Burn Surgery

1. Burn Wound Infection

Infection - Burn Wounds

• healthy skin protects against fluid/electrolyte loss, infection, radiation & provides thermal regulation

• dermis derives from mesoderm whereas epidermis derives from ectoderm

• epidermis normally grows by keratinocyte division & differentiation at the stratum basale w/migration progressively outward over 2-4 weeks (through stratum spinosum, granulosum, lucidum, & corneum)

• in wounds w/disrupted epidermis basal layer (i.e., superficial partial-thickness or deeper), keratinocytes proliferate & migrate from the wound edges & epidermal appendages (i.e., hair follicles, sweat glands, sebaceous glands)

• dermis heals by fibrosis & scarring (not regeneration)

• zones: burn injuries

  • coagulation: irreversible tissue damage (non-viable cells)

  • stasis: will heal vs necrose w/wo adequate perfusion (mixed viable/non-viable cells)

  • hyperemia: will heal w/out treatment (viable cells)