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Treatment of burns and its complications
Burns the skin lesions formed under the influence of pathogenic quantities of heat, chemicals, electricity or various types of radiation onto the surface of the body.
The burns are divided by the depth of burned skin on:
First degree burns, which are manifested by redness, swelling and pain sensitive skin. It heals spontaneously in the course of a few days.
- The second degree is divided in two subgroups, depending on the depth of damaged skin:
- Superficial or II-A level, is characterized by discoloration and blistering of the skin (bulla).
- Deep or II-B level, the skin is wet, swollen and in addition to redness, an off-white surface is present with, painful sensitivity.
- The third degree burn– skin is injured marble, dry, covered with a brown crust (slough), painless and insensitive to touch.
The classification of the burns in regard to the surface of burned skin area:
- Children: up to 5% of burned area and there is no third degree burns.
- Adults: total burned area does not exceed 15%, (no third degree burns).
- Medium severe burns
- Children burned skin area is 5 -15%.
- Adults: The burned area covers 15% -30% of the skin of which up to 10% is third degree burn.
- Severe burns
- Children: burned area is over 15% and contains the components of deep burns up to 5%.
- Adults: burned area covers more than 30% and there are elements of III degree burns, (over 5%).
All burns over 10% require hospitalization.
Treatment of burns
Treatment and therapy of burned patient depends on etiology , percentage and size of the affected area of the burned skin.
After initial medical treatment and assessment of severity of the injury, we determine further course of treatment that can be administrated ambulatory or in hospital.
Burns’ can be treated by 2 methods:
- Non-surgical – through, (dressing, applying topical agents, antiseptic solutions, enzyme based products, antibiotics, oxygen and laser therapy …).
- Surgical treatment, (tangential excision of necrotic tissue, necrectomy, skin transplantation, the use of artificial skin …).
Treatment of the complications in burned patient
Contracture scars and burns are the most common complications in burned patients.
After each tissue or organ is damaged, the regeneration process occurs in order to create new cells or to replace impaired ones with the connective tissue, which, itself, has the characteristics of a scar.
The process of wound healing is conditioned by the balance of creation and destruction of collagen. In some situations, this balance is disturbed and leads to collagen deposition and scar that becomes pronounced, aesthetically unacceptable which leads to the possibility of the occurrence of secondary deformity and functional failure. These scars when exposed to trauma for a long time, may alter malignantly into Marjolin’s Ulcer.
The process of maturation of scar tissue (scar maturation), in the first month is 50%, in the second month, 75%, and after six months, reaching 95% of maturing, and the remaining 5% is formed in the course of 1-2 years.
Excessive growth of scar, clinically, is most often manifested by the appearance:
- Hypertrophic scar -situated within the wound limits in early stage and tends to regress partially in time. In early stage it is larger and hyperemic and later becomes thinner and paler.
- Keloid – enlarged scar that spreads out of the initial wound zone in early stages of the wound healing process. There is no tendency to spontaneous regression; on the contrary, it may be increased over the time. It appears as irregular, tough, red, tense, brilliant, often painfully sensitive.
- Compression treatment – with an elastic bandage, elastic mask or costume.
- Silicone adhesive sheets are placed directly on the scar. They are worn 24 hours per day (taken off only during bathing), in duration of 6 – 12 months. This treatment leads to regression and scar remodeling.
- 0.05% retinoic acid – inhibits the formation of collagen. It is applied locally, twice on daily basis, for a period of one year.
- Contractubex gel t , Thiomucase creams, Zink oxide… locally applied, two to three times a day for 6 to 12 months.
- Steroids, (Kenalog 10), injected once a month.
- Interferon is injected once weekly for 10 months.
- Wave Therapy
- Electrophoresis- application of medicinal substances into the scar itself.
- Hydrotherapy, (water temperature up to 37C , 2-3 weeks).
- Dermabrasion is conducted by specialized device (a burr or fraise) for dermabarsion.
- Z – plastic, simple or multiple for solving contracture scars.
- The application of skin graft (auto transplantation, different thickness of skin grafts)
- Reconstructive surgery with various types of skin flaps.
- RF surgery