is always free, and you won't need to pay any attorney fees until they help you win monetary compensation.

One of the cases they handled involves an infant who was burned as the result of domestic hot water that measured 158 degrees Fahrenheit. She suffered 2nd and 3rd degree burns over 20% of her body. She was hospitalized for one month. Debridement and skin grafting was done. She developed an infection and she passed away. A case was brought against the landlord for the excessively high water temperature and the medical professionals who failed to diagnose and treat the infection that caused her untimely death.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.


July 15, 2014

Laser Skin Burns After Hair Removal

Laser hair removal is one of the medical procedures used to remove unwanted hair from the skin. Laser simply works by distinguishing color differences between the hair and the skin, it goes and hits the darker color area which is the hair, leading to heating of the hair follicle and destroying it making it unable to grow new hair.

This procedure has become more popular over the years, and although laser hair removal is relatively safe in the hands of an experienced technician, side effects may occur. These side effects may range from skin swelling and redness to skin burns and even scaring (replacement of normal skin with fibrous tissue).

Skin burns occur either due to the prolonged use of the laser on specific areas or may result when the intensity of heat is too high. The skin will absorb the laser energy which may lead to skin burns. These burns are usually minor burns but severe burns may also occur ( Second degree burns and third degree burns). Seek medical attention if the burn doesn't heal or it takes a long time healing.

Other side effects of laser hair removal may include:

Redness, swelling, slight pain, infection, bleeding, color change in the form of darkening of the skin (hyperpigmentation) or lightening of the skin (hypopigmentation).

Before going through a laser hair removal procedure, make sure you discuss all the other options available. You should discuss all the concerns and questions you have with a laser specialist, he/she should be able to answer all your questions, explain all the risks associated with the procedure and tell you if you are an appropriate candidate for the procedure. The success of the procedure depends on how much experience and training the technician/specialist has.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

July 14, 2014

Keloid Scar

A keloid scar is a type of scar that results in an overgrowth of tissue at the site of healed skin injury due to aggressive healing process. This type of scar grows and extends beyond the site of injury unlike hypertrophic scar. They occur as a result of the body's continuous production of collagen which is a fibrous protein after the healing of the wound.

They often appear red or pink in color as compared to the surrounding normal skin. They are firm, rubbery lesions; they may appear shiny or as fibrous nodules. Keloid scars may be accompanied by severe itching, pain and may limit mobility if they are extensive. They may vary in size and some types may increase in size. They may occur anywhere on the body although some areas are more susceptible to form keloid scars such as the deltoid region. They occur more often in darker skinned patients.

Treatment:

The treatment of keloid scar varies and the recurrence after treatment is common. Treatment may include:

  1. Steroid injection: this involves injecting steroid into the keloid scar, it may help to reduce the size of the scar and decrease itching and redness that may be associated with these scars. It may be used with other procedures like surgery.
  2. External pressure therapy: eg, compression garments.
  3. Cryotherapy: this involves freezing the keloid scar with a medication.
  4. Surgical therapy: is used if the keloid scar is not responsive to nonsurgical treatment.
  5. Laser surgery: this method involves the use of different lasers depending on the underlying cause of scar. It may be used to smooth the scar, remove abnormal color of a scar, or flatten a scar. This method is often done with other methods like steroid injection.
  • Keloid scars have the tendency to re-occur and multiple treatments may be required.
  • It is important to follow your doctor's instructions, if you have been prescribed compression garments, it is important to wear them for 23 hours a day (taken off only when bathing), as they can minimize scarring. If you were taught any exercises than you have to do them as they will minimize the scarring.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

July 11, 2014

Skin Graft

It is a surgical procedure which involves the placement of a piece of healthy skin in areas where the skin is damaged. It is usually done in an operating room under local or general anesthesia depending on the size of the graft.

Skin grafts can be classified into:

  1. Autografts: where the skin for the graft is taken from the same person.
  2. Allograft: where the skin for the graft is taken from another person.
  3. Xenograft: where the skin for the graft is taken from animals (usually pigs).
A skin graft can be partial thickness where the first two layers of skin are taken, or full thickness skin grafts where the entire thickness of skin is taken which is done in patients with deeper tissue loss.
  • The area where the healthy skin is taken from is called the donor site.
  • The donor site can be any area of the body; it is usually in areas hidden by clothes like the inner thigh.
  • The area which receives the healthy skin is called the recipient site (the graft site).
The donor site will be covered with a dressing for the first one to two weeks. It usually heals within 10-14 days. Lotion is applied to the donor site after the dressing comes off.


For the recipient site (graft site) the dressing is left in place for two to five days before it is changed. The area is very fragile and great care should be taken to ensure that it is protected from trauma and heavy stretching for two to three weeks.

Complications:

  1. Infection.
  2. Bleeding.
  3. Graft failure.
  4. Graft rejection.
  5. Scarring.
  6. Skin discoloration.
  7. Chronic pain.
  8. Change in the sensitivity of skin.
Future care:

It is important to take care of the graft area by protecting it from excessive sun exposure, protect it from dryness (use ointment or creams after consulting with your doctor).


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

July 10, 2014

Burns And Fluid Replacement

When a person is burned and depending on the severity of burn, the blood vessels including the capillaries may be affected. Combined with the release of chemical substances into the blood, this will lead to increased capillary permeability to fluids, leading to the leaking of fluids from the blood vessels into the tissues. The higher the percentage of burned skin, the more severe the loss of fluid will be and the greater the dehydration will be.

Fluid replacement is one of the important objectives in the initial treatment of burned patients. The amount of fluid needed and the method of fluid given depends on the surface area of the skin burned as well as other factors. There are many formulas used for fluid resuscitation; one of them is called the Parklund Formula in which after the amount of fluids is calculated, it is given through an IV route and the type of fluid is usually Ringer Lactate. Urine output (0.5 ml/kg/hour in adult and 1 ml/kg/hour in children) is one of the methods used to evaluate adequate fluid resuscitation.


  • Fluid is replaced to prevent hypovolemic shock and other associated complications such as kidney failure.

  • Patients with minor burns can be resuscitated with oral rehydration therapy. You have to make sure that your child is taking enough fluids, is not vomiting and that he/she is producing a satisfactory amount of urine.

  • Ringer lactate is usually given because it's composition is most like normal extracellular fluid.

  • Fluid that leaks from the burned area can accumulate in the burned area only if the burned area was small; if the burned area was large this may lead to accumulation of fluid everywhere in the body.

  • Edema (accumulation of fluid in bodily tissue or body cavity) may become worse after fluid resuscitation and if this edema is in a compartment (closed space of nerves, muscle tissue and blood vessels) covered by dead tissue as a result of the burn which is inelastic and can't expand, this edema may lead to compression of the blood vessels in the compartment leading to compression of circulation in which escharotomy may be needed to release that pressure. It is advisable to watch the burned areas, especially in the extremities, for signs of decrease blood flow to the affected area (see Escharatomy) after fluid resuscitation.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.