Burns
Burn is a very complex and dynamic thermal injury, that similar to
frostbite, can involve both local (skin) and adjancent and deeper
structure
(muscle, tendon, nerve and bone).
Thermal injuries lead to tissue damage by reduction of blood
flow (ischemia) and tissue oxygen tension (hypoxia). Increased
capillary permeability causes swelling locally and in uninjured
surrounding tissue. Local blood coagulation and thrombosis closing
local capillaries are the major
factors of local tissue death (necrosis). The damage however continues
over the
days after the initial injury, because of the inability of the
surrounding tissue to supply
viable borderline cells with vital oxygen and nutrients for survival.
Failed microcirculation also cannot supply fluids to the injured area
causing dessication and progression of the wound in the deeper layers
prone to infection.
Severe burn
injury not only damages the skin but all the system in the body. As a
result of systemic response to inflammation and infection sepsis
develops which leads to shock and multiple organ failure such as lung,
intestinal and kidney failure. Main wound complications are deep
infection,
osteomyelitis, flap necrosis and failure.
Oxygen role
Many
burn centers have hyperbaric unit where main goal is to improve
the success of plastic surgery. Clinical studies show better
skin
graft survival and minimal scarring when oxygen therapy is used. Oxygen
effectively reduces
swelling, preserves the vaible tissue, reestablishing the
microcirculation, enhancing body's defence system an reducing the
infection rate. Very good review is found in
hyperbaric medicine text books (ref 1, 2). Out of hospitals centers,
such as ours, mostly deal with delayed complications of burn injury:
non healing wound and infection. If burned victim was caught in a fire
there could be also delayed complications due to carbon monoxide
poisoning (headache, etc.)
Benefits of
hyperbaric oxygen therapy in acute and delayed frostbite injury
- improves
tissue oxygenation
- reduces
tissue swelling
- improves
tissue micro-circulation by enhancing capillary growth
- enhances
wound healing (collagen formation and fibroblast proliferation)
- reduces
pain
- reduces
scarring
- reduces
and
prevents infection by
- inhibiting bacterial growth
- increasing activity of white blood cell to destroy
bacteria
- improving body's defense mechanism
- enables
quick demarcation of the necrotic tissue from the viable, so that part
of the involved tissue can be salvaged
- reduces the
need for surgical intervention
- improves skin graft survival
- reduces mortality due to systemic organ failure
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