[an error occurred while processing this directive] Treatment for Burn Injuries: Surgical, Skin grafts, Pain Management

Treatment for Burn Injuries

There are some general guidelines to remember in burn injury treatment. Following simple steps can reduce the pain and healing time association with burn injuries.

First, submerge the burned area in cool water for 20 minutes as the burn can continue to damage the skin. The cool water will eventually stop the burn. Remember: never remove clothing or material sticking to a burned area. Use clean a non-fluffy material, such as cling film, to cover the burned area.
If the burn covers a large area or if the burn is on a sensitive part of the body, face or genitals, contact your doctor or local hospital immediately.

Victims under the age of 5 and over the age of 70 should seek medical treatment for burns. Children between the ages of 5 and 20 years have the best recovery from burns.

Generally, older adults and children will need to be hospitalized for second degree burns that cover more than 15% of their total body surface. Body surface can be estimated with the “rule of nines” – the head, right arm, and left arm contribute approximately 9% of total body surface each; each leg contributes 18% (2 x 9); the chest and back each contribute 18%; and the palms of the hands contribute another 1% each.
Small, deep burns may often be treated at home as wells as large first degree burn will typically not require hospitalization.

Burn injuries to eyelids, hands, feet, and groin usually require the patient to receive assisted living arrangements until the injury begins to heal. Also, burn injuries may worsen several conditions requiring hospitalization and observation including diabetes, kidney failure, congestive heart failure, and chronic obstructive pulmonary disease.

Surgical Procedures

One of the most common surgical procedures used to treat burn injuries are skin grafts which involve removing skin from another area of the victim’s body and transferring it to the burned area. When a patient suffers severe burns, doctors often turn to skin banks. Skin banks are similar to blood banks. Grafts from skin banks are used as a temporary covering to protect against infection, reduce pain, reduce fluid loss, and allow the tissues underneath to heal. However, because the body’s immune system recognizes some grafts as being foreign, it rejects the graft in 1 to 3 weeks. It is then removed.

Another type of surgical procedure used on burn injuries is called dermabrasion or dermaplaning. Some scars heal differently than others. Some scars can cause embarrassment and distress to the victims, in which case dermabrasion can smooth scars by resurfacing the skin's top layers through surgical scraping.

Be sure to research your doctor carefully when considering a surgical procedure. Usually plastic surgeons and dermatologists receive the most training in skin resurfacing. Make sure your doctor is “board certified.” Every specialty has a board that certifies which doctors have met the board’s requirements to become a specialist. To confirm a board certification qualification on a specific plastic surgeon, visit American Society of Plastic Surgeons.

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Skin Substitutes

Two common skin substitutes used in the treatment of burn injuries are known as Biobrane® and AlloDerm®. These products are applied to the burned area of the skin to replace the injured skin.

Another type of skin substitute, known as cultured skin, involves growing a patient's skin in the laboratory and expanding it from a small biopsy to 10,000 times its normal size. Using skin substitutes and cultured skin reduces a patient's hospitalization time, pain, and likelihood of death suffered from the injury.

Real skin contains nerve endings, hair follicles, and sweat glands, which skin substitutes can not yet duplicate. One type of skin substitute gaining attention is fetal skin taken from miscarried and aborted fetuses. A single four-centimeter piece of fetal skin is enough to form a bank that can produce several million grafts for burn treatment.

Fetal skin grafts were studied in treatment for eight children with severe burns. The children's dressings were changed every three to four days for three weeks. The grafts were applied so easily that no staples or other fixative measures were needed with hardly any anesthesia. All the wounds in the study healed in a little more than two weeks, and no traditional grafts were needed.

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Medication

Managing pain medication for burn injuries will vary depending on the severity and location of the burn. Burns in more sensitive areas of the body will require strong pain medication. First- or second-degree burns are usually treated with over-the-counter products such as aspirin, Tylenol (acetaminophen) or Motrin (ibuprofen). Doctors often treat larger and deeper second-degree burns with narcotic pain medication for relief.

Medications differ for thermal, electrical and chemical burns as the key factor in treating electrical burns is hydration while thermal burns require analgesics and topical antibiotics. Doctors usually prescribe analgesics for thermal burns such as Morphine sulfate, Demerol and Vicodin. These drugs are prescribed for severe pain.

Nonsteroidal anti-inflammatory agents are used for the relief of mild to moderate pain. Ibuprofen (Advil, Motrin) is usually used for initial therapy, but other options such as Naproxen, Ansaid, and Anaprox may be prescribed.

In addition to pain medications, doctors apply topical antibiotics to prevent infection of the burned area. Usually Neosporin is used to treat minor infections and is applied to the affected areas. More severe burns require the use of Silvadene, a sulfa medicine used to prevent and treat bacterial or fungus infections.

Most chemical burns are treated with topical antibiotics, calcium and magnesium salts. Once a doctor decontaminates the affected area, a standard IV fluid and narcotic therapy is prescribed. Scar treatment medications, such as Mederma, reduce the visibility of scars. These gels are usually rubbed into the scar 3 to 4 times a day for 3 to 6 months for burn scars. Cica-Care gel sheets are made of a silicone gel which flatten and soften scars.

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Homeopathic Treatments

While major burns should always be treated by a medical practitioner, some patients may find alternative approaches, known as homeopathic treatments helpful as well. Two common homeopathic treatments, Cantharis and Causticum can expedite the burn healing process. Several botanical remedies, applied on the outside of the skin each day aid in the healing of burns. These topical treatments include aloe (Aloe barbadensis), oil of St. John's wort (Hypericum perforatum), calendula (Calendula officinalis), comfrey (Symphytum officinale), and tea tree oil. Patients also find success in using vitamin supplements to help the healing process with vitamin C, vitamin E, and zinc.

In addition to homeopathic drugs, recent research has revealed the effects of distraction therapies in reducing burn procedural pain. Doctors are now using computerized virtual reality distraction techniques which are having a significant analgesic effect. Additionally, hypnosis is another method being used extensively by a number of burn teams across the country. These alternative treatment techniques can often be time-consuming, but have proven successful in reducing the amount of fear and anxiety, especially during long procedures. Physicians are using these types of therapies to supplement more traditional medical treatments and do not plan on replacing pharmacological treatments with distraction techniques.

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Pressure Garments

Doctors regularly advise burn patients to wear pressure garments while burn scars are actively healing and immature. Because scar tissue is highly responsive in the early stages, applying pressure garments is highly successful in aiding the healing process. Pressure garments should be worn as long as possible only to be removed for bathing and cleaning of the burn sites. Patients generally wear pressure garments for 12 to 18 months.

Burn injury patients wear pressure garments to prevent the thickening, buckling, and nodular formations seen in scars. Because of the counter-pressure applied by pressure garments, a soft, pliable elastic scar will develop and allow for unrestricted joint movement. Also, the external pressure of the garments reduces the inflammatory response and the amount of blood in the scar which will reduce itching and prevent injury.

As pressure garments are custom-designed for each burn victim, they can become expensive. Some pressure garments are available by prescription only. With the help of a pressure garment, the connective tissues form a three-dimensional mesh or collagen fibers under the skin. Burns destroy the skin and ability for the body to apply normal pressure during healing. Without this pressure, hypertrophic scars will form irregularly causing possible deformities.

Here are links to ready-made and custom pressure garments:
http://www.pressuregarment.com/
http://www.bio-con.com/
http://wound.smith-nephew.com/
http://www.gottfriedmedical.com/
http://www.jobst-usa.com/

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Pain Management

Burns often cause some of the most intense and prolonged types of pain. Burn pain is difficult to manage because of its unique characteristics, changing patterns, and various components. Levels of pain may increase during the treatment of burns as the doctors cleanse wounds and replace dressings. Studies show that the management of burn pain can be inadequate requiring more aggressive treatments for pain.

As burns heal, patients will feel a lessening of the extreme pain accompanying most burn injuries. Burn patients can experience a feeling of skin tightness, numbness, or a tingling or burning sensation as the skin cells regenerate and wounds heal. The severity of burn pain is difficult to predict from wound depth, but for many patients it is extremely severe. Burn pain has been reported as lasting for over a year after the initial injury and often includes psychological and functional difficulties.

Pain management should begin with treating the acute injury. On arrival in the hospital, for any but the most trivial burns, intravenous narcotics are generally used to prevent under-treatment of pain. Subsequent treatment of pain should distinguish between background pain and procedural pain, such as the pain associated with burn debridement. Oral medications may be substituted for intravenous narcotics and drug combinations with benzodiazepines or NSAIDS are also effective.

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Counseling and Support Groups

Counseling helps burn victims deal with a roller-coaster of emotions as they begin to recover from the emotional and physical effects of burn injuries. Support groups foster a sense of camaraderie and help with the healing process while bringing patients together who share common concerns and experiences.

Burn victims can maximize their counseling sessions by speaking as openly and honestly as possible. Most counseling will require you to try something new or a "different approach." Keeping an open mind is essential during counseling. Your counselor may expect you to experiment and try things without jumping to conclusions. Also, be up front with your counselor and let him or her know if you feel as though you are not making any progress in dealing with your issues. Before you attend your counseling session, be ready to focus on a specific problem or issue. You may even want to jot down some concerns and keep a notebook of your feelings and how the sessions are helping you.

The following is a list of links to counseling and support groups available for burn injury victims and their loved ones in specific areas across the country:

A database across the U.S.:

Burn Care Foundation:

http://www.burncarefoundation.com


Percy R. Johnson Burn Foundation:

Northwest Burn Foundation:

Alisa Ann Ruch Burn Foundation:

Ohio State University - Burn Care

WoundCareNet:

Shrine & Shriners Hospitals:

The Phoenix Society for Burn Survivors:

Burn Surgery:

Burn Prevention Foundation:

Burn Institute:

Burn Survivors Online:

B.C. Professional Firefighter's Burn Fund

Lynn's Story - A Burn Victims Story

Angel Flight Central:

More Links to Burn Foundations

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