Burns Definition A burn is a coagulative destruction of the surface layers of the body. It can be
Epidemiology The risk of burns is highest in
the 18 to 35 years age group. There is a higher incidence of scalds
(burn injury due to hot liquids) in children and in the elderly. The
death rate is higher in the extremes of age.
Prevention Prevention is always better
than cure. Burn injury can be accidental, suicidal or homicidal. In a
big country like India, illiteracy is one of the root cause for all
such incidents.
Prevention can be done in the following ways:
- Increased awareness of specific hazards among the public
- Improved safety practices in the work environment
- Education of the workforce on burn hazards and first aid management.
Structure of the Skin Skin consists of two layers - the epidermis and the dermis. Epidermis acts like the raincoat. The functions of the skin are:
- It acts as a semipermeable barrier to evaporative water loss.
- It protects the body from adversities of the environment.
- It controls the body temperature.
- It is an important organ for sensation.
The dermis is the most
important layer of the skin and it supplies the strength and integrity
of the skin. Dermis is divided into papillary layer (superficial
layer) and reticular layer (deep layer). It contains the skin
appendages such as the hair follicles, sweat glands and sebaceous
glands. These skin appendages contain epithelial cells that can
proliferate and heal a partial-thickness wound by epitheilalization.
Pathophysiology The effects of burn injury upon the patient can be considered as follows:
- Local effects
- Regional effects
- Systemic effects
Local effects: Tissue necrosis is directly
proportional to the temperature and duration of exposure. It is
related to the thickness of the skin in different parts of the body
and in different ages.
Heating of tissue results in direct cell rupture or cell necrosis.
There is a marked and immediate
inflammatory response. There is release of inflammatory mediators
like histamine, kinin, serotonin, arachidonic acid metabolites like
prostaglandins, interleukins (from macrophages) and free oxygen
radicals.
They increase the capillary
permeability and vasodilatation thereby resulting in loss of plasma by
evaporation and radiation. They also result in edema (fluid
collection within the intersitial spaces) and third space losses
(fluid collection within the cavities).
In a burn over 15 % of the
total body surface area, the capillary leak may be systemic, causing
generalized oedema and a significant fall in blood volume.
The fluid shifts are maximum in the first 16 –18 hours after burns injury and decreases after 24 – 48 hours after injury.
The burn wound is described as having three zones:
- Zone of coagulation ( tissue is irreversibly destroyed with thrombosis of blood vessels)
- Zone of stasis ( there is
stagnation of the microcirculation; treatment is aimed in saving this
zone from progressing into the zone of coagulation or irreversible
tissue damage)
- Zone of hyperaemia (there is increased blood flow; there is minimal damage to the cells; spontaneous recovery is likely
The damaged tissue represents a nidus for infection. Infection is responsible for at least 50 % of deaths due to burns.
Colonization (colony count
between 103 to 105) by endogenous organisms will occur invariably
within 24-48 hours and this may remain as a local wound or regional
infection. There may be, in addition, a bacteraemia or septicaemia
(due to bacterial invasion when the colony count is more than 106) and
metastatic infections may develop at other sites.
Bacteraemia is a common cause of fatality in a severe burn and
may occur at any time from the first day until the point when all the
wounds have entirely healed.
b-hemolytic streptococci and Corynebacterium diphtheriae are the commonest organisms to colonize in the burn wound.
b-hemolytic streptococci and Pseudomonas produce protease enzymes that prevent skin graft adhesion.
Regional effects: Limb circulation may be
compromised. It can occur due to direct vessel damage from high-
tension electrical burns, gross oedema in a limb causing venous
obstruction (particularly in an eschar which is incapable of
distending), or a muscle compartment syndrome.
Accumulation of large
quantities of interstitial fluid in the hand drives it into a claw
posture (MCP joint extension; PIP joint flexion).
Systemic effects: Fluid and electrolyte abnormalities seen in burns shock, are largely due to alteration in
cell membrane potentials with intracellular flux of water and sodium
and extracellular migration of potassium secondary to dysfunction of
the sodium pump. Loss of circulating plasma volume leads to
haemoconcentration and hypovolemia, the severity of which increases
with the severity of the burn.
There may be multiple organ
failure (MOF). It may be renal, hepatic or heart failure. The precise
cause of these complications is unccertain. The theories postulated
are –1. Fluid loss 2. ‘toxemia’ from infection 3. Uncontrolled
overreaction of the inflammatory response to sepsis.
In burns of > 60 % of BSA,
depression of cardiac output is frequently observed with lack of
response to aggressive volume resuscitation. Ultimately, the patient
will demonstrate signs of hypovolemic shock as the cardiac output
falls.
The end of the shock phase in
the adequately resuscitated patient with burns is usually marked by a
diuresis. This occurs approximately 48 hours after the burn and is usually associated with fluid balance, which is more like that of a
normal patient.Hematologic derangements include an increase in the hematocrit with increased blood viscosity during the early phase followed by anaemia from erythrocyte extravasation and destruction.
However blood transfusion is infrequently required for patients with
isolated burn injury.
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======================================== First degree burns:
It involves only the epidermal
layer of the skin. (E.g.) Sunburn (it is caused by ultraviolet light
instead of thermal injury).
The burned skin is red, painful and tender without blister formation.
It usually heals in about 7 days without scarring and requires only symptomatic treatment.
Other examples include: scalds
by non-boiling liquids; some chemical burns; and the edges of areas of
flame burns and flash burns.
Second degree burns: It involves the epidermis and extends into the dermis.
Superficial partial-thickness burns |
Deep partial-thickness burns |
Epidermis and superficial dermis are injured.
| Epidermis, superficial dermis and part of the deep dermis are injured. |
Deeper layer of the dermis & the skin appendages are spared.
| The skin appendages are damaged, but the deeper portions usually survive. |
They are very painful to touch
| They are usually pain insensitive |
There is good perfusion of the dermis with intact capillary refill. They do not blanch on pressure.
| Blisters are present and the exposed dermis is pale white and there is no capillary refill. |
They heal in 14 – 21 days with minimal scarring
| They heal in 3 weeks to 2 months’ time and scarring is common |
Usually there is a full return of function.
| Surgical debridement & skin grafting may be necessary to obtain maximum function. |
(e.g.) Hot water burns
| (e.g.) Hot liquids, steam, grease or flame injury |
Third degree burns (Full thickness burns): It involves the entire
thickness of the skin. All the epidermal & dermal structures are
destroyed. They are usually caused by flame, hot oil, steam or
prolonged contact with hot objects {as in unconscious state of
epilepsy or due to sensory loss (autonomic neuropathy) in diabetic
patients}.
The skin is charred, pale,
painless and leathery. This charred layer consists of denatured,
contracted dermis and is called an eschar. These injuries will not
heal spontaneously as all dermal elements are destroyed. Surgical
repair and skin grafting are necessary and there will be significant
scarring.
Fourth degree burns: They extend through the skin to
the subcutaneous fat, muscle or even bone. These are devastating,
life threatening injuries which require amputation or extensive
reconstruction.
Classification of Burns |
Type of burn |
Tissue injury |
Scalds Fat burns Flame burns Electrical burns Cold injury Friction burns Ionizing radiation Chemical burn | Partial-thickness skin loss Usually full-thickness skin loss Patches of partial and full –thickness Full thickness with deep extensions Ice formation, tissue freezing, vasospasm Heat plus abrasion Early tissue necrosis, later tissue dysplastic changes Inflammation, tissue necrosis, systemic effects |
Scalds Hot water produces a
particularly well-defined type of skin damage. The temperature of
boiling water (100°C) or steam is constant and the major determinant
of the severity of injury is the duration of contact.
People who are least able to
protect themselves (the very young, the very old and the very drunk)
are particularly vulnerable.
The larger the volume of the agent, the more severe is the injury in terms of area and depth.
Although the spills cool
rapidly, limiting the duration of damage, the worst injuries of this
type may leave permanent scarring.
Fat burns Cooking fat or oil has a much
higher temperature (180°C) than boiling water and hot fat cools slowly
on the skin surface. Spills therefore cause deep burns.
Flame burns They have a varied etiology:
house fires, clothing fires, spills of petrol on the skin, butane gas
fires. They often occur in confined spaces and may be associated with
inhalation injury. Generally deep burns will result.
Electrical burns The passage of electric current
through the tissues causes heating that results in cellular damage.
Heat produced is a function of resistance of the tissue, the duration
of contact and the square of the current. Bone is a poor conductor of
electrical current, whereas blood vessels, nerves and muscles are good
conductors. Bone can therefore become very hot and cause secondary
damage to tissues near the bone.
Low voltage (<1000 V) such
as from a domestic supply (240 V) causes significant contact wounds
and may induce cardiac arrest, but no deep tissue damage.
High voltage burns (>1000 V)
cause damage by two mechanisms: flash and current transmission. The
flash from an arc may cause a cutaneous burn and ignite clothing but
will not result in deep damage. High-voltage current transmission will
result in cutaneous entrance and exit wounds and deep damage.
Lightning strikes cause very
high-voltage, very short-duration discharge. A direct strike has a
high mortality. A side strike may cause superficial burns to the skin
and deep exit burns to the feet. Internal damage is not common, but
respiratory and then cardiac arrest can occur.
Cold injury It can occur in industries due
to spills of liquid nitrogen or similar substances. It can cause acute
cellular damage producing either a partial-thickness or a
full-thickness burn. Severe cooling can freeze tissues and ice
formation is particularly likely to cause cellular disruption.
Freezing injuries however seem to be less damaging to the connective
tissue matrix than heat injuries.
Frostbite is due to prolonged
exposure to cold and there is often an element of ischaemic damage.
Vasoconstriction reduces the resistance of the tissue to cold exposure
as the warming effect of the circulation is reduced. There is therefore a combined tissue damage from freezing, together with
vasospasm.
Friction burns It is due to a combination of
heat and abrasion. There is generally a superficial open wound that
may progress to full-thickness skin loss. It may be associated with
degloving injuries where the damage is judged to be deep. Early
surgical excision and skin cover is the best management advised.
Ionizing radiation X-ray irradiation may lead to
tissue necrosis. The necrosis may not develop immediately. They are
limited in area. Surgical excision and flap reconstruction may be
appropriate management. Of greater significance is the long term
cumulative effect of ionizing radiation in inducing skin cancers and
other tumors.
Chemical burns Tissue damage depends on the
strength and quantity of the agent and the duration of contact. Some
agents penetrate deeply and have specific toxic effects. Chemicals
cause local coagulation of proteins and necrosis, and some also have
systemic effects (e.g. liver and kidney damage with tannic, formic and
picric acids). The harmful effect will continue until the chemical is
diluted or neutralized. The most important initial treatment is
dilution with running water.
Acid burns cause tissue damage by coagulative necrosis. Their action is rapid and relatively short-lived.
Alkali burns cause tissue damage by colliquative necrosis and are very penetrating and their effect is much more prolonged.
Area of Burns
Wallace’s rule of nines in adults: 9 % - head and neck
9 % - left arm
9 % - right arm
9 % - front of chest
9 % - back of chest
9 % - front of abdomen
9 % - back of abdomen
9 % - front of left lower limb
9 % - back of left lower limb
9 % - front of right lower limb
9 % - back of right lower limb
1% - external genitalia (perineum)
In children, this method is modified as the head is relatively larger compared to the limbs.
An approximate method of
calculating the area of burns would be to measure the burned surface
area with the palm of the hand, which corresponds to 1%.
A more precise estimation of the percentage of Body Surface Area burned is obtained by using Lund & Browder burn chart.
Particulars
| Minor burns | Moderate burns | Major burns |
Partial thickness burns in 10–50 yrs age group
| <15 % BSA | 15 –25 % BSA | >25 %BSA |
Partial thickness burns in children under 10 or adults over 50 yrs
| <10 % BSA | 10 –20 % BSA | >20 % BSA |
Full thickness burns in any person
| <2 % BSA | <10 % BSA | >10 % BSA |
Other associated injuries
| Absent | To be excluded | Present |
Treatment | Often managed as outpatient | General hospital with designated team | Usually specialized burn care facility |
Note: BSA = Burned Surface Area
|
Clinical Features A careful quick history should
be ascertained – 1. To know the person 2. To know the mechanism of
injury 3. To find out associated injuries 4. To know the associated
illnesses the patient is suffering from (e.g.) diabetes, epilepsy,
hypertension 5. To know the circumstances of injury – whether it is a
closed or an open space injury.
Pain Pain is immediate, acute and
intense with superficial burns. It is likely to persist until strong
analgesia is administered. With deep burns, there may be little pain.
Acute anxiety The patient is often severely distressed at the time of injury. It may result in secondary injury also.
Fluid loss and dehydration This is more in case of
superficial burns where there is extensive epithelial loss and plasma
oozes out of the burned surface from the leaky capillaries. This is
manifested as tachycardia and a fall in BP.
Local tissue oedema Superficial burns will blister
and deeper burns develop edema in the subcutaneous spaces. This may be
marked in the head and neck with severe swelling which may obstruct
the airway. Limb edema may compromise the circulation.
Burns of the eyes occurs commonly in explosion injuries or chemical burns.
Coma This may be due to asphyxia or head injury, hypovolemic shock or due to carbon monoxide or cyanide poisoning.
Major burns also include:
- Burns involving the hands, face, feet or perineum
- Burns crossing the major joints
- Circumferential burns of an extremity
- Burns complicated by inhalational injury
- Burns in the infants and the elderly
Inhalation Injury It has emerged as the main cause of mortality in the burn patient.
This injury occurs in
association with closed-space fires, conditions that decrease
mentation, such as overdose of sedatives, alcohol intoxication, drug
abuse and head injury.
Exposure to smoke includes exposure to heat, particulate matter and toxic gases.
Direct thermal injury is
limited to the upper airway. Thermal injuries below the vocal cords
occur only in cases of steam inhalation. This is manifest by stridor,
hoarseness of voice, cough and respiratory obstruction.
Inhalation of the products of
incomplete combustion of organic material (particulate matter less
than 0.5m size) leads to chemical burn to the bronchial tree and
lungs. This is manifest by hypoxia, ARDS and respiratory failure.
Systemic absorption of carbon
monoxide (as also of hydrogen cyanide from burning plastics) causes
poisoning. Carbon monoxide binds to the haemoglobin molecule
displacing oxygen and thus forming carboxyhaemoglobin, thus reducing
the oxygen carrying capacity of the blood resulting in tissue hypoxia
and coma. It has intracellular effects too.
Burning mattresses can produce
nitrogen dioxide, which is associated with a tri-phasic illness. The
first phase is characterized by cough, wheeze and progressive
dyspnoea. In the second phase, there is progression to pulmonary edema
at approximately 24 hours. After 2 – 6 weeks, bronchiolitis
obliterans and chronic interstitial lung disease develop.
Recognition of inhalation injury:
- History of fire in an enclosed space
- Physical signs – facial burns, singed nasal hair, soot in the mouth or nose, hoarseness of
voice, carbonaceous sputum, expiratory wheezing
- Investigation – Bronchoscopy to determine the full extent of injury; Arterial blood
gas analysis; Carboxyhemoglobin levels if necessary. Levels > 10 %
are significant and levels > 50% are generally lethal.
Treatment:This should be instituted in suspected cases prior to definitive diagnosis.
Humidified Oxygen 100 % by a non-rebreathing mask should be administered.
Bronchodilators
Pulmonary toilet
Control of upper airway by prompt endotracheal intubation is done in conditions like:
- Full-thickness burns of the face or perioral region
- Circumferential neck burns
- ARDS
- Progressive hoarseness of voice or air hunger
- Respiratory depression
- Altered mental status
- Supraglottic edema and inflammation on bronchoscopy
Systemic Complications of Burns
- Curling’s (gastric or duodenal) ulcer that may result in acute haematemesis.
- Immunosuppression increases the risk of septic complications.
- Catabolic response to trauma with severe weight loss.
- Nonspecific complications like UTI, DVT and pulmonary embolism.
- Toxic shock syndrome (life-threatening exotoxin mediated disease caused by S. aureus) can
occur in children with even small surface area burns.
Risk factors for death after burn injury:
- Age > 60 years
- Burn surface area of more than 40 %
- Presence of inhalation injury
Management of the Burned Patient The management of patients with moderate to major burns can be divided into three phases:
- Prehospital care
- Emergency department resuscitation and stabilization
- Admission or transfer to a specialized burns unit
I. Prehospital care - First aid
- Stop the burning process
- Cool the burn surface
- Establish the airway
- Initiate fluid resuscitation
- Relieve pain
- Protect the burn wound
- Transport the patient to an appropriate center
Cool the burn surface Immediate cooling of the part is beneficial and should continue for 20 minutes.
With scalds, irrigation with
cold water under a tap or pouring a readily available jug of cold
water or milk immediately over the scalded area is advisable.
Irrigation in cold water is
particularly valuable for chemical burns.Hypothermia must be avoided.
The ideal temperature of cooling water is 15ºC.The burn should then be
wrapped in any clean linen or plastic ‘cling film’ and the patient
transported immediately to the hospital.
II. Emergency Examination and Treatment A - Airway maintenance
B - Breathing and ventilation
C - Circulation
D - Disability – neurological status
E - Exposure and environment control – keep warm
F - Fluid resuscitation
Emergency Department Care:
- Quick history of the incident and general history of the past medical and surgical illnesses
- ABCs should be reassessed and stabilized
- The need for cervical immobilization should be reassessed.
- Examine for evidence of inhalation injury and if present, endotracheal intubation should be performed.
- Insert IV lines even through the burned area if required and initiate fluid resuscitation according to the formula.
- Burns size and depth are estimated and recorded initially and at the end of 24 hours.
- Patients with > 20 % partial-thickness burns routinely require a nasogastric tube as ileus frequently occurs.
- A Foley’s catheter should
be inserted to measure urine output and prevent urinary retention in
the patients with perineal burns.
- Secondary survey – head- to-toe assessment should be done.
- Eyes are examined for corneal burns.
Early escharotomy may be needed
in circumferential chest or limb burns where respiratory or
circulatory disturbance is observed.
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Investigations Blood sample for CBC, BUN, Creatinine, Glucose, Electrolytes & Blood grouping and Rh typing should be obtained.
ABG |
Carboxy hemoglobin levels | In patients with inhalation injury
Cyanmethaemoglobin levels |
Chest X-ray |
ECG |
Fluid resuscitation: It is important at an early stage to secure two large-bore IV lines.
Burns involving > 10 % BSA in children or > 15 % of the BSA in adults need intravenous fluid resuscitation.
Principles of fluid resuscitation:
- A fluid containing salt and water is required for the first 48 hours after the burn.
- The total volume is between 2 and 4 ml / kg / % BSA burn and should contain 0.5 mmol sodium /kg / %burn.
- The total volume required can be reduced by the addition of colloid or by using hypertonic saline solutions.
- Water loss through the
burn wound will vary according to the environment but when nursed in
conventional dressings, metabolic water requirements will be of the
order of 1.5 – 2 ml / kg /hour with a minimum of 30 ml / hour for
infants.
- Care must be taken to avoid overprovision of water with the development of hyponatremia.
Estimate the percentage burned surface area and measure the body weight. The simplest formula (for adults) is:
Half of this volume is given in the first 8 hours and the rest in the next 16 hours.
The Baxter or Parkland formula
employs lactated Ringer’s solution 4ml/kg/% burn, half of which is
given in the first 8 hours and half in the next 16 hours. In the
second 24 hours the volume required is 2 litres of 5 % dextrose plus
colloid (0.5 ml x % burn x body weight in kg).
Timings begin from the time of the burn, and not from the time of hospital admission.
50 % and above 50 % is considered to be 50 % BSA only.Isotonic crystalloid usually Ringer’s
lactate solution is preferred, but other isotonic fluids may also be
used.Metabolic fluid requirements are also needed (either IV or orally as dextrose water 50 ml / kg / day)
Formulae are only a guide and the adequacy of fluid resuscitation is monitored by regular clinical assessment.
Thermal injury in the presence
of concomitant multisystem trauma generally requires fluids in excess
of calculated needs.Inhalation injuries have been shown to increase
total fluid needs.Burns patients with pre-existing cardiac or
pulmonary disease require much greater attention to fluid management.
A urinary catheter is
essential. Urine output is the best guide to adequate tissue
perfusion; in an adult one should aim for 0.5 ml to 0.75 ml / kg /hour
(i.e. 30 – 50 ml /hour) and in children 1 ml / kg /hour.
Clinical assessment:
- Vital signs – Body temperature (core and peripheral), pulse rate, pulse volume, blood pressure, respiratory rate
- Signs of cerebral and skin perfusion
- Urine output hourly
- Haematocrit & haemoglobin 4 hourly
In deep burns, one unit of
blood should be given for every 10 % deep burn and this should be
administered at the end of the 48-hour ‘shock phase’. Attempts should
be made to keep the haemoglobin levels above 10g %.
Further management: Adequate pain relief by IV Morphine. Anxiolytic agents may be used as adjuvants in pain management.
Good notes and drawing of the burned area are needed.
Smaller burns are managed
satisfactorily on an outpatient basis with arrangements for further
dressing either at a hospital follow-up clinic or by the General
Practitioner.
Patients with major burns
should ideally be treated in a specialized burns unit.Routine Tetanus
toxoid prophylaxis should be administered based on the patient’s
immunization history. Tetanus immune globulin should be administered
whenever necessary.
III. Indications for referral
- Burns requiring fluid resuscitation – moderate and major burns
- Burns of special areas ( face, hands, feet, perineum, major joints)
- Full-thickness burns > 5 % of BSA
- Circumferential limb or chest burns
- Electrical burns including lightning injury
- Chemical burns with the threat of functional or cosmetic impairment
- Inhalation injury with burns
- Burns in the children or the elderly
- Where non-accidental injury is suspected in the case of a child
- Associated medical conditions or pregnancy
- Associated with concomitant trauma such as fracture
Adequate assessment, resuscitation and fluid administration should be secured before transfer of the patient.
The burns unit is the ideal
place for regular dressings to minimize the cross infection rate. It
should have facilities for immediate physiotherapy and occupational
therapy to minimize limb stiffness.
Nutritional requirement as advised by Sutherland are in the order of:
Adults: Calories – 20 kcal/kg + 70 kcal / % of burn
Protein - 1g / kg + 3 g / % burn
Children: Calories – 40 kcal / kg
Protein – 2 g / kg
Supplemental iron and vitamins
are required throughout the hospital stay and zinc supplements are
recommended in extensive burns in a dose of 20mg Zinc sulphate / kg /
day
Early normal feeding protects the small bowel mucosa and prevents the translocation of endogenous Gram negative bacteria.
Inhalation injuries are best managed in respiratory intensive care units.
Dressings: Epidermal burns with erythema and without blisters do not need dressings. Analgesia and moisturising cream are used.
Burns of the face are generally treated by exposure.
When there is much crusting, it
may be necessary to apply an ointment such as petroleum jelly around
the eyes with frequent toileting of the eyes and orifices.Burns of the
trunk and limb are dressed.
The assessment of the area and
depth of the burned surface is done initially and at the end of 24
hours by an experienced doctor before any ointment or creams are
applied. Till then saline-soaked dressings can be done.
Superficial dermal burns with
blistering are usually dressed to absorb exudate, prevent dessication,
provide pain relief, encourage epithelialization and prevent
infection. Blisters are popped but not removed.
Appropriate dressings are plastic films, hydrocolloids, preserved cadaver or pig skin, alginates or paraffin gauze.
A thick layer of gauze may then
be placed on top to allow transudation of any fluid and layers of
wool or padding are applied over this to act as a sump for exudate.
Dressing changes are painful and can be done under anaesthesia.Any
wound that remains unhealed or granulating at 3 weeks or if the wound
is extensive or showing evidence of considerable slough formation,
then surgical intervention is required.Enzyme preparations may be used
to facilitate sloughing.
Deep burns are managed by dressing with topical antimicrobial agent such as 1 %silver sulphadiazine cream.
Extremity burns should be elevated for 24 – 48 hours to prevent edema.
Management of infections: There is a controversy about
the routine use of prophylactic antibiotics as the burned surface will
be inevitably colonized by microorganisms.Children suffering from
burn wounds are often given routine antibiotics to limit the
possibility of metastatic infection.
Frequent wound swabs should be cultured and when there is rise in temperature, blood cultures should be taken.
Monitoring for the onset or progress of infection should consist of:
- Routine temperature measurement
- Frequent wound swab cultures
- Wound inspection by an experienced doctor at the time of dressing change
- Blood cultures
Surgical treatment: Full thickness burns require surgical management.
There are two protocols:
- Wait for spontaneous desloughing and apply split- skin grafts at the end of 3 weeks.
- Disadvantage – slow healing and greater scarring.
- Early excision of the burn wound with the application of a skin cover by a graft or a flap.
Advantage – rapid healing, early restoration of function & minimal scarring.
All grafts in children should be harvested from the buttocks.
Thighs are the first choice in adults and limbs and trunks may be necessary in addition.
Early mobilization and rehabilitation is done to minimize the risk of infection, DVT & joint contractures.
Surgical reconstruction of the burn injury can be done for scarring and it is called as “Scar therapy”.
Counselling is a very important aspect
in patients surviving after burns. It should be done both for the
patients and their relatives. It helps to reduce the ‘flash-back
phenomenon’ which can be very traumatizing to the patient and may last
for 2 – 3 months.
Conclusion Prevention of Burns is the ideal treatment for burns