Understanding Burn Injuries

In accordance with the National Skin Health Month, in this article, we are listing down some of the most common causes of burn injuries, when to seek an emergency consult, and how you can care for your burn injuries.

What are burn wounds?

A burn wound is characterized by damage to the layers of the skin due to contact with heat or chemicals. This is a traumatic injury, and may commonly occur because of the following mechanisms:

Flame: Contact with fire (i.e. flammable liquids ignited, careless smoking, etc.); this also includes flash burns from exposure to explosions or blasts

Scald: Contact with hot liquids or steam (i.e. hot water, soups, sauces, oil, etc.)

Contact: Prolonged contact with heated solids (i.e. metals, plastic, glass, coal, etc.)

Electrical: From electrical currents (i.e. electrical socket currents, livewire, lightning, etc.)

Chemical: From strong alkali or acids (i.e. cleaning agents such as liquid sosa/ lye, etc.)

How do we analyze burn wounds?

After assessing your overall status, your burn specialists will check the extent of your injuries. The following is the classification of depth of burn injuries:

First Degree Burns: These are minor injuries, typically causing damage to the epidermis or outermost layer of the skin. A common example of this would be a sunburn. Healing period usually takes anywhere between 7-10 days, with little to no scarring.

Second Degree Burns: Also referred to as partial thickness burns because the top layers of the skin have been injured, and are usually characterized by formation of blisters. They are generally split into two categories:

Superficial partial thickness burns (SPTs) which look pink, moist and are painful. Since it only involves the topmost layers of the skin, they can heal with just dressings and wound care and typically within 2 weeks with little to no scarring but may have some minor skin discoloration. 

Deep partial thickness burns (DPTs) which may vary from pale to cherry red in color, are less moist and less painful than SPTs.  Some of them may heal within 2-3 weeks but most would require surgery, otherwise they may progress to scars and non-healing wounds.

Third Degree Burns: Severe burn injuries are also typically known as full-thickness burns. In this instance, the injury extends to the full depth of the skin. Appearance varies from white, brown to gray with a waxy, leathery feel. These wounds would require surgery to heal properly and to prevent complications such as infection.

Do you need to have surgery when you get burned?

All burn wounds should ideally be seen by the nearest plastic surgeon specializing in burns. A level of expertise may be needed to handle some burn wounds --depending on the size and severity. Some may be managed with wound care with dressings on an out-patient basis, but some might need admission in specialized burn centers.

In moderate to severe burn injuries such as full thickness burns, your burn wound may require several reconstructive treatments throughout the rehabilitation stage to restore function and minimize scarring.

Your PAPRAS surgeons may recommend any of the following treatments:

Debridement: Your surgeon will start off by cleaning up the wound through the removal of dead skin tissue. There can be many ways to do this, whether by using dressings, chemicals, or by surgery.

Skin Grafts: This involves the process of harvesting healthy skin from other parts of the body, and transplanting it into the clean and healthy wound to cover the area of trauma.

Wound Care: Burn wounds that do not require surgery to heal may be treated with application of dressings. There are advanced dressing products available that would require less frequent dressing changes.

What to do when you get burned?

FIRST AID

Here are some simple first-aid tips to follow when initially treating minor burn wounds at home. 

1. Stop the burning process and remove burnt/hot clothes. For scalds, remove soaked clothing as soon as possible.

2. After the injury, apply cool running water for at least 20 minutes to burnt area​ . Cool running water is still useful for up to 3 hours after injury.

3. Clean the wound with mild soap and water. You may also use 7.5% povidone-iodine solution.

4. Small blisters can be left intact. For larger blisters or more severe burns, consultation with a specialist plastic surgeon should be done.

5. Application of a hydrocolloid dressing, beta sitosterol ointment (MEBO), petroleum jelly, or any topical emollients (ointments, cream, lotion) is enough to keep the burn wound moist and provide an adequate environment for wound healing.

6. For burns that have a higher risk of infection (minor burns in the elderly, or with co-morbidities like diabetes), or with any suspicion of infection, application antibacterial ointment or cream such as silver sulfadiazine cream, mupirocin ointment, or BNP ointment to the burn area is recommended. Re-apply 2-3x a day and cover with clean gauze and/or bandage.

7. Seek medical help via telephone or mobile for ongoing wound care and advise on the indications to bring to the nearest health facility.

When should you seek medical help?

It is important to know some indications in bringing patients to the nearest health facility:

• Presence of any signs of wound infection such as persistent fever, pain, redness, and tenderness on the burnt area

• If the wound has not healed or showed signs of healing in 10 -14 days

• If you are not comfortable in managing the wound at home

• Any burns in very young or very old patients

• Electrical burns, chemical burns, possible smoke inhalation injuries

• Burns involving the face, hands, major joints and private parts

• Any third degree or full thickness burns

Our PAPRAS doctors advocate for patient safety and education.

Speak to any PAPRAS surgeon near you to know more about reconstructive, and cosmetic surgeries, as well as non-surgical modalities concerning Plastic Surgery.

References:

1. Philippine General Hospital (2018). Acute Burns: Intern’s Handbook on Diagnosis and Management. Unpublished manuscript.

2. Brownson, E.G. and Gibran, N.S. Chapter 10: Evaluation of Burn Wound: Management Decisions In Herndon, D.N. (Ed.), Total Burn Care, 5th Ed. (pp. 87-93). New York: Elsevier, Inc.