i bc27f85be50b71b1 (141 page)

Table 7-7. Continued

..,

'"

00

Product

Description

Use

�

AlioDerm (Life Cell Corp.,

Permanent graft option.

For full�thickness burns

The Woodlands, TX)

Composed of chemically treared cadaver dermis with rhe

Also used in post-burn reconr;!

'"

epidermal antigenic cellular components removed so

srruction after contracture

'"

chat it is immunologically inert.

release

J:

>

Applied to a debrided burn with an ultrathin split thick�

Z

o

ness autograft immediately applied over if.

�

Integra (Integra Life Sciences,

Permanent graft option.

For life-threatening full

)1

Plainsboro, NJ)

Two�layered material composed of a disposable outer

thickness burns or deep

o

"

layer of silastic that acts as a barrier to evaporative

partial-thickness burns

Of

water loss and bacteria and an inner layer of bovine

i<1

collagen and chondroitin-6-sulfate that becomes

n

>

incorporated into the burn to form a neodermis. When

r

the neodermis becomes vascularized, the silastic

:ji

'"

covering can be removed and replaced with thin

5:

�

autografts.

�

Sources: Dala from SL Hansen, DW Voigt, P Wiebelhaus. eN Paul. Using skin replacement produces to treat burns and wounds. Adv Skin Wound Care 2001; 14:37�4; and P Dziewu!ski, JP BarreL Assessmenr, Operative Planning, and Surgery for Burn Wound Closure. In Sf Wolf, DN Herndon (ed,,), Burn Care. Ausrin, TX: Landes Bioscience, 1999.

BURNS AND WOUNDS 459

mal' be present postoperatively. The therapist should

become familiar with the surgeon's procedures and protocols and alter positioning, range of motion (ROM), therapeutic exercise, and functional mobility accordingly.

• The therapist should check with the physician to determine whether the graft crosses a joint and how close the graft borders the joint.

• If possible, observe the graft during dressing changes to get

a visual understanding of the exact location of the graft.

• The autograft site or donor site is often more painful

than the burn itself.

• Donor sites are oriented longitudinally and are commonly located on the thigh, low back, or outer arm and may be reharvested in approximately 2 weeks.

Nonsurgical Procedures

Burn cleansing and debridement may be performed many times a day

to minimize infection and promote tissue healing. These procedures,

as described in Wound Cleansing and Debridement, may be performed by a physician, nurse, or physical therapist depending on the hospital's or burn unit's protocol. Table 7-8 lists the topical agents

used specifically for the treatment of burns.

Physical Therapy Examination in Burn Care

Physical therapy intervention for the patient with a burn Injury IS

often initiated within 48 hours of hospital admission.

History

In addition to the general chart review (see Appendix I-A), the following information is especially relevant in the evaluarion, treatment planning, and understanding of the physiological status of a patient

with a burn.

• How, when, where, and why did the burn occur?

• Did the patient get thrown (as in an explosion) or fall during the

burn incident?

Table 7-8. Topical Agents Commonly Used for the Treatment of Burns

...

:;

Agent

Description

Advantages (A)lDisadvantages (0)

Silver sulfadiazine

Antimicrobial cream for use with parcial- and

A Painless application, wide spectrum coverage

§

=

(Silvadene)

full-thickness burns

D Poor eschar peneuation, may cause macer

&?

=

Applied with or without a dressing

ation and epithelial retardation, associated

'"

m

with leukopenia, costly

:t

>

Mafenide acetate

Antimicrobial cream for use with partial- and

A Penetrates eschar well, effective against

Z

=

c

(Sulfamylon)

full-thickness burns

Pseudomonas

8

Applied with a dressing

D Painful, nor for use on large areas, can cause

"

=

Can be applied directly to burns of the car

acidemia

o

'"

Actico3r (Wcstaim

Three-ply gauze dressing consisting of an

A Abrasion resistant, nonadherent, flexible

�

=

:t

Biomedical, Exeter,

absorbent rayon/polyester core and upper

D Cannot visualize the wound

=

�

NH) silver dressing

and lower layers of silver-coated, high

�

densiry polyethylene mesh

r

For use with partial- and full-thickness burns

J!

;::

and meshed autografts

>

�

Silver nitrate

Ami-microbial solucion or cream applied as a

A Wide spectrum coverage, painless

=

�

wct dressing

D Poor eschar penetration, frequent

=

Used for partial- and full-thickness burns

reapplication, stains the patient's skin and the

environment, can cause electrolyte imbalance

Bacitracin

Ointment effecrJve against gram-positive

A:;::: Minimal systemic absorption, painless, can be

organisms

used on the face

Used fot superficial and partial-thickness burns

o ::: Nephrotoxic in large amounts, no eschar

as well as dOll or sites

penetration, frequenr reapplication