Burn

Definition:

Is defined as a wound caused by exogenous agent

leading to coagulative necrosis of the tissue.
I. Types:
1. Thermal injury.
2. Non-Thermal injury.

II. Classification:

The burn classified according to:

1. Percentage of burn:
- Mild (minor).
- Moderate.
- Severe (major).
2. Involvement of skin layer:
 First degree.
 Second degree.
 Third degree.
 Fourth degree.

3. Skin thickness involvement:

 Partial.
 Full-thickness.
III. Assessment:

A. Assessing depth.
B. Assessing size:
1. Palmer method.
2. Wallace’s rule of nine.
3. Lund and Browder chart.
 IV. Pathophysiology:
A. Local changes.
B. Systemic:
1. Cardiovascular alterations.
2. Renal changes.
3. Pulmonary changes.
4. GIT abnormalities.
5. Metabloic changes.
6. Sepsis and immunity.
 V. Management:
A. Pre-hospital care:
 Stop the burning process.
 Check for other injuries.
 Cool the burn wound.
 Give oxygen.
 Elevate.
 If there is any indication for admission?
 B. Hospital care:
 Admit the patient, should be in burns unit.
- Maintain airway, breathing, circulation (ABC).
- Assess the percentage, degree, and type of burn.
- Sedation and proper analgesia.
 Chemoprophylaxis: tetanus toxoid, antibiotics and local
antiseptics.
- Ryle’s tube insertion: initially for aspiration purpose, later for
feeding.
 VI. Fluid resuscitation:
Formulas to calculate the fluid replacement:
1. Parkland regime.
2. Muir and Burclay regime.
3. Galveston regime.
4. Modified brooke formula.
5. Evan’s formula.
 VII. Local management:
1. Open method:
Silver sulphadiazine application without dressings commonly used in burns of
face, head and neck.
2. Closed method:
Dressing done to soothen and to protect the wound, to reduce the pain, as an
absorbent.
3. Tangential excision:
Can be done within 48 hours with skin grafting in patients with less than 25%
burn. Usually done in deep dermal burns wherein dead dermis is removed layer by
layer until fresh bleeding occurs. Later skin grafting done.
 VIII. Wound coverage:
- In 3 weeks the area granulate well, split skin grafting is done
(SSG, Thiersch graft).
- MESH split skin graft is used for wider area.
- If there is eschar, escharotomy is required to prevent
compression of vessels.
 IX. Complications of burn:

1. Eschar:
It is a charred, denatured, full thickness, deep burns with
contracted dermis.
Escharotomy:
• Incise along medial and/or lateral surfaces.
• Avoid bony prominences.
• Avoid tendons, nerves, major vessels.
2. Contracture:
Disorganized over formation of compact collagen (three times than
normal) causes hypertrophic scar finally leading to contracture.

 Classification of Contracture in Neck (BM Achauer):

A. Mild : Inability to see ceiling.
B. Moderate: Flexion is possible but not extension.
C. Severe: Fully contracted in flexed position with pull on lower lip.
D. Extensive: Mento-sternal adhesions
 Complications of contracture:
 Ectropion.
 Disfigurement of face and microstomia.
 Hypertrophic scar and keloid formation.
 Marjolin’s ulcer.

 Treatment:
 Release of contracture surgically and use of skin graft or “Z” plasty.
 Proper physiotherapy and rehabilitation is essential.
 Pressure garments to prevent hypertrophic scars.
 Management of itching in the scar using aloe vera, antihistamines and
moisturizing creams.
 X. Non-thermal burn:
 Electrical burns.
 Chemical burn.
 Cold injuries.
 Ionizing radiation.
N.B:

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