General data about burn

>> PROBLEMS DUE TO BURNED SKIN

 

WHAT KIND OF COMPLICATIONS CAN ARISE IN A BURNED AREA?

When we consider burn severity, the size of injury is not the only factor that matters.
The other main factors are:

- The depth of your burn (link to depth of burn).
- The part of the body where the skin was burned.
- Your Age.
- Presence of Smoke inhalation / Burns of the airways and lungs.
- Your previous health.


Local complications are related to the area of the burn wounds only and can be classified as:
- Related to wound coverage (non healing, partial / total loss or infection of skin graft),
- Related to burned skin itself (infection, bleeding)and
- Related to scars and defects left after burn wounds.

 

WHAT ARE THE COMPLICATIONS RELATED TO WOUND COVERAGE?
Superficial burns should heal without any problems in less than 2 weeks. Deep partial burns may heal in around 3 weeks. After this period, burn wounds that have not healed may not do so, and an operation may be required to cover the area with a skin graft.

 

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HOW DO WE RECOGNISE THAT A BURN WOUND IS NOT HEALING?


Skin has sweat and grease glands and hair roots that contain cell types from the surface layer.
The damaged skin can heal if the burn wound has a source of cells that can migrate and multiply on the surface of the wound.
In superficial burns, cells from glands and hair roots will migrate to the burn wound surface and will start to multiply to form a new skin surface.
In deep partial burns, only the hair roots can provide cells to cover the burn surface and the healing process will be slower.
If the burn surface does not become covered with a thin layer of new skin, the body will produce a tissue with a lot of blood vessels known as granulation tissue. This tissue bleeds easily, has a red or pink bobbly, irregular appearance with a shiny surface. It may take up to 7 - 10 days for your body to produce this tissue as an attempt at healing.
When this tissue grows on a burn wound surface, you may require surgery in order to remove it gently and to apply a skin graft. This tissue has a lot of substances that promotes healing and prepares the tissue underneath to receive a skin graft. If this tissue is not removed, it starts to shrink, becomes paler, with a matt surface and jelly-like appearance. This type of wound will have a slow rate of healing.

 

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Burn eschar

Granulated tissue

 

 

 

HOW DO WE RECOGNIZE IF A BURN WOUNDS IS INFECTED?


The burn wounds have a higher chance to get infected after the first few days. If the infection spreads outside the burned area, the normal skin surrounding the burn wounds will get hot, red and painful to touch. Antibiotics may be necessary by mouth or through a drip to stop the infection.
Silver based products (dressings, cream) have antibiotic properties and are commonly applied to the burn wounds.
The depth of infected wounds will increase and a superficial burn may turn to a deep partial one. Infection can delay wound healing.

 

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HOW DO WE RECOGNIZE IF A SKIN GRAFT IS INFECTED?


It is important to have a healthy and clean wound before a skin graft is applied. Certain bacteria (e.g. Streptococcus) present on the wound may dissolve the graft in a few days. It is important that we have checked the bacterial status of the burn wounds before a skin graft is applied. Other bacteria may affect the graft, but often not so severely.
When dressings are changed, an infected wound looks messy and the skin graft may not be seen. To minimize the loss of skin graft, antiseptic dressings are applied after a gentle wash.
You may require antibiotics for a few days to control this infection.
Depending on how much skin graft was lost, the wound may heal with regular dressings or may require further surgery for adequate coverage.


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Skin graft loss due to infection

KHOW DO WE RECOGNIZE THAT A SKIN GRAFT IS LOST?

After a skin graft is applied to clean wounds, it may take around 5-7 days till the graft sticks permanently to underlying tissues. If, by that time, the graft is not attached to the wound, there is a high chance of losing it.
There are several factors that contribute to graft loss:

 

1.If the bleeding is not controlled before you apply a skin graft, blood clots will get under the graft and adherence will not be possible.

2. If the wound underneath is not healthy or burned skin is still present, the graft will not stick to it.

3. If the granulation tissue is not removed adequately.

4. If the wound underneath the graft contains bacteria called Streptococcus that dissolves or destroys the skin graft.

If you had an operation to apply a skin graft, the first dressing change will be performed after 3 to 5 days. If the skin graft is floating on the surface of the wound, the graft is very likely to be lost.

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Partial take of the skin graft

 

 

   
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