Prevention is still the cheapest and most effective way to fight burns. Reconstructive plastic surgery plays an important role in the burn treatment in Nagpur.
Burns have several causes, such as: heat, cold, electricity, chemicals, radiation and friction. Their injuries can be classified according to their extent and depth.
Extent of burns
The extent or body surface area burned (BCS) can be quantified by the rule of nine (head and neck – 9%, trunk – 18% anterior region and 18% posterior region, upper limbs – 9% each, lower limbs – 18% each, perineum – 1%) or by comparing the burned area with the patient’s palm, which is equivalent to 1% of the SCQ. The rule of nine is not valid for pediatric patients, who have a proportionally larger head.
Depth of burns
Burns are classified into 3 degrees, according to their depth:
• First degree burn: superficial, it affects only the epidermis (first layer of the skin). Example: sunburn.
• Second degree burn: deeper than first degree, reaches the dermis (second layer of the skin), can reach the most superficial layers of the dermis (superficial second degree) to the deepest layers (deep second degree), causes blisters ( blisters) and is very painful (exposed nerve endings). Example: burn with hot liquids.
• Third-degree burn: deeper than the second-degree burn, it affects all layers of the skin and can affect fat, muscles and bones, has a whitish appearance and is painless (destruction of nerve endings). Example: electric burn.
Indications for hospital admission
According to their location, extent and depth, burn treatment in Nagpur can be initiated on an outpatient basis or require hospitalization. The criteria for admission are as follows:
• Second degree burns reaching more than 20% of the body surface in adults or more than 10% in children and the elderly (less than 10 years old or older than 50 years old).
• Second or third degree burns on the face, genitals, perineum, hands and feet.
• Third degree burns greater than 5% of the body surface.
• Circumferential burns.
• Electrical burns.
• Chemical burns.
• Burns complicated with infection.
• Inhalation injury (airway burn).
• Unfavorable clinical and social conditions.
Initial care of the burned patient
• Intubation and abundant oxygen supply for patients with airway burns.
• Venous hydration according to the burned body surface and monitoring through diuresis.
• Removal of all clothing, rings and watches from the involved areas.
• Pain relief with analgesics.
• Debridement of blisters and devitalized tissue.
• Escharotomies in third-degree circumferential burns, which compromise breathing or limb circulation.
• Cleaning with antiseptics and changing dressings every 12 hours.
• Occlusive dressings with topical antibiotics such as silver sulfadiazine, preventing burnt tissues from being further damaged by infections.
• Food rich in proteins and calories due to accelerated metabolism.
• Other precautions: special attention must be given to the agent causing chemical burns to avoid further reactions, the validity of the tetanus vaccination must always be checked, etc.
Burn treatment in Nagpur
Deeper burns in smaller areas may undergo total resection and suturing of edges. In addition, larger, deep partial-thickness burns (deep second degree) may undergo debridement and early grafting, reducing the chances of scarring changes and sequelae.
Skin grafts are very useful for the closure and protection of extensive wounds, but they depend on a vascularized bed in the recipient area for their integration. They can be donated by the individual (autografts), by individuals of the same species (allografts or homografts) or from other species (xenografts or heterografts), the last two being indicated when there are not enough donor areas in the patient and are used as dressings biological benefits or provisional coverage. In terms of thickness, skin grafts can be divided into partial-thickness and full-thickness grafts.
Partial skin grafts
They contain epidermis and part of the dermis, which can vary in thickness (thin, intermediate or thick grafts).
- Indication: it is the most used in the medium and large burn treatment in Nagpur.
- Format: can be used as small fragments (seal grafts), strips (blade grafts) or expanded by creating fenestrations (mesh grafts).
- Removal technique: they are removed with special devices (dermatome or Blair knife).
- Donor areas: scalp, abdomen, thighs and back. Fixation technique: can be fixed only with dressings or bandages.
- Integration time: 7 days.
- Advantages: they are easier to integrate into the recipient area, cover large surfaces, can be expanded and cover larger areas using fewer grafts.
- Disadvantages: suffer greater secondary contraction, become more fragile and dry (need for constant hydration).
- Donor area recovery time: the thicker the graft, the longer the recovery time.
Full skin grafts
They contain the epidermis and the entire dermis (all layers of the skin).
- Indication: they are used in small lesions of noble areas such as the face, hands and fingers, they are rarely used in the treatment of burns in its acute phase.
- Shape: usually have the shape of a spindle.
- Removal technique: they are obtained through the excision of the skin spindle and suture of the donor region.
- Donor areas: abdomen, inguinal region, groin, retroauricular regions.
- Fixation technique: it is necessary to remove all the remaining fat under the graft and fix it with suture and compressive dressing.
- Integration time: 7 days. Advantages: they suffer less secondary contraction, better mimic normal skin, are firmer, more resistant and hydrated.
- Disadvantages: they are less easy to integrate into the recipient area, requiring richly vascularized beds, and are only used to cover smaller lesions.
- Donor area recovery time: it is fast and leaves only a linear scar.
Skin substitutes (temporary dressings)
The solution established by plastic surgery for loss of skin lining is autogenous skin grafting (from the individual himself), but there are cases in which there is a shortage of donor areas, such as in major burns.
Currently, there is a lot of interest in biological, biosynthetic or synthetic materials that can replace the skin, even temporarily, reducing the risk of infections until the moment of definitive wound coverage. There is a wide variety of skin substitutes with different applications, advantages and disadvantages. Unfortunately, most of these materials are still very expensive or are not released in most Burn Treatment Centers.
What are burns?
It is skin damage caused by fire, heat, electricity, radiation or chemicals.
They are classified as follows:
- First-degree burns: the skin becomes red and painful (slight burn, for example).
- Second degree burns: the damage is deeper and blisters on the skin.
- Third-degree burns: Tissues in all layers of the skin are destroyed.
- The first thing to do is to limit the extent of damage and to prevent the burn from getting worse.
How can you reduce damage?
The burned area should be cooled by placing it under cold running water for several minutes until the pain has eased. If it’s a big burn you should go to an emergency department.
First-degree burns (which affect only the outer layer of the skin’s epidermis), such as from the sun, are treated with specific creams or ointments.
What requires medical treatment?
The ones that are bigger than the palm of your hand.
Burns on the face, neck and hands.
All third grade.
Most second-degree burns.
It can be difficult to distinguish between second and third degree burns.
If possible, continue to pour water over the burn or use sterile, moist compresses until you are attended to by healthcare personnel.
Do not handle blisters (pricking or skin removal).
Never apply ointments or other home remedies. Water is the only thing to use.
Don’t forget to get the tetanus shot if you haven’t been vaccinated in the last ten years.
What complications can arise?
When the skin is burned, it loses its protective function, which increases the risk of infection.
For this reason it is important that the damaged area is well cleaned for the first six hours and kept clean while it is healing. If after a few days there are signs of infection (eg, the skin becomes red, hot, drains, or the victim experiences sharp pain), you should see a plastic surgeon in Nagpur.
Severe burns can cause scarring.
In cases of severe and large burns, the body can lose a significant amount of fluid. This can hamper blood circulation and cause problems with the body’s balance. These wounds must be treated in the emergency medical service.
Remember that a burn assessment must be performed by a plastic surgeon, an extensive superficial burn can lead to serious complications.
What can you do to prevent burns?
Keep children away when cooking (especially preparing hot drinks), using coffee makers, barbecues, and other types of fires. Remember that barbecues can produce sparks, flames when flammable liquids are poured.
When preparing the children’s bath, first fill the bathtub with cold water to avoid the risk of entering the water that is too hot.
Never pour water into boiling oil (pots, for example). This can cause an explosion with serious consequences. The fire must be turned off, covering the pan with a lid or damp cloth.