الفهرس | Only 14 pages are availabe for public view |
Abstract urns of the front of the chest and abdomen and sometimes the front of the neck and axilla, mostly done in domestic accidents and are very common in Egypt. Following resuscitation and stabilization, management of the burn wounds becomes the next priority. The goals of reconstructive surgery for the burn patient are first to restore function, then to restore aesthetic appearances. The later effects of burns, which are related to loss of normal tissue and scarring, include limitation of movement, pain, disfigurement, and social embarrassment. In acute management of burns to the breast; the burn eschar should not be excised from the nipple areola complex, but should be allowed to separate spontaneously as healing proceeds from the deep glandular structures. The key to longerterm local burn care is scar management, which can be achieved through surgery and physical therapy. For burns to the breast during pregnancy, it is important to note that pregnancy, by itself, does not alter maternal outcome in burn injuries, and foetal and maternal survival correlate with the total body surface area burned. B Summary -172- It is suggested to use split-thickness skin grafts to reconstruct the burned anterior chest wall in young girls and prefer to delay reconstruction with flaps and release of contractures until after breast development. The reconstruction in the fully developed breast needs to take into consideration the restoration of nipple height, the adequate definition of the inframammary fold and the symmetry in volume, size, and shape of both breasts. It is suggested to use autologous tissue, either as a free or pedicled flap (with or without prosthesis insertion) to provide the optimal cosmetic result for restoring volume and shape. Various options are available for breast reconstruction with autologous tissue. These include the free transverse rectus abdominis myocutaneous (TRAM) flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, superior gluteal artery perforator flap, and transverse/vertical upper gracilis flap. In addition, pedicled flaps can be very successful in the right hands and the right patient, such as the pedicled TRAM flap, latissimus dorsi flap, and thoracodorsal artery perforator. A tissue expander or implant can be used to enhance the results if the autologous tissue is insufficient. Asymmetry is best addressed by performing a breast reduction of the larger breast in cases of a unilateral burn and impaired breast development. Reduction mammoplasty can also be done in postburn deformities of the large both breasts . Summary -173- A second staged procedure to reconstruct the nipple papilla should follow breast volume and shape restoration. Local tissue is typically used to form the papilla. Once the scar is mature, tattooing provides an excellent option to enhance the appearance of the nipple areola complex . The ultimate goal of burn care, beyond survival and functional restoration, is to restore the quality of life and the potential for productive lives. It is also clear that exercise after hospital discharge is critically important for facilitating physical functional and metabolic recovery following a major burn injury. Scientific advances in treating acute burns have led to a marked increase in the number of victims surviving massive burns. As the number of females living with burns has increased, so too has concern for the psychosocial outcomes and interest in action to enhance quality of life for burned female. |