Overview

Overview

Overview

Burns are traumatic, affecting not only you as the patient, but also your family and friends. For this reason, we have provided material her you and your loved ones to better understand burns and how best to care for them.

On this site, “burn injury” will include thermal, chemical, and electrical burns as well as soft tissue diseases, open wounds requiring special care, frostbite, and TENS.

As part of the initial exam, the doctor will determine the severity and the percentage of burns. The degrees of burns refer to the depth of the affected tissue and range from first degree to third degree, with third degree burns being the deepest.

Degree of Burns

First Degree Burns

  • Sunburn
  • Involves first layer of skin only
  • Local pain and redness
  • No blisters or delayed blisters
  • Will heal without treatment

Second Degree Burns Partial Thickness

  • Bright red, moist surface
  • Involves first and second layer of skin
  • Tense, fluid-filled blisters
  • Very painful
  • Superficial second degree burns heal in 10-14 days

Deep Second Degree Burn Deep Partial Thickness

  • Involves first and second layer of skin
  • Dry, waxy, white, or dull red in color
  • Blisters may be present
  • Relatively less painful
  • Takes more than 10 days to heal

Third Degree Burns Full Thickness

  • Involves all layers of skin
  • Dry surface
  • Often leathery
  • Tight swelling
  • Relatively painless
  • Color varies

Nutrition for Burn Patients

Meal suggestions

  • Eat small meals, five to six times a day.
  • Don’t drink beverages with meals (makes you feel more full, faster).
  • Add butter, powdered milk or a protein supplement to foods.

US Department of Agriculture Food Guide

  • 6-11 servings of breads, grains, cereals
  • 3-5 servings of vegetables
  • 2-4 servings of fruit
  • 3-4 servings of meat, poultry, beans, nuts, fish
  • 3-4 servings of milk, yogurt, or cheese

High Protein Foods

  • Meat and eggs
  • Beans—pinto, black, garbanzo, etc.
  • Milk, yogurt, and cheese
  • Nuts and peanut butter
  • Tofu

High Protein and Calorie Drinks

There are many drinks available to add protein and calories to your diet. Milk is the easiest and least expensive option. Other options vary in price and include choices such as Carnation Instant Breakfast, Ovaltine or other mixes you can add to milk to increase calories and protein.

Nutrition and Wound Care

Burn patients have special dietary needs to provide additional nutrients for the body to heal wounds.

Even though you may not have much of an appetite, we encourage patients to follow a diet high in calories and protein. If this is not possible, you may need a feeding tube. Patients rarely go home with a feeding tube and most are eating regular food at discharge.

The burn dietitian and kitchen staff will work with you and team members to make sure you receive adequate nutrition.

Wound Care

Basic Principles of Wound Care

  • Prevent infection with daily hygiene.
  • Promote and assess wound healing by keeping wound moist.
  • Prevent secondary problems.
  • Provide pain control.
  • Determine the need for surgery.

Initial Wound Care

When admitted to the burn unit, your wounds receive an initial cleaning, or debridement. Heavy sedation, pain medication, or general anesthesia may be administered for this process. After pain medication is given blisters, loose tissue and debris are removed. Hair, including the scalp, is shaved within a two inches of the burn. The wounds are then washed, using a mild antibacterial soap and water.

Dressings consisting of an antibiotic ointment and gauze are placed over the wound. Depending on the depth and stage of the burn, there are many types of ointments and creams that are used. You and your loved ones will be trained how to care for the wounds and use these products before hospital discharge.

Wound Changes

Dressing changes are usually done twice a day, once in the morning and again at night. As healing progresses, it may only be necessary to change dressings once a day.

In the morning, dressing changes are usually done in the tank room, a special shower room. In the evening, changes typically take place in your room.

Many patients are able to walk and sit without difficulty during their dressing changes. These patients can take a shower using the shower chair. Patients are encouraged to wash their wounds and participate with dressing changes as soon as they are able.

Patients having a difficult time walking, or those who cannot walk, lie down on a special bed called a shower table. Staff members will clean wounds and apply dressings.

Staff participating in a dressing change will wear a hat, mask, plastic gown, and gloves to protect you from contamination. If you would like, a family member or friend may participate during wound care. If a visitor is present, they will also need to wear a hat, gown, mask, and gloves.

All nurses and health care assistants are specially trained in wound care. A wound care nurse is also available to provide expert advice. If you have questions about the wound, please ask.

Factors Affecting Wound Healing

  • Patient age
  • Infections
  • Nutrition
  • Disease (Diabetes)
  • Steroid use
  • Smoking
  • Decreased immune system (Chemotherapy)

Common Post-burn Problems

  • Scar
  • Joint contracture
  • Dry skin
  • Itching
  • Hyper & Hypo pigmentation
  • Hypersensitive & fragile skin
  • Decreased sensation
  • Poor body temp regulation
  • Chronic pain
  • Post Traumatic Stress Disorder

Not all burn wounds require surgery. Size and depth of the wound will determine if surgery is needed and which surgery is most appropriate. This may take several weeks.

Types of Surgery

Excision and Primary Closure

Small burns are typically treated with this technique. The burn wound is surgically removed and the edges are sutured together. This method provides the best cosmetic result.

Excision and Skin Grafting

This procedure is necessary for large wounds. A skin graft, also known as an autograft, involves taking skin from an unburned part of the patient’s body and placing it on the wound after the burn has been removed. Skin from organ donors can be used as a temporary covering. It is temporary because this skin will eventually be rejected. This is known as a homograft.

Homografts may be required initially if the injured area is too large to be covered by the patient’s own skin. Donor skin is generally taken from the thighs, buttocks, abdomen, and back using a dermatome, a surgical instrument that prepares donor skin. The physician will choose the best location for the donor site.

Skin grafting may have to be postponed until the burned area is healthier and ready to graft. Deep second and third degree burns that heal without grafts may have thick scar tissue, restricting the movement around the area. These burns take significantly longer to heal and there is an increased risk of infection.

Types of Grafts

Meshed Split Thickness Auto Graft (STAG)

Is a thin layer of donor skin that is stretched with a device called a mesher to cover a larger area. The meshing creates a pattern of small slits in the skin, which creates a better bond. These grafts typically take better and patients can resume activity sooner.

Split Thickness Sheet Grafts

With sheet grafts, the donor skin is not put through the mesher and lacks the criss-cross pattern. Because these grafts produce a smoother appearance, they are typically placed on hands and faces. This procedure requires more donor sites to complete, which limits the use in covering large areas. Sheet grafts typically take longer to heal and require the patient to have restricted movement and activity.

Preparing for Surgery

Before Surgery

If the doctor decides surgery is needed, the procedure will be explained to you and a written consent to perform surgery is signed. A day before the surgery, you should not have anything to eat or drink after midnight. If you are an outpatient, check with the doctor before taking any medications the morning of the surgery.

Outpatients should register at the check in desk located to the right of the hospital entrance. Once registered, head to the third floor pre-operative waiting room. Before surgery, the anesthesiologist and the operating room nurse will come talk to you and your loved ones. You will then be taken to the operating room. Y

our family can accompany you to the door of the operating room. Family and friends will wait in the burn center support room.

After Surgery

After surgery, you will be taken back to the Burn Center if you are an inpatient, or the PACU, post anesthesia care unit, if you are an outpatient. After settling in to your room, visitors are welcome. You may experience pain from your donor sites. Your physician and pharmacist will work with the anesthesiologist to manage your pain.

Dressings are not typically changed for three days after surgery. The dressings are bulky and often splinted to protect the new graft. Movement, bleeding, infection, smoking, or lack of proper nutrition can prevent the graft from healing properly. For this reason, patients with new grafts are required to keep the grafted body part very still for several days. This usually means bed rest.

The graft begins to adhere within 48 hours and is fully adhered in five to seven days. Staples holding the graft in place are removed within a week of the procedure. Wound care is usually done daily on the grafted areas beginning on post operative day three with a thin layer of an antibiotic ointment being applied to the open areas.