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BURN SURGERY

Thermal burns

Thermal burns are common injuries resulting from contact with sources like heat, electricity, radiation, chemicals, friction, or cold. They frequently occur from exposure to hot surfaces, boiling liquids, or steam, causing damage to the skin.

These burns are particularly prevalent in toddlers and children, accounting for nearly a quarter of all burn injuries in the United States, especially scalds from hot liquids or flames.

Symptoms and severity of thermal burns vary depending on their location and depth. They often entail pain, blisters, swelling, and skin discoloration, and airway burns may cause specific symptoms like burned lips, coughing, or voice changes.

Medical attention is crucial for severe burns, especially those on the face, in infants or older individuals, larger than three inches, or accompanied by concerning symptoms such as pus, worsening pain, change in appearance, or fever. Burns are categorized into first-degree (superficial), second-degree (partial-thickness), and third-degree (full-thickness) based on their depth and severity.

For minor burns, immediate steps include cooling the burn with cool water, avoiding lotions or oil application, loosely bandaging the area, and taking OTC pain relievers. Seek medical help if signs of infection develop or for more serious burns.

Preventative measures at home are vital since a large proportion of burn injuries occur domestically. These involve attentive cooking practices, using back burners, keeping pot handles away, ensuring appliance switches are off, safeguarding hot drinks from children’s reach, regulating water heater temperatures, supervising children during baths, and practicing safety around hot objects.

Electrical Burns

Understanding the severity of a burn injury is crucial for determining the appropriate response and treatment, as minor burns can often be managed at home, while severe burns necessitate immediate medical attention.

Electrical burns occur when a person encounters live electricity, resulting in an electric shock that may cause visible burns on the skin where the current enters and exits the body. However, the more concerning impact lies within the body, affecting internal organs.

Understanding Electrical Burns and Shocks

Live electricity, such as from lightning, household appliances, outlets, or power lines, can lead to an electric shock when it passes through the body. This can manifest as an electrical burn on the skin where the current enters and exits. The internal effects can range from mild to severe, sometimes resulting in fatality

Impact on Internal Organs

Internal injuries caused by electrical shocks can affect various vital organs:

  • The heart, potentially causing irregular rhythms or cardiac arrest.
  • The kidneys, leading to impaired function.
  • Muscles, where severe damage might release harmful substances into the blood, impacting other organs.
  • The nervous system, potentially affecting the eyes, ears, and muscle control.
Severity Factors
The severity of an electrical shock hinges on several factors, including voltage and the type of current (direct or alternating). High voltage poses a greater risk, potentially leading to more extensive damage or death. Alternating current (AC) is more commonly responsible for electrical shocks, as it’s the prevalent type in most homes and offices.
Symptoms of Electrical Burns
Identifiable symptoms of an electrical burn include:
  • Skin injury or burn.
  • Confusion, dizziness, or headaches.
  • Irregular heartbeat.
  • Muscle contractions.
  • Numbness or tingling.
  • Balance issues.
  • Red or red-black urine.
  • Seizures.
  • Shortness of breath or difficulty staying awake

Immediate Actions and Medical Care

  • Call emergency services (911).
  • Safely remove the source of electricity if possible
  • Perform CPR if trained and necessary for breathing issues.
  • Look out for shock signs and elevate the victim’s feet and legs.
  • Keep the person warm.

Diagnosis and Treatment

Doctors evaluate electrical burns to determine their severity:

  • First-degree burns affect the top skin layer.
  • Second-degree burns impact two skin layers.
  • Third-degree burns can penetrate into the subcutaneous skin layer.

Serious cases may be referred to specialized centers for comprehensive care. Medical examinations and tests, including EKGs, urinalysis, X-rays, and CT scans, help diagnose internal injuries. Treatment for severe burns may involve prescription medication, surgical intervention, and care for internal trauma.

Scald burns surgery

Surgery for scald burns is not the primary treatment; however, in severe cases where the burn has penetrated deeper layers of the skin or affected a larger surface area, surgical intervention might be necessary. The primary goal of surgery in scald burns is to remove damaged tissue, improve healing, and possibly perform skin grafts to promote skin regeneration.

Here are some surgical options for severe scald burns:

Debridement: This surgical procedure involves the removal of dead or damaged tissue to prevent infection and promote healing. It can be done using various methods, including surgical excision or enzymatic debridement.

Skin Grafts: In cases where the burn has affected deeper layers of the skin, skin grafting may be performed. This involves taking healthy skin from another part of the body (donor site) and transplanting it onto the injured area to assist in the healing process.

Scar Revision: For scald burns that have already healed but resulted in significant scarring or contractures (restrictions in movement due to tight skin), surgical procedures like scar revision or contracture release may be considered to improve function and appearance.

Reconstructive Surgery: In severe cases where scald burns have caused disfigurement or functional impairment, reconstructive surgery may be recommended to restore appearance and function.

It’s essential to note that the approach to treating scald burns, including the necessity for surgery, is based on the severity, depth, and extent of the burn injury. Most minor to moderate scald burns can be managed with appropriate wound care, dressings, and supportive therapies without the need for surgical intervention. Consulting with a healthcare professional specialising in burns is crucial to determine the most suitable treatment plan for each individual case.

Post burn contracture

Addressing Post-Burn Hand Deformities

The functionality of a burn survivor’s hands significantly influences their quality of life. Post-burn hand deformities, especially if bilateral, can render individuals entirely disabled (Figure 1). These issues often arise due to inadequate acute care or as a consequence of severe burns.

General Principles in Management

  • Functional Restoration: Prioritize hand functionality over individual joint mobility. Surgical interventions should focus on restoring pinch, grasping abilities, and power grips.
  • Procedures for Maximum Benefit: With severe involvement, prioritize initial procedures that deliver the most significant patient benefits, fostering early independence in hand usage.
  • Aesthetic Consideration: Besides function, aesthetics matter. Aesthetically acceptable reconstruction aids in social reintegration, significantly impacting a patient’s psychological well-being.
  • Comprehensive Evaluation: Assess deformities across skin, tendons, joints, and bones to plan effective treatment. Correction strategies must address all contributing components.
  • Addressing Deforming Forces: Correct deformities by excising scar tissue and addressing the forces causing deformation, not just by skin replacement.

Crucial Aspects in Corrective Management

  • Optimal Timing for Surgery: Plan surgery when tissues achieve equilibrium, characterized by reduced scar induration and paler scars.
  • Complementary Measures: Implement physiotherapy, splinting, and scar control practices to augment surgical outcomes.

This comprehensive approach—prioritizing function, considering aesthetics, and addressing all components of deformity—is critical in successfully managing post-burn hand deformities. Early intervention, meticulous planning, and a holistic care regimen are key to restoring hand function and improving the quality of life for burn survivors.