Yanık Bakımı, Pansuman, Debridman ve Acil Eskarotomi İlkeleri
Özet
Yanık hastalarının yönetiminde, pansuman uygulamaları, debridman yöntemleri ve acil eskarotomi müdahaleleri, hasta prognozunu doğrudan etkileyen kritik adımlardır. Yanık derinliği ve yaygınlığına göre uygun pansuman materyallerinin seçimi enfeksiyon riskini azaltmakta ve iyileşme sürecini hızlandırmaktadır. Debridman sürecinde geleneksel cerrahi tekniklerin yanı sıra enzimatik ve otolitik yöntemler de klinik kararlarda yer bulmaktadır. Kompartman sendromu, torasik veya abdominal basınç artışı gibi acil durumlarda eskarotomi, acil tıp pratiğinde zamanında uygulanması gereken hayati bir girişimdir. Güncel literatür doğrultusunda hazırlanan bu metin, acil servise başvuran yanık hastalarında hızlı değerlendirme ve müdahale prensiplerini kapsamlı biçimde ele almaktadır.
Referanslar
Kara YA. Burn Etiology and Pathogenesis. In: Hot Topics in Burn Injuries [Internet]. London: IntechOpen; 2018 [cited 11 Jun 2025]. Available from: https://www.intechopen.com/chapters/57336
Mathers C, World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008. 156 p.
American Burn Association. Burn Incidence Fact Sheet – American Burn Association [Internet]. Available from: https://ameriburn.org/resources/burn-incidence-fact-sheet/ [Accessed 11 Jun 2025].
T.C. Sağlık Bakanlığı. Yanık Tedavi Birimleri Hakkında Yönetmelik. Resmî Gazete. 2019;30912.
Davis BN, Xu H, Gottlieb LJ, et al. Acute Burn Care. Plastic and Reconstructive Surgery. 2024;153(4):804e–823e.
Kim E, Drew PJ. Management of burn injury. Surgery (Oxford). 2022;40(1):62–69.
Sjöberg F. Prehospital Management of Burn Injuries. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE, editors. Handbook of Burns Volume 1: Acute Burn Care [Internet]. Cham: Springer International Publishing; 2020 [cited 13 Jun 2025]. p. 147–158. Available from: https://doi.org/10.1007/978-3-030-18940-2_11
thePlasticsFella. Total Body Surface Area Calculations in Burns [Internet]. 2025 [cited 15 Jun 2025]. Available from: https://www.theplasticsfella.com/total-body-surface-area-in-burns/
Pruitt BA. Protection from excessive resuscitation: ‘pushing the pendulum back’. The Journal of Trauma. 2000;49(3):567–568.
Saffle JIL. The phenomenon of ‘fluid creep’ in acute burn resuscitation. Journal of Burn Care & Research: Official Publication of the American Burn Association. 2007;28(3):382–395.
Sparling JL, Martyn JAJ, Shank ES. Perioperative Care of the Burned Patient. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE, editors. Handbook of Burns Volume 1: Acute Burn Care [Internet]. Cham: Springer International Publishing; 2020 [cited 15 Jun 2025]. p. 309–321. Available from: https://doi.org/10.1007/978-3-030-18940-2_24
Hettiaratchy S, Dziewulski P. Pathophysiology and types of burns. BMJ (Clinical research ed.). 2004;328(7453):1427–1429.
Shubert J, Sharma S. Inhalation Injury. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 15 Jun 2025]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513261/
Knighton J. Nursing Management of the Burn Patient. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE, editors. Handbook of Burns Volume 1: Acute Burn Care [Internet]. Cham: Springer International Publishing; 2020 [cited 15 Jun 2025]. p. 347–384. Available from: https://doi.org/10.1007/978-3-030-18940-2_27
Steinvall I, Bak Z, Sjoberg F. Acute respiratory distress syndrome is as important as inhalation injury for the development of respiratory dysfunction in major burns. Burns: Journal of the International Society for Burn Injuries. 2008;34(4):441–451.
Greenhalgh DG. Early Management of Burn Patients and Fluid Resuscitation. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE, editors. Handbook of Burns Volume 1: Acute Burn Care [Internet]. Cham: Springer International Publishing; 2020 [cited 13 Jun 2025]. p. 199–209. Available from: https://doi.org/10.1007/978-3-030-18940-2_15
Cartotto R, Johnson LS, Savetamal A,et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. Journal of Burn Care & Research: Official Publication of the American Burn Association. 2024 May 6;45(3):565–589.
Investigators FB study. A randomized prospective comparison of the Baxter and Modified Brooke formulas for acute burn resuscitation. Burns Open. 2021;5(3):89–95.
Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Annals of the New York Academy of Sciences. 1968;150(3):874–894.
Greenhalgh DG. Burn resuscitation: the results of the ISBI/ABA survey. Burns: Journal of the International Society for Burn Injuries. 2010;36(2):176–182.
Vlachou E, Gosling P, Moiemen NS. Microalbuminuria: a marker of endothelial dysfunction in thermal injury. Burns: Journal of the International Society for Burn Injuries. 2006;32(8):1009–1016.
Béchir M, Puhan MA, Fasshauer M, et al. Early fluid resuscitation with hydroxyethyl starch 130/0.4 (6%) in severe burn injury: a randomized, controlled, double-blind clinical trial. Critical Care (London, England). 2013;17(6):R299.
Ms O, H S, Iw G, et al. A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. The Journal of Trauma [Internet]. 2005;58(5). Available from: https://pubmed.ncbi.nlm.nih.gov/15920417/
Kahn SA, Beers RJ, Lentz CW. Resuscitation after severe burn injury using high-dose ascorbic acid: a retrospective review. Journal of Burn Care & Research: Official Publication of the American Burn Association. 2011;32(1):110–117.
Lin J, Falwell S, Greenhalgh D, et al. High-Dose Ascorbic Acid for Burn Shock Resuscitation May Not Improve Outcomes. Journal of Burn Care & Research: Official Publication of the American Burn Association. 2018;39(5):708–712.
Neff LP, Allman JM, Holmes JH. The use of therapeutic plasma exchange (TPE) in the setting of refractory burn shock. Burns: Journal of the International Society for Burn Injuries. 2010;36(3):372–378.
Friedrichsdorf SJ. Treatment and Prevention of Pain in Children and Adults with Burn Injuries. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE, editors. Handbook of Burns Volume 1: Acute Burn Care [Internet]. Cham: Springer International Publishing; 2020 [cited 13 Jun 2025]. p. 323–338. Available from: https://doi.org/10.1007/978-3-030-18940-2_25
Friedrichsdorf SJ, Goubert L. Pediatric pain treatment and prevention for hospitalized children. Pain Reports. 2019;5(1):e804.
ISBI Practice Guidelines Committee, Advisory Subcommittee, Steering Subcommittee. ISBI Practice Guidelines for Burn Care, Part 2. Burns: Journal of the International Society for Burn Injuries. 2018;44(7):1617–1706.
Faucher L, Furukawa K. Practice guidelines for the management of pain. Journal of Burn Care & Research: Official Publication of the American Burn Association. 2006;27(5):659–668.
Wu L, Huang X, Sun L. The efficacy of N-methyl-D-aspartate receptor antagonists on improving the postoperative pain intensity and satisfaction after remifentanil-based anesthesia in adults: a meta-analysis. Journal of Clinical Anesthesia. 2015;27(4):311–324.
James DL, Jowza M. Principles of burn pain management. Clinics in Plastic Surgery. 2017 Oct;44(4):737–747.
Drummond S, Ackerman RS, Somasundaram A. Pain assessment and treatment for the trauma and burn patient. In: Noe CE, editor. Pain Management for Clinicians: A Guide to Assessment and Treatment [Internet]. Cham: Springer International Publishing; 2020 [cited 2025 Jun 13]. p. 3–30. Available from: https://doi.org/10.1007/978-3-030-39982-5_1
Friedrichsdorf SJ, Postier A, Eull D, Weidner C, Foster L, Gilbert M, et al. Pain outcomes in a US children’s hospital: a prospective cross-sectional survey. Hospital Pediatrics. 2015;5(1):18–26.
Türkiye Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Uzmanlık Derneği. Erişkin Bağışıklama Rehberi 2024. Ankara: Bilimsel Tıp Yayınevi; 2024.
Wasiak J, Cleland H, Campbell F, et al. Dressings for superficial and partial thickness burns. Cochrane Database of Systematic Reviews. 2013;2013(3):CD002106.
Norman G, Christie J, Liu Z,et al. Antiseptics for burns. Cochrane Database of Systematic Reviews. 2017;7(7):CD011821.
Heyneman A, Hoeksema H, Vandekerckhove D, Pirayesh A, Monstrey S. The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: a systematic review. Burns: Journal of the International Society for Burn Injuries. 2016;42(7):1377–1386.
Fuller FW. The side effects of silver sulfadiazine. Journal of Burn Care & Research: Official Publication of the American Burn Association. 2009;30(3):464–470.
Zahmatkesh M, Manesh MJ, Babashahabi R. Effect of Olea ointment and acetate mafenide on burn wounds: a randomized clinical trial. Iranian Journal of Nursing and Midwifery Research. 2015;20(5):599–603.
Yowler CJ, Coffee TL. Outpatient burn management. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE (eds). Handbook of Burns Volume 1: Acute Burn Care [Internet]. Cham: Springer International Publishing; 2020 [cited 2025 Jun 13]. p. 435–42. Available from: https://doi.org/10.1007/978-3-030-18940-2_33
Palmieri TL, Greenhalgh DG. Topical treatment of pediatric patients with burns: a practical guide. American Journal of Clinical Dermatology. 2002;3(8):529–34.
Ibrahim A, Fagan S, Keaney T, et al. A simple cost-saving measure: 2.5% mafenide acetate solution. Journal of Burn Care & Research. 2014;35(4):349–53.
Gravante G, Caruso R, Sorge R, et al. Nanocrystalline silver: a systematic review of randomized trials conducted on burned patients and an evidence-based assessment of potential advantages over older silver formulations. Annals of Plastic Surgery. 2009;63(2):201–5.
Grauberger JN, Joshi N, Joo A, et al. Xeroform stick-down dressing: a novel treatment for pediatric partial-thickness burns. Annals of Plastic Surgery. 2024;92(4S Suppl 2):S123–8.
Vloemans AFPM, Hermans MHE, van der Wal MBA, et al. Optimal treatment of partial thickness burns in children: a systematic review. Burns. 2014;40(2):177–90.
Leon-Villapalos J. Surgical management of burn patients. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE (eds). Handbook of Burns Volume 1: Acute Burn Care [Internet]. Cham: Springer International Publishing; 2020 [cited 2025 Jun 13]. p. 443–57. Available from: https://doi.org/10.1007/978-3-030-18940-2_34
Anyanwu JA, Cindass R. Burn debridement, grafting, and reconstruction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jun 13]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551717/
Edmondson SJ, Ali Jumabhoy I, Murray A. Time to start putting down the knife: a systematic review of burns excision tools of randomised and non-randomised trials. Burns. 2018;44(7):1721–37.
Skärlina EM, Wilmink JM, Fall N, et al. Effectiveness of conventional and hydrosurgical debridement methods in reducing Staphylococcus aureus inoculation of equine muscle in vitro. Equine Veterinary Journal. 2015;47(2):218–22.
Granick MS, Posnett J, Jacoby M, et al. Efficacy and cost-effectiveness of a high-powered parallel waterjet for wound debridement. Wound Repair and Regeneration 2006;14(4):394–397.
Battistini A, Gottlieb LJ, Vrouwe SQ. Topical hemostatic agents in burn surgery: a systematic review. Journal of Burn Care and Research 2023;44(2):262–273.
Fijany AJ, Givechian KB, Zago I, et al. Tranexamic acid in burn surgery: a systematic review and meta-analysis. Burns 2023;49(6):1249–1259.
Butts CC, Holmes JH, Carter JE. Surgical escharotomy and decompressıve therapies in burns. Journal of Burn Care and Research 2020;41(2):263–269.
Faucher LD. Are we headed for a shortage of burn surgeons? Journal of Burn Care and Rehabilitation 2004;25(6):464–467.
Orgill DP, Piccolo N. Escharotomy and decompressive therapies in burns. Journal of Burn Care and Research 2009;30(5):759–768.
Kupas DF, Miller DD. Out-of-hospital chest escharotomy: a case series and procedure review. Prehospital Emergency Care 2010;14(3):349–354.
Amirhassankhani S, Berner JE, Dheansa B. Re: Feasibility and safety of enzymatic debridement for the prevention of operative escharotomy in circumferential deep burns of the distal upper extremity. Surgery 2020;167(2):512.
De Waele JJ, Kimball E, Malbrain M, et al. Decompressive laparotomy for abdominal compartment syndrome. British Journal of Surgery 2016;103(6):709–715.
Ferguson JS, Franco J, Pollack J, et al. Compression neuropathy: a late finding in the postburn population: a four-year institutional review. Journal of Burn Care and Research 2010;31(3):458–461.
Wu C, Calvert CT, Cairns BA, et al. Lower extremity nerve decompression in burn patients. Annals of Plastic Surgery 2013;70(5):563–567.
American Burn Association. Advanced Burn Life Support (ABLS): Burn Center Referral Criteria. Available from: https://ameriburn.org/wp-content/uploads/2017/05/burncenterreferralcriteria.pdf (Accessed 13 June 2025).
Austin RE. Transfer, telemedicine and transportation in pre-hospital burn management. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE (eds.) Handbook of Burns Volume 1: Acute Burn Care. Cham: Springer International Publishing; 2020. p. 159–170. Available from: https://doi.org/10.1007/978-3-030-18940-2_12