General data about burn

>> HOW TO TREAT BURNED SKIN

Most burns heal without major complications. The more severe the burns are, the higher the chance of possible complications which will require complex treatment.

A burn is healed when the damaged skin is replaced with a newly formed skin surface(epidermis). Burn wound coverage is achieved by healing on its own or with an operation.

 

HOW DO THE BURNS HEAL?

The skin has two layers which are crossed by numerous glands that produce sweat and oily substances and hair roots (see skin structure).

SUPERFICIAL BURNS
When you sustain superficial burns, the skin has the capacity to heal. In superficial burns, only the top layer of the skin is damaged.
Cells from the hair roots and sweat skin glands will move to the surface of the burn and will build a new surface layer of the skin. The burn will heal in about 7 to 14 days.

 

PARTIAL DEEP BURNS
The superficial and part of second layer of skin are damaged in partial deep burns and the skin might struggle to heal on its own.
Cells from hair roots will be the only ones to contribute to skin healing because most of the skin glands were damaged. The healing process is slower and may extend beyond 14 days.
If the area of burn wound is relatively large or if the healing process stops, an operation may be required to cover the burn surface.

 

DEEP BURNS
When you have sustained deep burns, all the layers of the skin are damaged and the wounds will not heal by themselves.
Skin glands and hair roots are destroyed. The healing will be very slow and surgery may be required to cover the burn surface.

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Healing process on shallow burns

 


DO BURNS LEAVE SCARS?

Yes, most burns leave scars.

Superficial burns due to overexposure to sun might heal with minimal or no scars.

Other superficial burns may leave a skin discolouration (pinker or whitish) which may fade

with time, especially in adults.

Children tend to overproduce scar tissue and superficial burns may be visible for many

years.

If the burns are deeper, the scars will be obvious and may affect the function of the

involved part of the body. Scars are different for every person.


The scars may look better or worse than expected.


Children produce worse scars to begin with but most of these scars gradually improve

with time, whereas older people will have better scars.


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Healed burn in a child's hand

Healed burn in an adult

Healing process after partial deep burns

HOW IS THE SCAR FORMED?

Normal skin strength is given by protein fibres (collagen) present in the second layer of the skin (dermis). Collagen fibres give the skin its strength. In dermis there are elastic fibres which give the skin elasticity. The skin appearance and texture is the result of the proportion of elastic and strength fibres.
When all layers of the skin are damaged by burning or a sharp object, the body tries to repair it. The more skin is damaged, the longer it will take to heal and the greater the chance of a noticeable scar. Skin repair starts from bottom of the wound to the surface.
It may take up to 14 to 21 days for scar tissue to fill the skin defect.
Scar tissue will have more collagen fibres than non damaged skin and the proportion and orientation of these fibres are totally different from normal skin. In the early stages of wound healing, the collagen fibres do not have any orientation, but later on a rearrangement will take place due to forces that act on scar.
In the first 3 months the newly formed scar will look red, lumpy and sometimes will be painful. After a while, the scar will start to fade and will be shorter but more elastic. The scar will change in appearance and strength for the next 6 to 18 months.
The repaired skin will not have the same qualities as a normal skin (appearance, colour, smoothness, strength).
The best scars may have as much as 70-80% of the original strength of the skin.

A scar that crosses natural expression lines or is wider than a wrinkle will be more apparent because it will not follow a natural pattern nor look like a naturally occurring line.

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Skin structure


Scar tissue formation


WHAT IS A HYPERTROPHIC SCAR?

Sometimes the repair process is excessive. The scar will look wider and larger than the

area of damaged skin, raised, thick, red, hard and painful - a hypertrophic scar.

Some areas of the body (chest, shoulders, back) may produce worse scars and have a

higher chance of developing hard lumpy scars.

Children and people with darker skin tend to overproduce scar tissue.

A wound left more than 21 days which show signs of slow healing has a higher chance of producing lumpy scars.


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Hypertrophic scar


YOU HAVE JUST SUSTAINED A BURN INJURY. WHAT CAN YOU PUT ON THE BURN SURFACE?

If the burn was caused by hot liquids, hot surface or flame, try to cool the area with cold water.
Be aware that if the burns cover large area, avoid applying cold dressings for a long period of time because the temperature of your body will drop rapidly.

 

Seek medical help as soon as you can. When you attend the Accident and Emergency Department, the doctors will decide if you require further admission to a specialized centre. Cover the burned area with a clean cloth.

 

WILL THE DEPTH OF THE BURNS STAY THE SAME?

The skin will lose its properties when it is damaged by burning.

The depth of the burn may change slightly in the first few days after the incident.

A burn that looks shallow at the first glance might get deeper after few days.

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First aid in a small burn injury

 

WHAT ABOUT BURN DRESSINGS

WHAT ARE THE PURPOSES OF BURN DRESSINGS?

TO PROTECT AGAINST INFECTION

TO REDUCE HEAT LOSS

TO PROVIDE COMFORT

WHAT ARE THE PRINCIPLES FOR A CORRECT BUR WOUND CARE?

If you were admitted to a Burn Unit/Centre, dressings will be applied depending on the extent and depth of your burn wounds. Dressings are used to absorb fluid that weeps from the burn wound and to protect the wound from the environment. Certain conditions need to be fulfilled for application of burn wound dressings:
- Adequate pain relief will be given before the burn wounds are dressed.
- If the burned area is large, the dressings are changed in a warm room.
- The whole body is not exposed all at once in order to avoid a drop in body temperature.
- Before any dressings are applied, the burned areas are washed gently with warm solutions and open blisters and dead skin will be removed.
- The dressings will be applied in a way that will not immobilize you but you will be as comfortable as possible.

 

HOW MANY LAYERS DOES A BURN DRESSING HAVE?

A burn dressing may have several layers, each of them having its own purpose. Sometimes all of its properties are found in one layer dressing.
The properties required of a dressing for burned skin are:

1. the contact with the damaged skin has to be non-adherent and to let the fluid coming from burns pass through.
2. to isolate the wounds from the environment.
3. to absorb the fluids secreted from burn wounds.
4. to hold some way the dressings in place.

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The layers of burn wound dressing

WHAT KIND OF DRESSINGS CAN WE APPLY ON A BURN WOUND?

Burn wound dressings vary, but the principles are the same.
There are different types of dressings that can be applied on the burned skin area. Several factors influence the decision of choosing a certain dressing such as depth, extent and the body region involved by burn wounds.
Certain dressings have antibiotics or silver in their composition in order to reduce the infection of burn wounds
.

CHILDREN

Choosing the right dressing is important. The dressing needs to be non sticky, to cause minimal discomfort when it is removed. Most dressings are left in place for several days if possible.


SUPERFICIAL BURNS
If your child sustains shallow burns, dressing changes may be a distressing procedure. If it is required, the child may need to be asleep (sedated) when the dressings are changed.
In the last few years, new synthetic skin substitutes have been designed and nowadays they are used frequently. (see skin substitutes)
Before these dressings are applied to superficial burns, all dead skin and blisters have to be removed in order to reduce the chances of infection.
The dressings are usually applied under anaesthesia. Afterwards, the child will feel much more comfortable. Early home discharge may be possible but regular visits to the Burns clinic for dressings change is required every 2 or 3 days.
When the burn is healed these dressings will peel off, revealing the newly formed skin underneath.

The presence of infection underneath the dressings can make the child unwell. In this case, dressings are removed completely.
If the burns are deeper, this dressing will not adhere and hence, the application is not recommended.

ADULTS

SUPERFICIAL BURNS
If you have sustained superficial burns, adequate pain relief will be given. Creams or other dressings containing silver or other antibacterials are usually used. The dressings will be changed daily or every other day.

 

PARTIAL DEEP BURNS
If you have sustained partially deep burns or a mixture with superficial burns, regular dressings are required and assessment of the healing will be done over a period of approximately 2 weeks. All the areas which are not healed in 2-3 weeks may require surgery.


DEEP BURNS
Deep burns will not heal without surgery.


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Biobrane glove applied to a foot

 


HOW CAN WE MANAGE BURN WOUNDS ON CERTAIN AREAS OF YOUR BODY
?

HOW DO WE MANAGE FACE BURNS?


If you sustain superficial facial burns, a gentle wash with water and mild soap or soaking two or three times a day will be all that it is required. No dressings will be applied. In the following days, the burn wounds will weep. In order to avoid infection, it is advisable to stay indoors till the wounds heal.
If you sustain deeper burns, you may need an operation to remove the dead tissue earlier rather than later (first 3 days) and the defect will be covered with sheets of skin graft.

 

HOW DO WE MANAGE EYE BURNS?


If you have burns to the face, the eyes may be affected as well. An eye specialist will see you while you are in the hospital. If your eyes are involved, antibiotic ointment will be applied onto your eyes regularly. Artificial tears will be required if your eyes are dry.

 

HOW DO WE MANAGE EAR BURNS?

 

If you sustain burns to the face, your ears may be affected. Wound treatment will be the same as for burns of the face. The skin over the ears is very thin and underneath there is cartilage that gives the shape to your ears. This special tissue does not have a lot of blood vessels and if it gets infected, part of it may die, leaving you with a distorted ear. Due to this reasons, ear burn require special attentions.

 

HOW DO WE MANAGE BURNS OF THE HANDS?

Hands have specialized function and are very important parts of our body. Any burns to the hand can restrict your activities and interaction with other people.
If you sustain superficial or deep partial burns to one or both hands, you may require admission to a specialized unit. If the burns are mainly superficial, synthetic skin dressings may be applied. When dressings are applied to hands, it is important to allow fingers to move as much as possible to preserve the function. After a silver based cream is applied, burned hands are often placed in gloves made of thin plastic. In this way you can move your hands freely in a controlled environment (inside the gloves).
If you sustain deep burns, you have to keep the hands elevated for the first few days as they will be swollen. If the burns are all around the fingers or hand, cuts are needed through the burned skin as it may restrict he blood flow to the fingers. The functions of the hand are complex, and in order to maintain and preserve them, you will be fitted with custom made splints to avoid curling of fingers. If your hands are splinted, it is important to move them several times daily. The physiotherapist will show you the exercises.
If the burns affect the tendons that move your fingers, you may need several operations to restore the hand function(s).

 

HOW DO WE MANAGE BURNS OF THE FEET?


Burns of the feet are very painful and walking becomes very difficult. You or your child may need admission to a specialized unit. For superficial burns, synthetic skin can be applied directly onto the wound. Firm supportive dressings may be used when you start walking. For deep partial burns, silver or antibiotic based cream is applied at least once a day after adequate cleaning of the burns. Surgery may be required if the burns are deep.

 

HOW DO WE MANAGE BURNS DOWN BELOW?

 

Burns in this area (hot drink spilled onto your trousers/skirt) are difficult to treat because of the high risk of infection. A plastic tube may be inserted into your bladder (urinary catheter) for a few days and admission to a specialized unit is needed. Regular antibiotic based cream and/or dressings are applied at least once a day. Infection of the wounds will make the burn deeper. The need for surgery will be decided after approximately 2 week.

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AIRWAY BURN AND HOW IT WILL AFFECT YOU?

Damage of the interior lining of the air passages by heat is an airway burn injury.
Your breathing will be affected in 24-48 hours after the incident. The lining of the upper air passages may be damaged by hot air. Larger and smaller air pipes may be affected and the inner diameter of the bronchi is decreased. The lungs may swell up and the breathing may require assistance.

 

WHAT IS THE TREATMENT?

If you find it difficult to breath, a tube will be put in the windpipe through the mouth or nose under an anaesthetic and will be put through a breathing machine.

In the next few days, the lung will produce a considerable amount of secretions that will be sucked out regularly from the air passages to ease the breathing. You will have chest physiotherapy several times a day in order to help your lungs eliminate the secretions and to improve the oxygen take up. Breathing assistance may be required for few days or more.

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Burn injury to the face


SWELLING OF THE AIR PASSAGES

When you have facial burns, you may expect that swelling will develop fairly quickly (in the first 24 hours). Facial burns may be an indicator of smoke inhalation and the air passages may be affected.
In this case, the inner diameter of the airways above the neck can be reduced rapidly due to swelling. Patency of the upper air passages is essential and early intubation of the windpipe is required.
A machine will push air and oxygen into your lungs. You will have chest physiotherapy several times a day in order to help your lungs eliminate the secretions and to improve the oxygenation. Breathing assistance may be required for few days or more.

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Treatment for swelling of the air passages

   
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