Round table. burns.ipras
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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”
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Burn injuries and their sequelae are, in our countries,a major health problema major social medical problema challenge for plastic surgery
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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
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Resources are required to
FundingFacilitiesHuman resourses
►Prevention, ►Acute phase treatment►Rehabilitation►Sequelae surgical treatment
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Traditional approach
Sequelae Surgical treatment. After the acute phase.During rehabilitation stage.
Following cases …
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improving facial expression
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Respecting Aesthetics UnitsDebridement to healthy tissue
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Changing the skin graft of dorsum of the hands. Improving function
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Recover the extension
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Full thickness skin graft
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Reverse abdominoplasty
Mastoplasty
Trunk extension limited
Breast and abdomen sequelae
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Improving skin coverage of thorax in a girl before puberty.
Tissue Expander
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Planning the progress
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Complementary expansion
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Lateral Abdominoplasty
Latissimus dorsi flap
Lateral trunkextension limited
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When the repair is planned at the acute phase results are better
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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
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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
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Changes produce changes
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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
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2003. Intensive Care in the Burns Unit
2005. Changed treatment protocols SurgicalIntensive Care
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►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
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The survival of our serious burns patients is increasing
% SURVIVAL
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A.R. 1984
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What is the best level of amputation?
Colostomy. Is it necessary?
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We had not experience in this types of patiens
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Thesepatiens diedbefore.
RehabilitationSequelae manageA new problem
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High electrical voltage burn
Abdominal wall necrosis Bowel necrosis
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intestinal anastomosis
Abdominal wall reconstruction with remaining muscles
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Short-term Long-term
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Self Injury
Repairing the burnt surface
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Eyeballs savedEyelids destruction
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Soleous muscle flapProviding new circulation
tibia exposure
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Kneearthrodesis
Covering with muscle flap
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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
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.
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
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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
.
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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
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Changes produce changes
That is what we are doing
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Thanks for coming