Dr. Jorge VillegasServicio de QuemadosHospital de Urgencia Asistencia PúblicaInstituto TraumatológicoClínica INDISASantiago. CHILEwww.cirugiaplasticayquemados.cl

"Sequelae of burns,

traditional and emerging issues

in a developing country”

Burn injuries and their sequelae are, in our countries,a major health problema major social medical problema challenge for plastic surgery

The incidence of burns is related to ►Life conditions►Lifestyle

The treatment of burned patiens is►Difficult►Long►Expensive

Burn frequency and severity are greater Resources are minor

Resources are required to

FundingFacilitiesHuman resourses

►Prevention, ►Acute phase treatment►Rehabilitation►Sequelae surgical treatment

Traditional approach

Sequelae Surgical treatment. After the acute phase.During rehabilitation stage.

Following cases …

improving facial expression

Respecting Aesthetics UnitsDebridement to healthy tissue

Changing the skin graft of dorsum of the hands. Improving function

Recover the extension

Full thickness skin graft

Reverse abdominoplasty

Mastoplasty

Trunk extension limited

Breast and abdomen sequelae

Improving skin coverage of thorax in a girl before puberty.

Tissue Expander

Planning the progress

Complementary expansion

Lateral Abdominoplasty

Latissimus dorsi flap

Lateral trunkextension limited

When the repair is planned at the acute phase results are better

What are, for us, the issues in the treatment of sequelae today?

The problem is not only surgical technique indication performance

The problems are►access, ►timeliness►financing►quality of care

A challenge for Plastic Surgery

A challenge for Health Service

ChileHealth System Public - PrivateNational Health expenditure per capita U.S. $ 670Distribution Fifty- FiftyPublic System must attend 75% of the population.The per capita expenditures in Public Service isabout 450 $ US Dollars

Resources

Changes produce changes

In Public Health System was necessary to prioritize and to optimize the use of resources

Focusing on pathologies of greater health impact,guaranteeing by law :

access, timeliness, quality of care funding

2003. Intensive Care in the Burns Unit

2005. Changed treatment protocols SurgicalIntensive Care

►Serious burns patients were included in the group of by law Guaranteed Pathologies

►The treatment of severe burns was concentrated in our service as National Reference Center*

2007.

*130 Severe burns a year

The survival of our serious burns patients is increasing

% SURVIVAL

A.R. 1984

What is the best level of amputation?

Colostomy. Is it necessary?

We had not experience in this types of patiens

Thesepatiens diedbefore.

RehabilitationSequelae manageA new problem

High electrical voltage burn

Abdominal wall necrosis Bowel necrosis

intestinal anastomosis

Abdominal wall reconstruction with remaining muscles

Short-term Long-term

Self Injury

Repairing the burnt surface

Eyeballs savedEyelids destruction

Soleous muscle flapProviding new circulation

tibia exposure

Kneearthrodesis

Covering with muscle flap

These new survivors are now patients with larger and deeper burned body surface, older, and also have concomitant diseases

In many cases

They are alive but with severe sequelae a large burden of disease

,

These patients need plastic surgery techniques, already within the acute phase

.

This new situation generates a new scenario for both:

►rehabilitation and social reintegration. ►treatment of sequelae

Our Public Health System is not prepared to face thatThere are few plastic surgeons in the public system

In summary ,

►the increased survival of serious burns generates a new scenario

►That scenario demands amongst other measures: integration of plastic surgeons in the medical team from the acute stage

.

For plastic Surgeons►To strength their training in these areas.►To take the challenge

For The Public Health System►To generate conditions to get necessary

infrastructure and equipment►To develop incentives for incorporating plastic

surgeons to the Public Hospital network

That means

Changes produce changes

That is what we are doing

Thanks for coming