Clinical Update TEN TOP TIPS Management of burn wounds


"Assessing the burn is key in clinical decision-making,


and in the decision to refer."


the hair 2 cm–5 cm around the burnt area. This allows for more accurate assessment of the extent of the wound, and helps avoid complications like folliculitis. A study of burn cleansing by Hayek et al[12]


found an almost 50/50 split in burns units that used either tap water or sterile saline. However, the units reported using only sterile saline in outpatients and for smaller burns. Broadly, burn wounds should be cleaned using an aseptic, non-touch technique.[13]


decision-making, and in the decision to refer (see also Top Tip #7). Size and depth are the two factors by which burn wounds are primarily classified:


4


Size. A range of methods for estimating the extent of a burn are available. Burns extent is recorded as a percentage of TBSA. Lund and Browder’s[14]


ACCURATE ASSESSMENT Assessing the burn is key in clinical


refill upon release of the pressure, which is a hallmark of the superficial partial- thickness burn. Thin-walled, fluid-filled blisters will develop within minutes of the injury.[18]


This burn type will heal without


surgical intervention. Dressings should be changed every 2–3 days to allow for regular reassessment. If initially assessed in a burns unit, these wounds can be treated in the community.


• Deep dermal burns present as blotchy, cherry red skin loss.[19]


Blanching may


not be seen on assessment as a result of capillary damage.[17]


Deep dermal burns


take a long time to heal and may require skin grafting.[20]


Once assessed in a burns


unit these wounds can be cared for in the community by district or practice nurses. Patients will need regular reviews by the burns service. The deeper dermal damage means this burn type may take several months to fully heal.


method charts the percentage of


REFERENCES 1. Mock C et al (2008) A WHO plan for burn prevention and care. World Health Organization, Geneva


2. National Burn Care Review (2001) Standards and Strategy for Burn Care: a review of burn care in the British Isles. NBCR, London


3. Tobelem et al (2013) First-aid with warm water delays burn progression and increases skin survival. J Plast Reconstr Aesthet Surg 66(2): 260–6


4. Cuttle et al (2010) The optimal duration and delay of first aid treatment for deep partial thickness burn injuries. Burns 36(5): 673–9


5. Cuttle L et al (2009) A review of first aid treatments for burn injuries. Burns 35(6): 768–75


6. Cuttle L, Kimble R (2010) First aid treatment for burn injuries. Wound Practice and Research 18(1): 6–13


7. Latarjet L (2002) The management of pain associated with dressing changes in patients with burns. EWMA Journal 2(2): 5–9


8. Gouin JP, Kiecolt-Glaser JK (2011) The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin North Am 31(1): 81–93


9. Richardson, P Mustard L (2009) The management of pain in the burns unit. Burns 35(7): 921–36


body area burned using a chart that sections the body into portions for easier calculation of extent. The palmar method takes the palmar surface of the patient’s hand as being equivalent to 1% of total body surface area (TBSA), enabling the clinician to estimate the extent of the burn wound.[15]


The "Rule


of Nines" method is advocated by the British Burn Association's Emergency Management of the Severe Burn Course. This method is a good, quick way of estimating medium to large burns in adults. The body is divided into areas of 9%, and the total burn area can be calculated. It is not accurate in children.[16]


Depth. It is important to keep in mind that a single episode of wounding may include regions of varying depth. In summary, burn depth can be classified as follows: • Superficial burns [Figure 1A] involve only the epidermal layer and are highly painful. Healing is rapid and uncomplicated. Superficial areas should not be included if using burn size to determine fluid resuscitation.[17]


• Superficial partial thickness burns [Figure 1B] extend through the epidermis downward into the papillary, or superficial, layer of the dermis. These wounds become erythematous because the dermal tissue becomes inflamed. When pressure is applied to the reddened area, the area will blanch, but demonstrate a brisk or rapid capillary


10 [A]


• Full thickness burns [Figure 1C] can have a dry, white, waxy, brown, or black appearance. Wounds are insensate due to nerve damage and rarely heal without surgical intervention.[21]


Full thickness


burns will need to be assessed by a plastic surgeon as soon as possible so


[B]


[C]


Figure 1. Examples of [A] superficial, [B] partial thickness, and [C] full thickness burns.


Wounds International Vol 5 | Issue 1 | ©Wounds International 2014 | www.woundsinternational.com


Ten Top Tips


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