Burns

Severe burn wounds are among the most debilitating injuries because they can significantly affect the entire body. The body’s inflammatory response to a severe burn injury can lead to fluid loss, dangerously low blood pressure, and shock. The risk of infection is also elevated in patients with severe burn wounds. Therefore, prevention of these complications is a key component of care for these patients.

Acute wound: An alteration in skin integrity, such as a simple laceration or a surgical wound, that typically moves through the healing process and heals in a predictable timeframe without complication. An acute wound results from a documentable event with the assumption that it will progress normally through the 4 phases of wound healing.

February 6th to the 12th marks the American Burn Association's Annual Burn Awareness Week. The topic for 2022 is burning issues in the kitchen. It is estimated that almost 50% of home fires are started when people have been cooking, and so, it's really important that we use some prevention techniques.

By Steven A. Kahn, MD

When treating severe burns, surgeons generally consider eschar removal to be the major factor and the top challenge in both initiating and planning for the optimal course of treatment for each patient. Before grafting, all devitalized tissue must be removed, leaving a wound bed of only healthy tissue. Some burn wounds are clearly full-thickness on initial examination, and some are clearly superficial, with relatively straightforward decision making. However, some wounds have an indeterminate depth and are more challenging. Deep partial-thickness, indeterminate-, and heterogenous-depth wounds require more complex decision making and/or a protracted interval to allow the wound to declare. Eschar removal is sometimes necessary to allow surgeons to assess the wound bed and confirm the depth and severity of certain burns. This, in turn, provides the insights a surgeon needs to determine the best course of treatment, including whether a patient must be treated with an autograft to cover a wound area.

By Michel H.E. Hermans, MD

How should I treat a patient with a partial-thickness burn on less than 10% of their body but poor vascularity?

It is not possible to give a specific answer to this question because burns larger than 10% could be anywhere from 11% to 99%. As mentioned in the presentation, larger burns cause burn disease with all its potential complications. “Poor vascularity” is a bit vague. If it is the result of diabetes, then the disease itself, including the typical microvascular problems, will contribute to poorer healing. On the other hand, peripheral arterial disease usually does not have a significant impact on the healing of partial-thickness burns unless occlusion is very severe.

Burns occur when the skin comes into contact with a heat source or caustic substance, commonly fire or flames, boiling liquid, hot objects, electrical current, or chemical agents. Different mechanisms of injury that can cause a burn include scalding, fire, chemical exposure, electrical exposure, and radiation. The extent of injuries that can occur from a burn is highly variable, and morbidity and mortality tend to increase as the surface area of the burn increases. Proper classification of burns is essential in guiding the initial management of the burn wound and achieving optimal outcomes.

By the WoundSource Editors

After an injury or surgery, the body responds by forming scar tissue. Scar formation is a normal part of the wound healing process, but not all scars are the same. Some scars form in only the superficial epidermal layers, whereas others encompass deeper subdermal layers, involving nerves and tendons. The process of scar formation is the result of myofibroblast cells forming new collagen fibers to repair a wound.

By the WoundSource Editors

Complex wounds pose a significant challenge for many health care providers. These wounds are often multifaceted, making treatment tremendously difficult. They represent a substantial burden on the health care industry, with annual costs in North America alone estimated at $10 billion annually. They often also result in patient discomfort and pain, caregiver frustration, individual economic losses, and diminished quality of life.

Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article Title: Stem Cells Derived from Burned Skin – The Future of Burn Care
Authors: Saeid Amini-Nik; Reinhard Dolp; Gertraud Eylert; Andrea-Kaye Datu; Alexandra Parousis; Camille Blakeley; Marc G. Jeschke (Sunnybrook Research Institute, Canada)
Journal: EBioMedicine
Reviewed by: Akhil Korrapati, Temple University School of Podiatric Medicine Class of 2021, Temple University School of Podiatric Medicine

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

Immobility and decreased sensation can cause major problems related to the skin in the patient with spinal cord injury. Even though the average age of the veteran with a spinal cord injury is increasing, there are still many younger veterans affected by spinal cord injuries. When skin issues arise in this population, the impact is not only physical but also emotional as skin issues sometimes make it difficult for the veteran to remain in their chairs, thereby decreasing mobility and socialization.