Burn wounds are a common admission to the Christiaan Barnard Memorial Hospital ER, with the frequency of admissions increasing in the winter months. When considering burn injuries, (please refer to our previous post under Trauma and emergency Centre: Feeling the heat of the kitchen 12/7/2014):
Serious burns requiring hospitalization include:
- Greater than 15% burns in an adult
- Greater than 10% burns in a child
- Any burn in the very young, the elderly or the infirm
- Any full thickness burn
- Burns of special regions: face, hands, feet, perineum
- Circumferential burns
- Inhalation injury
- Associated trauma or significant pre-burn illness: e.g. diabetes
- Greater than 15% burns in an adult
- Greater than 10% burns in a child
- Any burn in the very young, the elderly or the infirm
- Any full thickness burn
- Burns of special regions: face, hands, feet, perineum
- Circumferential burns
- Inhalation injury
- Associated trauma or significant pre-burn illness: e.g. diabetes
Whilst this month looks into the surgical treatment of burns, it is important to remember that many minor burn wounds can be treated at home. Remember:
- Management of Burns. WHO Surgical Care at the District Hospital. 2003
Burn care requires a series of ongoing, but separate, interventions until healing of all wounds, whether operated or non-operated, is achieved. Multiple staged and non-staged surgical procedures may be necessary followed by substantial clinical care including optimal nutrition, fluid management and infection prevention.
Intensive Care services are very often a necessary component of daily care for patients with extensive or complicated burn injuries. The management of burn patients requires significant attention to pathophysiologic changes caused by the systemic response to the burn injury. Patients require meticulous evaluation and correction of fluid & electrolyte, metabolic, cardiopulmonary, homeostatic and infectious abnormalities.
This labor-intensive daily critical care evaluation and management in addition to various surgical procedures are absolutely necessary to achieve satisfactory outcomes.
This labor-intensive daily critical care evaluation and management in addition to various surgical procedures are absolutely necessary to achieve satisfactory outcomes.
Surgical treatment
An escharotomy may be defined as a surgical incision through burn eschar (necrotic skin). The procedure is usually performed within the first 24 hours of burn injury.
(Burn eschar has an unyielding, leathery consistency and is characterized by denatured proteins and coagulated vessels in the skin, which are the result of thermal, chemical or electrical injury.) |
Debridement is the removal of loose, devitalized, necrotic, and/or contaminated tissue, foreign bodies, and other debris on the wound using mechanical or sharp techniques (such as scraping, rongeuring, or cutting). The level of debridement is defined by the level of the tissue removed, not the level exposed by the debridement process. |
Excision is a surgical procedure requiring incision through the deep dermis (including subcutaneous and deeper tissues) of open wounds, burn eschar, or burn scars. An excision entails the surgical removal of all necrotic tissue. Burn scars may also be excised in preparation for surgical reconstruction. |
Skin grafting reduces the number of days in the hospital and usually improves the function and appearance of the burned area, especially when the face, hands, or feet are involved.
An thin superficial layer of non-burnt skin is surgically removed, meshed and attached to the freshly excised or debrided area to allow for adhesion to cover the wound. |
- Surgical Management of the Burn Wound and Use of Skin Substitutes. American Burn Association. 2009
Consider some of the information provided in the infographic to help prevent burns in the home:
Serious burns requiring hospitalization include:
- Greater than 15% burns in an adult - Greater than 10% burns in a child - Any burn in the very young, the elderly or the infirm - Any full thickness burn - Burns of special regions: face, hands, feet, perineum - Circumferential burns - Inhalation injury - Associated trauma or significant pre-burn illness: e.g. diabetes
WHEN IN DOUBT, PHONE YOUR APPROPRIATE EMS ORGANIZATION FOR ASSISTANCE, OR REPORT TO YOUR CLOSEST TRAUMA UNIT.
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An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.