BURNS

What happens in burns? When the skin comes in contact with something hot, it may be damaged, with death of cells in the skin. The depth of the injury depends on the intensity of the heat and the length of time that it is applied. If sufficiently severe, the full thickness of the skin can be destroyed, as well as tissues under it. Burns can also result from contact with certain chemicals.

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1st Degree (Superficial Burns): Treated primarily for comfort with local analgesics and pain medications. These usually heal within a week.

2nd Degree (Partial Thickness Burns): Blisters may or may not be trimmed but the hand and forearm should be splinted in a position of safety to prevent later stiffness. If there are open, raw surfaces, cleaning with frequent dressing changes and the application of local topical antibiotics is performed until the wounds are healed. Wound healing occurs within two to three weeks. Some 2nd degree burns may need excision of damaged skin followed by skin grafting.

3rd Degree (Full Thickness Burns): The dead skin will need to be removed and replaced with skin grafts. The timing of this depends on the size and location of the burns. Most surgeons remove the dead skin as soon as it is evident that the burn is full thickness, and graft immediately. The hand is then splinted (see Figure 3) until the grafts are healed, and then mobilization begins. Ideally this is within two to three weeks after the injury. Small full thickness burns may be treated like the partial thickness but will take longer to heal and will leave scarring. A burn that goes around the full circumference of the limb can sometimes constrict it like a tourniquet. In such cases, the constriction may need to be released, a procedure known as escharotomy.