Burn wounds are dynamic and change in appearance, particularly in the first 48 hours. It follows, therefore, that the initial burn dressing should be one that can remain intact for 48 hours and prevent infection. The microbiology and infection risk in Australia is unique because of the very variable climate and prolonged transfer times in some rural areas to medical attention.
Practical tips for the use of nanocrystalline dressings include:. After 48 hours, the silver dressing is removed and an assessment of the burn injury is made.
Although silver dressings are toxic to bacteria, there is some in vitro evidence that they inhibit keratinocytes and fibroblasts, which could potentially prolong healing times. In this instance, a further 48 hours of nanocrystalline silver would be applied. Dressings that can be used after this time are summarised below with indications for each. Other dressings are available and all can be sourced online or via other purchasing agreements but prices will vary.
All burns in the early phase of healing require moisturiser and sun protection. The newly healed epidermis is dry and can have increased melanocyte activity if exposed to sunlight following a burn injury, 9,10 causing permanent hyperpigmentation. The length of time a conservatively managed burn takes to heal has an impact on scar formation.
Burns that take longer than 21 days to heal do so with exaggerated inflammation and have a high rate of hypertrophic scarring. These patients may require referral to a local occupational therapy service for scar management with silicone and pressure garments, or to a burns service for consideration of scar revision by laser or surgery.
Smaller burn injuries can be managed well in the community with good wound care and appropriate dressings. At 48 hours, management of injuries that appear large or deep should be discussed with a regional burns service, whereas smaller, more superficial injuries can be dressed with hydrocolloid, foam, hydrogel or alginate dressings and reviewed every two to three days. Certain burn wounds and patients are at higher risk of poor scarring, and these should be identified early to allow scar management to commence.
Every intervention from burn to healing has an impact on the eventual outcome. By managing all burn injuries effectively at every step, we can reduce burn injury morbidity as a community.
Australian Family Physician. Search for: Search AFP. Filter Relevance Date. Issues by year. Volume 46, Issue 3, March Management of smaller burn injuries in the community can be improved by appropriate first aid, good burn dressings and wound management. This can reduce the risk of the burn becoming deeper or infected, and can potentially reduce the requirement for specialist review or surgery.
Objective The objective of this article is to provide healthcare professionals with information about the pathophysiology of burn wound progression. This information includes the aims of burn wound dressings and indications for different types of dressings in different burn depths, advantages of blister debridement, and the reasoning behind advice given to patients after healing of the burn wound.
Discussion This article provides a framework used by the State Burn Service of Western Australia, by which clinicians can understand the needs of a specific burn wound and apply these principles when choosing an appropriate burn dressing for their patient. Every intervention in the journey of a patient with a burn injury affects their eventual outcome.
By managing all burn injuries effectively at every single step, we can reduce burn injury morbidity as a community. Aims of burns dressings When considering the choice of dressing for a burn injury, it is important to think of the size and depth of the burn, and also the aim of the dressing to be applied. Figure 2. Superficial epidermal burn A superficial dermal burn eg hot water scald, where there is skin blistering over a wet, pink and painful dermis requires a dressing to absorb fluid, avoid maceration and seal the wound from the outside environment to reduce pain and infection Figure 3.
Figure 3. Superficial dermal burn A deep dermal or full-thickness burn eg prolonged flame, contact burn, where skin under the broken or destroyed blister is less painful and a fixed red or pale white colour due to damaged blood vessels, proteins and nerve endings will require a dressing to debride and lift the dead skin if it is a small area, or to temporise for surgery if it is larger area Figure 4.
The cool water lowers the skin temperature and stops the burn from becoming more serious. You may: Place arms, hands, fingers, legs, feet, or toes in a basin of cool water. Apply cool compresses to burns on the face or body. Do not use ice or ice water, which can cause tissue damage.
Take off any jewelry, rings, or clothing that could be in the way or that would become too tight if the skin swells. Clean the burn Wash your hands before cleaning a burn. Do not touch the burn with your hands or anything dirty, because open blisters can easily be infected. Do not break the blisters. Gently wash the burn area with clean water.
Some of the burned skin might come off with washing. Pat the area dry with a clean cloth or gauze. Do not put sprays or butter on burns, because this traps the heat inside the burn. Bandaging the burn If the burned skin or blisters have not broken open, a bandage may not be needed. If the burned skin or unbroken blisters are likely to become dirty or be irritated by clothing, apply a bandage. If the burned skin or blisters have broken open, a bandage is needed.
To further help prevent infection, apply a clean bandage whenever your bandage gets wet or soiled. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. Show references Burns.
Merck Manual Professional Version. Accessed Nov. What to do in a medical emergency. American College of Emergency Physicians. Mass casualties: Burns. Centers for Disease Control and Prevention. Purdue GF, et al. Acute assessment and management of burn injuries. Kermott CA, et al.
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