Page 254 - Critical Care Notes

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MULTISYS
Wound Grafting and Wound Care Materials
Temporary impervious dressing materials: TransCyte. A variety of biological
and synthetic skin grafts may be used for wound grafting:
■ Homografts or allografts: Skin from another human, such as a cadaver
■ Heterografts or xenografts: Skin from another animal, such as pigskin
■ Autografts: Skin from oneself that is transferred from one part of the body
to another
■ Skin substitutes: Biobrane, Dermagraft, Integra, Apligraft, Matriderm, Orcel,
Hyalomatrix, Renoskin, Kollagen, Matriderm, and AlloDerm
Complications
■ Hypovolemia
■ Decreased renal function, possibly leading to acute renal failure
■ Infection and sepsis
■ Paralytic ileus (decreased bowel sounds, distention, nausea, and vomiting)
■ Curling’s ulcer (stress ulcer or duodenal erosion)
■ Metabolic acidosis
■ Neurovascular compromise secondary to decreased blood flow to areas
distal to the burn. It can result in tissue necrosis and possible amputation
of extremity
■ Hypothermia
■ Acute respiratory failure and ARDS
■ VAP
■ Heart failure, pulmonary edema
■ Sepsis
■ Scarring
■ Compromised immunity
■ Changes in functional status, appearance, and body image, with associated
depression
■ Extremity compartment syndrome resulting from increased pressure in the
fascial compartments of an extremity → compression and occlusion of
blood vessels and nerves to the extremity. Symptoms include delayed cap-
illary refill, tense skin, progressively diminishing or absent pulse to the
extremity, intense pain, paresthesia, and paralysis of the extremity →
ischemia and necrosis → loss of limb. Escharotomy is the treatment of
choice. Eye orbital edema may require lateral canthotomy to reduce
intraocular pressure.
■ Abdominal compartment syndrome with symptoms including an increase
in intra-abdominal pressure, tense abdomen, decreased urine output,
hypercapnia, and difficulty with ventilation. This condition is treated by
laparotomy, trunk escharotomies, and diuretics. Refer to GI tab.
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