Burns and Skin Grafts

Marc Dolce, DPM
Department of Surgery
Ohio College of Podiatric Medicine
 

When you monitor a stock every day, the progress is never awe-inspiring. Yet the profit over a twenty-year period is usually pretty impressive.

July marks my 23rd year in private practice. Over this time I have seen phenomenal growth in Podiatric Medicine and Surgery. Many of our peers are treating devastating injuries to the ankle. Others are active members of wound care centers, deeply involved in Limb Salvage. Granted, the progress may seem “snail like” at times. Our associations still have a lot of work to do insuring that there are no barriers to our continued growth.

Dr. Marc Dolce’s lecture on Burns and Skin Grafts is another fine example of podiatrists treating injuries using cutting edge technology...something I never would have foreseen when I started out in 1981.

A burn is a thermal trauma to the skin. This is significant because the skin protects our internal environment and body structures from physical trauma as well as from invasions by foreign organisms.

Dr. Dolce familiarizes us with a new classification system for burns. This new system more clearly defines the extent to which the burn has affected the skin. “Partial thickness superficial” (1st degree) describes a burn that only affects the epidermis. “Partial thickness deep” (2nd degree) describes a burn that affects the epidermis and part of the dermis. A “full thickness” (3rd degree) burn includes the epidermis, the dermis, and the subcutaneous tissue.

The four Principles of Wound Care are discussed:

1)   Proper diagnosis/evaluation
2)   Immediate use of measures to lessen the effects of the burn by removing the caustic agent and cooling the area
3)   Protect and close the wound
4)   Rehabilitate properly

Dr. Dolce takes us through proper burn management...Cooling the area with sterile saline, washing the burn with soap and water, then applying topical creams such as Silvadene, which will suffice for simple partial thickness burns.

When treating advanced, full thickness burns, the astute physician must be familiar with appropriate lab values, tetanus prophylaxis, fluid replacement (to prevent hypovolemic shock), the potential need for escharotomy and temporary skin coverage with xenografts.  Proper antibiotic coverage is imperative in treating all burns.

Become familiar with Baxter’s rule , the Zone of Coagulation, and the Rule of Nines. Learn why full thickness burns are typically painless. See how compressive garments benefit the rehabilitative process.

Dr. Dolce then offers us a complete discussion of skin grafting. We review split and partial thickness grafts, as well as the role of meshing and fenestration.

Excuse my digression here, but I recall a time when I requested instructions before sodding a small area of my own lawn. The busy gentleman at the nursery simply replied “green side up” !  When performing split thickness skin grafting, Dr. Dolce kindly reminds us “Dermal Side Down”.
 

CLICK IMAGE BELOW TO VIEW LECTURE

VIEW LECTURE