What you need to know

Most burns are minor injuries that occur at home or work. It is common to get a minor burn from hot water, a curling iron, or touching a hot stove. Home treatment is usually all that is needed for healing and to prevent other problems, such as infection.

There are many types of burns

• Heat burns (thermal burns) are caused by fire, steam, hot objects, or hot liquids.
• Scald burns from hot liquids are the most common burns to children and older adults.
• Cold temperature burns are caused by skin exposure to wet, windy, or cold conditions.
• Electrical burns are caused by contact with electrical sources or by lightning.
• Chemical burns are caused by contact with household or industrial chemicals in a liquid, solid, or gas form. Natural foods such as chili peppers, which contain a substance irritating to the skin, can cause a burning sensation.
• Radiation burns are caused by the sun, tanning booths, sunlamps, X-rays, or radiation therapy for cancer treatment.
• Friction burns are caused by contact with any hard surface such as roads (“road rash”), carpets, or gym floor surfaces. They are usually both a scrape (abrasion) and a heat burn. Athletes who fall on floors, courts, or tracks may get friction burns to the skin. Motorcycle or bicycle riders who have road accidents while not wearing protective clothing also may get friction burns.

Breathing in hot air or gases can injure your lungs (inhalation injuries). Breathing in toxic gases, such as carbon monoxide, can cause poisoning.

Burns injure the skin layers and can also injure other parts of the body, such as muscles, blood vessels, nerves, lungs, and eyes. Burns are defined as first-, second-, third-, or fourth-degree, depending on how many layers of skin and tissue camera.gif are burned. The deeper the burn and the larger the burned area, the more serious the burn is.

• First-degree burns are burns of the first layer of skin.
• There are two types of second-degree burns:
  • Superficial partial-thickness burns injure the first and second layers of skin.
  • Deep partial-thickness burns injure deeper skin layers.
• Third-degree burns (full-thickness burns) injure all the skin layers and tissue under the skin. These burns always require medical treatment.
• Fourth-degree burns extend through the skin to injure muscle, ligaments, tendons, nerves, blood vessels, and bones. These burns always require medical treatment.

The seriousness of a burn is determined by several things, including:

• The depth, size, cause, affected body area, age, and health of the burn victim.

  Any other injuries that occurred, and the need for follow-up care.

  Burns affect people of all ages, though some are at higher risk than others.

• Most burns that occur in children younger than age 5 are scald burns from hot liquids.

  Over half of all burns occur in the 18- to 64-year- old age group.

  Older adults are at a higher risk for burns, mostly scald burns from hot liquids.

  Men are twice as likely to have burn injuries as women.

Babies and young children may have a more severe reaction from a burn than an adult. A burn in an adult may cause a minor loss of fluids from the body, but in a baby or young child, the same size and depth of a burn may cause a severe fluid loss.

A child’s age determines how safe his or her environment needs to be, as well as how much the child needs to be supervised. At each stage of a child’s life, look for burn hazards and use appropriate safety measures. Since most burns happen in the home, simple safety measures decrease the chance of anyone getting burned.

When a child or vulnerable adult is burned, it is important to find out how the burn happened. If the reported cause of the burn does not match how the burn looks, abuse must be considered and resources for help, such as social services, offered. Self-inflicted burns will require treatment as well as an evaluation of the person's emotional health.

Infection is a concern with all burns. Watch for signs of infection during the healing process. Home treatment for a minor burn will reduce the risk of infection. Deep burns with open blisters are more likely to become infected and need medical treatment.

Immediate first aid for burns

First, stop the burning to prevent a more severe burn.

Heat burns (thermal burns): Smother any flames by covering them with a blanket or water. If your clothing catches fire, do not run: stop, drop, and roll on the ground to smother the flames.

Cold temperature burns: Try first aid measures to warm the areas. Small areas of your body (ears, face, nose, fingers, toes) that are really cold or frozen can be warmed by blowing warm air on them, tucking them inside your clothing or putting them in warm water.

Liquid scald burns (thermal burns):

Run cool tap water over the burn for 10 to 20 minutes.

Do not use ice.

• Electrical burns: After the person has been separated from the electrical source, check for breathing and a heartbeat. If the person is not breathing or does not have a heartbeat, call 999.
• Chemical burns: Natural foods such as chili peppers, which contain a substance irritating to the skin, can cause a burning sensation. When a chemical burn occurs, find out what chemical caused the burn.
• Tar or hot plastic burns: Immediately run cold water over the hot tar or hot plastic to cool the tar or plastic.
• Next, look for other injuries. The burn may not be the only injury.
• Remove any jewelry or clothing at the site of the burn. If clothing is stuck to the burn, do not remove it. Carefully cut around the stuck fabric to remove the loose fabric. Remove all jewelry, because it may be hard to remove it later if swelling occurs.
• Prepare for an evaluation by a doctor.
• If you are going to see your doctor soon:
  • Cover the burn with a clean, dry cloth to reduce the risk of infection.
  • Do not put any cream/solution or medicine on the burned area, so your doctor can properly assess your burn.
  • Do not put ice or butter on the burned area, because these measures do not help and can damage the skin tissue.
• With a proper first aid, the depth of the burn injury can be reduced and the healing time of the burn injury can be faster.

When is Hospital admission necessary in Burn Injuries?

Burn injuries that should be referred to a burn surgeon in a hospital include the following:

1. Partial thickness burns greater than 10% total body surface area (TBSA)

2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints

3. Third-degree burns in any age group

4. Electrical burns, including lightning injury

5. Chemical burns

6. Inhalation injury

7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality

8. Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be necessary for such situations and should be in concert with the regional medical control plan and triage protocols.

9. Burned children in hospitals without qualified personnel or equipment for the care of children

10. Burn injury in patients who will require special social, emotional, or long-term rehabilitative intervention

Treatment of Burn injuries

Depending on the severity and thickness of the burn injury, the burn surgeon will determine whether conservative management using wound dressing is necessary or surgical debridement is needed to fasten the healing of the burn wound.

If conservative management is adopted, aseptic burn wound dressings will be performed at regular intervals to enable the wound to heal in a timely and controlled manner.

If surgical management is indicated, it means that the burn wound has necrotic skin which requires surgical removal in order to prevent infection and fasten the wound to heal.

Use of modern wound dressings in burn wound management

Currently, the majority of burn wounds are treated using modern wound dressings which contain anti microbial properties to reduce the incidence of infection and promote faster wound healing.

Modern wound dressings have proven to achieve faster wound healing times compared to conventional methods and improve patient satisfaction and reduce the number of wound dressing changes necessary.

Use of skin substitutes in burn injuries

Skin substitutes have enabled to fasten the healing of burn wounds due to the presence of various growth factors. Various skin substitutes are used in burn wounds. Collagen sheet dressings, artificial dermal regeneration matrix, cultured epidermal autografts ( CEA ) and skin allografts are some of the widely used skin substitutes currently.

Use of Advanced skin grafting techniques in treating Major burn injuries

Management of major burn injuries is challenging and requires a team work for a favorable outcome. Use of advanced skin grafting methods like MEEK Micrografting has enabled skin expansion ratios of 1:2, 1:3, 1:6 and 1:9 respectively. Hence with adequate skin expansion, the larger burn wound can be skin grafted using a small skin graft. Hence reducing the amount and size of the donor sites.

The combination of MEEK Microskin grafting and CEA has also further enhanced the survival rates and improved the scar outcomes in major burn injuries.

Before & After Photos