Treating burns on a larger area is often long and demanding, and bacterial infections are almost sure to occur.
Burns are injuries that can be caused by high temperatures, chemicals, electricity or radiation. The type of the treatment depends on the degree, or the affected area and depth of damage.
Burns are classified in several degrees. Depending on the degree of the affected area and depth of tissue damage, there are several degrees of burns, namely:
First degree – only the surface layer of skin (epidermis) is affected, with redness, minor pain. For example: sunburn.
Second degree – the surface layer of the middle layer of skin (dermis) is affected, with redness, blisters filled with a clear liquid, and more prominent pain. For example: brief contact with a flame or a hot liquid.
Second B degree – the deeper layer of the dermis is affected, with a noticeable swelling, redness, even more prominent pain.
Third degree – all layers of the skin are affected, pale tissue, no feeling of pain (destruction of the nerve endings).
Fourth degree – when deep structures are affected (blood vessels, muscles, bones).
First aid for burns
Regardless of the source of heat, it is essential to cool the affected part with cold water (no ice!) for a few minutes (a shower or immersion in water). If your clothes are soaked in hot liquid, remove them, but not forcefully. If your skin has glued pieces of cloth on it, cut them and do not remove them forcefully. If you burned your hands, remove all jewelry because of possible swelling. Do not puncture the blisters. Don’t cover the burns with fat, oil, powder or something similar. Cover the burn with a clean cloth. Depending on the extent of burned area and the burned part of the body, you may require immobilization (arm or leg). Seek medical treatment to categorize the degree of the burn.
When is hospitalization unavoidable?
Burns that require medical supervision, and intensive care or surgical treatment in certain cases, are treated in the Burn Unit. In principle, the hospitalized people have a higher surface area of the body burned (more than 10 – 12 percent), or have burned a certain area of the body. Thus, the compulsory hospitalization is necessary in cases of sunburned face, hands and genitals, even when it is a minor sun-burned surface.
More extensive burns require more demanding treatments
The treatment consists of assessing the size and depth of the burn, protection against tetanus (ANAT) and primary surgical treatment of burns. Later treatment requires regular bandaging with the proper products. Third-degree burns, with a diameter greater than 1.5 cm, require hospitalization and surgical treatment, because they can heal only by epithelization of the edges, which results in unsightly scars after the long healing process. Extensive burns that have affected more than 40 percent of body surface area require intensive treatment like evoking during the burning shock, continuous infusion therapy with monitoring of all vital functions and therapeutic interventions correction of the electrolytes, parental nutrition and antibiotic treatment if necessary.
Patients with internal burns very often need mechanical ventilation (intubation) at the beginning of their treatment, which is linked to the tracheotomy in prolonged treatments. Treating burns on a larger area is often very long and demanding, and complications, such as bacterial infections and super-infections, are almost the rule. Opened surfaces are ideal for the penetration of microorganisms in the blood, and septic complications that require intensive care and continuous supervision can be expected. During the treatment, the patient is mobilized as soon as possible; a continuous physical therapy is performed, even with the most severe cases, in order to prevent stiffness. After discharge, it is recommended to continue physical therapy in order to achieve full range of motion, with regular check-ups and following the instructions for skin and scar care and protection from ultraviolet radiation, given that the burned areas of skin can be expected to be hyper-pigmented and hypo-pigmented within two years.
The scars often remain as companions
The scars are a result of the natural process of healing which restores the protective function of the skin. Their size depends on the length of the healing, the natural creases of the skin, and the reaction of the skin to the trauma. 3rd degree burns, and sometimes 2b degree, depending on the biological response of the individual, result in a relief of the skin that most patients find difficult to accept aesthetically, and of course, they depend on the location of the burn. The scars can impair the function of a particular limb or fine hand movements, which restricts the movement and working ability in younger people, and in some cases it can lead to a significant disability.
Today, there are techniques that can reduce the unacceptable cosmetic scars, and, depending on the procedure, most of them are routinely carried out in dermatological clinics, under local anesthesia. But, scars which are a result of burns often require plastic reconstructive surgery, usually under general anesthesia in the domain of a specialist of plastic and reconstructive surgery. However, despite all the possibilities provided by today’s medicine, no scar can be completely “erased” from the surface of the skin and there isn’t a technique that could make the skin look as it did before the injury. Burned and changed skin surface should be adequately cared for. The recommended gel for scar care is Contractubex, which can be used after 10 to 14 days after the epithelization of the wound. Gently massage with it three to four times a day from the center to the edges. It is recommended to be used for three to four months, and the use may continue, particularly in people who react to hypertrophy scars. It was noted that the use of the Contractubex gel led to improvement in the aesthetic sense, even in older scars.