Burn trauma, which is one of the most serious injuries to the human body, can be seen together with fire, scalding with hot water and electric shock, as well as fatal lung and brain damage due to indoor burning. It can also develop with radiation and extremely innocent-looking sun rays. Although the burn is an injury that often involves the skin due to its nature, it is possible to encounter situations where deep tissues are also affected in severe flame burns and electric shocks. Although there is no complete and healthy statistical study, approximately 200,000 – 250.00 people are exposed to minor or major burn injuries every year in Turkey, 12-13 thousand of them are hospitalized and 500-600 are lost. In addition, the number of patients with burns who have lifelong sequelae or disability at varying degrees is substantial.
Burn injury, unlike other traumas, is a situation that the majority of the society has experience, even if it is in a very mild form. Almost all of us have suffered a hot liquid burn or a minor hot surface contact burn. As a result, we are all aware of the discomfort of such injuries. Presumably, this gives us information about the pain and suffering that a larger skin surface can be affected by. Indeed, in its severe forms, burn injury may be considered the most severe form of life-threatening trauma. If survived, such an injury will change every aspect of an individual’s life. You will be faced with situations that greatly affect the comfort of life, such as external appearance, functioning independently in society, and as a result, the psychological state of the individual.
The most important thing that can be done to avoid trauma from the burn is to take the necessary precautions to prevent the burn from occurring. For this reason, it is necessary to keep in mind and follow extremely simple precautions in order to minimize the burns of children especially at home and in the kitchen. For example, simple precautions such as not keeping the cord of wired kettles or the handle of the pan on the stove within the reach of children, installing protective covers of electrical outlets, keeping the teapot and teapot away from the children at the breakfast table will always work. The most common example of minor burn trauma is the type of burn caused by scalding with hot liquid, which is seen in children aged 0-5 years. Despite all the precautions taken, correct and effective first aid should be given in such a situation. After a burn injury, cooling the area that comes into contact with hot water for only 15-20 minutes under tap water significantly limits the damage at the cellular level of the burn and seriously prevents the increase in the degree of the burn. It is important not to apply anything to the burned area (especially ointments or other substances that are difficult to clean later). After this area is cooled, the best thing to do is to cover it with a clean cloth or towel – this is extremely helpful in controlling the pain as the contact of the burned area with air is cut off – and get professional support. Considering that the majority of those exposed to this type of injury are children, the only thing to do to avoid the pain caused by daily or every other day dressing changes and hospital visits should be to ensure that the wound heals smoothly with the only wound care and dressing performed immediately after the injury.
Goals of treatment
The aim of treatment in major burns is to return the patient to their pre-injury state and return to their place in society with an unchanged potential, apart from the survival of the patients. The nature of the burn injury often precludes this goal, but the goal should be constant and to maximize treatment by:
– Appearance; to restore the aesthetic characteristics of the injured area as much as possible in terms of skin color, structure and contour
– Function; It is to save the ability to carry out the maximum level of home life, work life and private life activities. This often means that the necessary reconstructive surgical effort is spent to preserve vital structures and restore the patient to their pre-injury state, while working specifically to maintain the range of motion of the joint.
– affect; to assist psychological recovery after a traumatic and devastating injury. It is necessary to try to help patients and their relatives during the painful and stressful prolonged treatment process. It is quite common for patients to encounter deprivation after the loss of one of their family members and friends.
Wound Care and Surgical Treatment
The issue of how to heal the burn wound in burns is completely related to the depth of the burn. For this reason, the first thing the physician who is faced with a burn should do is to try to determine the depth of the burn. As a classical knowledge, the depth of burn is defined with a degree expression between 1 and 4. According to this ;
First degree burns
It is a partial thickness burn, the upper layer of the skin is damaged, sunburn is an example, it is painful and heals within 7 days. Patients are recommended creams to keep the burned areas moist.
Second degree burns
There is partial thickness burn, and ther is no full thickness skin injury. The upper layer of the skin is completely damaged however, the lower layer is partially damaged. The upper part of the hair, sebaceous and sweat glands in the skin is affected, but healing is achieved with spontaneous wound care. It is characterized by bubbles (water collection). It is painful and easily turns into a third degree burn if not well cared for.
Third degree burns
All layers of the skin are burned, that is, it is full thickness. It is observed in the matte-grey colored burn area with the vein in which the blood is trapped. It is painless and the tissue that has lost its vitality due to burns is called eschar.
IV degree burns
These are injuries in which the skin and subcutaneous tissues are completely burned and important tissues such as the underlying bones, tendons and joints are exposed.
As can be seen in this classification, as the degree of burn increases, the treatment ranges from simple wound care and spontaneous healing to surgery and even complicated surgical interventions. In first degree burns, only pain control and moisturizing of the skin solve the problem, while II. In degree burns, special wound care materials are needed and the wound can be healed by itself. However, deep II. and III. In the first-degree burns, treatment requires closure of the burn wound with skin patches (grafts) taken from another part of the body in the early period, that is, 3-5 days after the burn. IV degree burns, on the other hand, are a type of deep burn that requires wound closure with much more sophisticated surgical techniques.
Although the treatment of burn injury concerns multiple specialties, the role of an experienced plastic surgeon is indisputable, mainly because the injury requires surgical techniques or requires a surgical perspective on how to close the wound. In addition, making well or poorly healed wounds less noticeable in the future is also within the specialty of plastic surgery.