burns

Epidermal (first degree) burns are usually treated with moisturizer alone and heal within a few days and without complications. Partial thickness (second degree) burns require specific burns dressings and often heal without the need for surgery but if it is taking too long to heal i.e. more than 2–3 weeks, surgery may be needed. Full thickness (third degree) burns may require surgery, depending on their size and location of the burn. The depth of a burn may change following management. It may require surgery if not managed correctly or increasing swelling, having medical conditions which affect wound healing, such as diabetes and vascular disease. Initial treatment of burns includes applying cool running water, it helps to limit its depth of burn, removing all rings, bracelets and other jewelry. If burn is contaminated cleansing the wound with an antiseptic to help prevent infection is needed. Blisters may form on the skin after a burn injury. Burns need a moist, clean environment to help them heal.

An electric shock occurs when a person comes into contact with an electrical energy source. Exposure to electrical energy may result in no injury at all or may result in devastating damage or death. Burns are the most common injury from electric shock and lightning strikes. Children, adolescents, and adults are prone to high voltage shock. Low voltage electric injury (< 500 volts) causes no significant harm while exposure to high voltage electricity (> 500 volts) can cause serious tissue damage and usually have an entrance and exit site on the body. A victim may have secondary injuries if fallen from a height should be moved with care. Lightning is an environmental form of electric shock that may or may not show external burns, but lightning can injure or kill due to cardiac or respiratory arrest. Flash injuries occur when electrical energy only travels to the skin. Treatment depends on the severity and nature of the burns or associated other injuries, Minor injuries with topical antibiotic ointment and dressings, more severe burns may require surgical cleaning of the wounds and coverage with skin grafting. Severe burns on the limbs and hands may require surgery to remove damaged tissue or even amputation. Secondary injuries may require treatment. Eye injuries may require examination and treatment by an eye specialist. Fractured bones require splinting, casting, or surgery to stabilize the bones. Victim may have internal injuries requiring observation or surgery.

Flame burn injuries are very common. Children are particularly at risk due to accidental burns. Majority of flame burns are preventable. Thermal burns usually caused by flame, scald (from steam, hot or molten liquid), contact from a hot object, welding exposures.

Management depends upon the extent and severity of the burn. The amount of surface area burned is determined to decide on treatment of the burn. No other special diagnostic tests are needed. Depth of the burn is assessed whether it’s superficial, partial thickness, or full thickness to start treatment appropriately. The most important first step is to get away from the source (stop, drop, and roll) and remove hot or burned clothing, cool the injured area with water ( not the ice – worsen the injury) and control the pain. Treatment depends upon the nature and severity of the burned area: Gentle cleansing, dressing, care of blisters, topical antibiotics, administration of IV fluids, oral or IV antibiotics, pain management and tetanus update. Criteria for referral to a burn centre include any full thickness burn greater than 5%; partial thickness burn greater than 20% in people between ages 10-50; any partial thickness burn greater than 10% in children younger than 10 years and older than 50 years of age; any significant burns to the ears, eyes, hands, feet, or genitals.

Smoke inhalation occurs when the products of combustion during a fire are breath in. Smoke is a mixture of heated particles and gases. It is impossible to predict the exact composition of smoke produced by a fire.

Management includes: Removing the person with smoke inhalation from the scene to a location with clean air. A number of treatments given to the victims of smoke inhalation. Oxygen is the mainstay of treatment given through a nose tube, mask, or a tube down the throat (ETT). If the patient present with hoarseness (signs and symptoms of upper airway involvement) endotracheal intubation may be necessary to keep the airway from closing due to swelling and keep the patient from choking on secretions.

Bronchoscopy: performed through a small scope to directly look at the degree of airway damage and to allow for suctioning of secretions and debris. It is necessary if the patient fails to improve clinically or showing signs of respiratory failure.

Hyperbaric oxygenation (HBO) In case of carbon monoxide poisoning, oxygen is given in a compression chamber. HBO can also causes quick recovery and a reduction in symptoms of the nervous system.

Medications may be prescribed on discharge i.e. pain medications, inhalers, bronchodilators etc. The patient may notice shortness of breath with minimal exertion.

Burns that take longer than 14 days to heal may form a hard sensitive scar known as a hypertrophic scar that may be itchy, raised, discolored, and painful and the overlying skin may break down from time to time or may restrict the joint movement. Treatment includes massage and stretching, compression garment therapy, silicone therapy, steroid injections, laser therapy and if nothing works surgery and fat grafting.

(Fingers, Hand, Elbow, Shoulder, Neck, Face, Knee, Ankle)

After a burn injury to neck, skin will tighten in an attempt to close and heal the wounds and develops skin contractures (tissue shortening) which may affect the ability to perform daily activities depending upon the involved structures i.e. Neck (turning head), Knee, foot and ankle (walking, running, squatting), hand and elbows (writing, eating, carrying and manipulating objects) and face (eating, closing eyes and communicating using facial expression). These contracture can be managed through physiotherapy and splinting in their developing phases nut needs surgical release once the contractures are sever and affecting daily routine activities. Surgery helps to release the contracture and can help a patient regain range of motion. Number of surgical procedure can be adopted for contracture release including skin rearrangements (z-plasty), excision and grafting, incision/excision and coverage with local flap etc.

It is an abnormal type of wound healing, it is an overgrowth of a scar, when the skin is damaged, which results in a large, soft growth.  These scars are more common in people with darker skins. Management includes:

• Intralesional corticosteroid treatment: help to stop the proliferation of the skin cells in the keloid scar.
• Approximately one injection is given a month, for 4-6 months.
• Silicone can reduce the thickness of the keloid scar.
• Laser therapy and radiotherapy has been shown to be effective for keloid scars.
• Surgery: Intralesional excision may or be followed by steroid injection or radiotherapy.

Surgery will not be able to remove a patient’s burn scars entirely, but to improve functions and make scars less noticeable. Scarring can limit the normal motion of the neck, shoulder, hands, or legs. Facial scarring leads to problems with the eyelids, lips, nose, or hair loss can also be helped with reconstructive burn surgery. Variety of operative and non-operative methods are available the patient must reach to an understanding about what he/she can expect from the procedure and the long term benefits. Every patient
behaves different, and the surgical technique and treatment plan is chosen what is right for the patient.

A skin graft is a surgical procedure to take skin from one part of the body and transfer it to another par It require tight “bolster" dressing to keep it in place for 3-5 days without any movement of the skin graft. The bolster helps the skin graft "stick" to the wound and begin to heal. Types of grafts includes split thickness skin grafts and full thickness skin grafts. The donor site is dressed in different ways and usually takes 7–14 days to heal.

It is a procedure which requires high magnification and uses a microscope for surgical assistance in reconstructive procedures i.e. anastomosis of tiny blood vessels or nerves. During the procedure, muscle, skin, or bone is transferred along with the original blood supply from one area of the body (donor site) to the surgical site in order to reconstruct the area. Healing of the surgical site can be slow and require frequent wound care. Total recovery may take six to eight weeks or longer. One type of flap surgery involves tissue that remains attached to its original site, retaining its blood supply.

Skin responds to mechanical stress. By expanding local skin surrounding the defect, wounds can be covered with tissue of similar color and texture without compromising the donor area. The tissue expander is placed adjacent to the wound defect to be covered and expanded gradually until the target width is reached, the device is removed, and the skin is advanced for coverage.