Burns

Steven A. Kahn's picture

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.

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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.

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Burns

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.

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Scar management

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.

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Complex Wounds

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.

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Temple University

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

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Cathy Wogamon's picture
Veteran with Spinal Cord Injury

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.

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Burn Treatment

by the WoundSource Editors

Burn management is typically based on the severity of the wound, and the goals are to prevent shock, relieve pain and discomfort, and reduce the risk of infection. Pathogens are present everywhere, and any breach in the skin, especially burns, can lead to infection. When burns cover up to 35% in adults and 30% in children, they are considered major burns, and anything above those levels is considered critical or life-threatening. A thorough assessment of the patient and burn site is necessary to determine the most appropriate treatment interventions given the type and severity of the burn injury.

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Aletha Tippett MD's picture
technology-in-wound-care

By Aletha Tippett MD

In looking at technology that helps in wound care, how many know about—and use—lasers? Cold lasers have been used by physical therapists for years, but cosmetic lasers can also be used. I have had tremendous success using laser therapy on wounds. Healing is much improved (and faster), with less scarring. I am not a technocrat. I’m much more old-fashioned, but the laser is a wonder.

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Michel Hermans's picture
monitoring the healing time of partial-thickness burns

By Michel H.E. Hermans, MD

Recently I paid a visit to one of the better known wound care centers in the North East. As I expected, treatment of the common lesions seen in this center, such as venous leg ulcers and diabetic foot ulcers, was top notch. The use of compression and offloading, proper wound debridement and modern dressings (including, where indicated, biologics and matrices), in combination with the option for vascular, plastic and orthopedic (i.e. for Charcot foot) reconstruction resulted in good healing results, with high percentages of reepithelialization within a relatively short time frame.