Burns are characterized by 4 degrees:
superficial burn , 1st degree + 2 nd degree superficial, will be
treated in a conservative manner. In this case the skin hasn't been burnt
completely and a spontaneous curing is possible. A deep burn
, 3 rd + 4rd degree, needs a surgeon treatment.The skin is
completely damaged and has to be replaced by a new skin.
- 1 st degree
There will only be seen redness and a little swelling
(oedema) of the skin.
The wound will be closed, feel supple but very
- 2 nd degree:
There will be blistering and the wounds are
painful.Dependent on the depth of the colour the skin beneath the
blister will be intense red (superficial) to light pink ( deep). The
sensibility is not disturbed and the wound feels supple.
- 3 rd degree:
These wounds aren't painful and feel leather-like.
The burnt skin looks white or beige. All layers of the skin are damaged
and spontaneously cure isn't possible anymore.
- 4 th degree:
These wounds can look as 3 rd degree burns, but
often the colour is black by carbonization. Not only the skin is burnt
but the underlying tissues as well.
An intermediary burn, 2 nd degree deep, forms an
exception to the management of this wound. This skin has been burnt
subtotally, and has the possibility of spontaneously healing. The slow
curing and great chance to scar-hypertrophy enhances the surgeon
The clinical judgement of the depth of the degree is
often difficult, especially with intermediary burns. Only three days after
the burn, a proper treatment can be given.
Eventually this allows us to start the right treatment and a quick
healing. Burns can also evolve to a higher degree if not treated
effectively. Dehydration, infections and mechanical damaging have to be
avoided. Extensively washing with lukewarm water and the right bandage
care can avoid this. At 2 nd degree burns not only the closure of the sink
defect is important but also the prevention of scar-hypertrophy
. The sooner the wound will be closed, the faster the beginning
with the pressure-therapy and the better the final result of the scar.
Especially children are notorious to develop hypertrophical scars.
Forms of conservative wound treatment
1. Occlusive wound treatment
This bandage aims at impermeability to microbes, creates an environment
in which the growth of microbes can be restrained and offers protection to
the grown epithelium. This bandage can be used in the follwing ways.
You can see some pictures of a man who has got donorskin at this link:
As long as the blister is intact no
infection can appear. Once punctured the blister needs to be treated to
prevent woundcontamination and infection. A daily disinfection and a
jelonet greasy bandage can be used for this. After five or seven days
the blister can be removed, washed and treated with flammazine.
- Polyurethane foil
This foil is limitedly
permeable to air and water and impermeable to microbes. Because there
isn't any anti-bacterial effect, it can only be used on small
superficial burns that aren't infected (eg. Tegaderm, Opsite)
- Hydrocolloid bandages
These bandages lay an artifial blister on the wound.
The outside exists of a polyuethane foil and the inside, a hydrocolloid,
sticks to the healthy skin and resorbs the fluid of the wound. In
combination with the fluid of the wound hydrocolloid forms a jelly with
a sour PH which has an anti-bacterial effect. These membrane bandages
are comfortable, adhesive and allow taking a short shower. (eg. Duoderm,
- Donor skin
Humane donor skin is reserved to the 2nd degree warm water burns
with children. It relieves pain, is applied once and gives, comparing to
flammazine bandage, less cause to scar-hypertrophy. Donor skin is a
temporary replacement of the own skin. It forms a new thin layer which
will get loose once the own skin is healing again. After 14 days a new
layer of donor skin is replaced and this procedure will be repeated as
long as necessary.
From left to right you can see:
- 2nd degree burn wound
- donorskin, fixated with mepithel
- cured, the result
2. Half-open bandage
Locating, depth, extension of the burn just as infection can render a
burn for a closed wound treatment.A flammazine bandage through a half-open
treatment will be the gold standard. The following bandages will be
applied once daily. It are all greasy bandages which have a stimulating
effect at the healing.
3. Open bandage
(silversulfadiazine) has a broad anti-bacterial spectrum and is active
against negative micro-organisms which frequently colonize burns.
Extended open wounds and infected wounds form an excellent
indication.The cream will ease the pain as well.
Is only used
for extended deep burns and often to prepare an operation. The
cerium-flammazine forms a dry crust on the wound that prevents a
bacterial invasion and cause spontaneous epithelisation. This cream
isn't used for the face and the hairy scalp and only applied in burn
Flamigel, a hydrocolloid in
jelly, can be used for 1 st degree burns. This jelly consists of
polymers which have a inhibitory function on the growth of microbes. It
consists no antiseptic or antibiotic. At 2 nd degree burns is can be
used in a closed form of bandage or as half-open bandage with daily
disinfection of the wound. The jelly relieves the pain.
A hydrocolloid in jelly
enriched with alginate polymers, especially indicated to 2 nd degree
burns where more wound-excudates are seen. Unlike flamigel it inhibates
the growth of microbes by its enzymatical working. This can also be
combined with a daily disinfection of the burns. An advantage compared
to flammazine cream is that it doesn't form a crust on the wound so it
won't hinder the judgement of the depth. It also gives better results in
combination with polarized light (see later on). Here too a reasonable
ease of pain has been observed.
Furacine (Nitrofurazon) has as
soluble dressing (cream) a place at the treatment of 2 nd degree burns.
This cream has a smaller anti-bacterial spectrum than Flammazine cream,
but is also very active against Staphylococcus Aureus. Furacine soluble
dressing is often used at facial burns and in variation with flammazine
used long-lasting. Combining these two products a local therapy with a
broad spectrum is gained, which can be supplied for a long term without
a chance of insensible micro-organisms.
Betadine-cream, Fucidin, Bactroban skin cream
and other products aren't suitable to primary treatment of
burns. They will be applied in a secondary stage after a treatment
before with one of the membranic wound-coverers or Flammazine cream. The
result of the wound culture is determined to the choice of the local
Jelonet greasy bandage:
Is a good
bandage to the treatment of small granulating rest defects which are
often seen in healing burns.
The following bandages are only used after indication. For the sake
of completeness they are mentioned below.
Wound infections with
Pseudomonas Aeruginosa are treated succesfully with acetic acid
bandages. Wound cultures have to be taken regularly to detect infections
with other germs and to adapt the bandage treatment. (Flamiclens)
Hypergranulate tissue can
be dabbed with AgNO3. At very extended zones the use of a corticosteroid
cream can be necessary.
This form of treatment is seldom being used nowadays. The wound is
being exposed to the air and a crust will form under which the healing
takes place. A facial burn and very small burns form the only exceptions.
Eg. An open bandage with Furacine soluble dressing for a facial burn.
The use of polarized light
Recent investigations show us that polarized light has a stimulating
effect on the healing of the wound. The bio-stimulating effect of this
therapy results in a accelerated epitheliation and a higher quality of the
forming of scars. The use of polarized light is applied once daily during
6-10 minutes per area (180 cm/2) and can be combined with a half-open
bandage. Flamigel and Flaminalg are eligible best.
The conservative wound treatment towards
extensiveness and depth
of the burn
1 st DEGREE I: A hydrating cream and a total sunblock
2 nd DEGREE II: = 20%
2 nd DEGREE II: = 20%
2 nd DEGREE II: = 30%
Membrane wound coverers like donor skin/Opsite/Duoderm
Flammazine cream 1x/d
Flaminalg + Bioptron
3 rd DEGREE III:
Membrane wound coverers like Opsite/Duoderm
Alginate bandage like Kaltostat