Burn Injury Resource Center

Published on: December 12, 2013

Escharotomy and Burns

When the skin is burned and depending on the severity of the burn, tissue will die, this dead tissue is called an eschar which is inelastic and can’t expand.

When the burn is a circumferential (burned all the way around) second and third degree burn, eschar will form and with the edema (fluid leak from injured vessels) formed; the pressure will increase in the burned area. If this happens in arms and legs, this will lead to compression of the underlying veins arteries and nerves acting like a tourniquet. If the circumferential burn happens in the neck or chest, the pressure will prevent chest expansion leading to breathing problems. In these situations escharatomy is often needed.

Escharotomy is a surgical procedure done by making an incision through the eschar to relieve the underlying pressure, measuring the pressure in the compartment (closed space of nerves, muscle tissue and blood vessels) distal (furthest) to the affected area is one of the parameters used to determine the timing of escharatomy. Another way to determine the timing of the escharotomy is clinically by assessing the perfusion (the flow of blood) distal to the area affected.

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Published on: December 5, 2013

Acute Respiratory Distress Syndrome (ARDS)

By Larry Kramer

Also known as Adult Respiratory Distress Syndrome is a life threatening lung condition in which fluid accumulates in the lung leading to low levels of oxygen in the blood.

When a healthy person breathes, air will enter the nose and mouth passing through the trachea (windpipe) to reach the alveoli (air sacs) of the lungs. Oxygen will pass from the alveoli to small blood vessels surrounding the alveoli called the capillaries and from the capillaries to the bloodstream where it will be carried to different parts of the body. When the lung is injured from many causes including severe burns fluid and blood will leak from the capillaries into the alveoli, this will prevent air from entering the alveoli leading to decreased oxygen in the bloodstream and in turn decrease the oxygen supply to different organs which will affect their function. The lungs become inflamed, the inflammation will lead to scaring and fibrosis of the lungs causing the lungs to become stiff. This stiffness of the lung with fluid will make breathing very difficult for the patient.

Causes may include:

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Published on: December 3, 2013

Compartment Syndrome (part II)

By Larry Kramer

Treatment:

Acute compartment syndrome is considered a medical emergency that requires immediate surgical treatment. The surgical procedure is called a fasciotomy which is simply done by making a long incision in the fascia to release the pressure building inside.

Subacute compartment syndrome is treated surgically by urgent fasciotomy.

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Published on: November 27, 2013

Compartment Syndrome (part I)

By Larry Kramer

A compartment is defined as a closed space of nerves, muscle tissue and blood vessels. This space is surrounded by fascia (thick layer of tissue) that doesn’t stretch. When the pressure inside the compartment increases from any cause and if the pressure increases substantially, this may lead to the compression of the nerves, blood vessels and muscles inside the compartment. The result may be impaired blood flow and reduced oxygenation that may result in muscle and nerve damage. Compartment syndrome most commonly involves the forearm and lower leg although it can occur in other places. Compartment syndrome can be acute, subacute or chronic (see below).

Causes:

An injury that leads to an increase in the pressure inside the compartment may cause compartment syndrome, these may include:

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Published on: November 21, 2013

The Importance of Smoke Detectors

By Larry Kramer

According to the Center of Disease Control and Prevention (CDC), death from fire injury is the third common unintentional cause of fetal home injury. As fire claims the lives of many people each year and destroys properties and belongings; Smoke detectors play a big and important role in preventing such fires. Smoke detectors are devices that detect smoke or other combustion products and when they sense them an alarm will sound alerting people for the danger of fire.

There are two types of smoke detectors:

1- Ionization smoke detectors: this device detects smoke particles emitted from fire whether they are visible or invisible. Smoke changes the electric current which triggers the start of the alarm.

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Published on: November 20, 2013

Z-plasty and Burns

By Larry Kramer

When the skin is burned, contracture scars may form, these contracture scars will affect the range of motion in the affected area and one of the methods used for scar treatment is Z-plasty.

Z-plasty is a surgical procedure used to improve the functional and/or cosmetic appearance of the scars.

Cosmetic Z-plasty is the repositioning the scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable.

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Published on: July 16, 2013

Third Degree Burns and Keloid Scar (Part I)

By Larry Kramer

Keloid scar is a benign scar composed of dense fibrous tissue formed as a result of an abnormal healing process in response to skin injury, extending beyond the original borders of the wound or inflammatory response. There is little to be done to prevent them and even with its removal there is a possibility of keloid recurrence. Keloid scar may affect the patient both physically and emotionally as it may become a cosmetic problem depending on its location on the body.

Keloid scar can happen in any age and can affect both sexes. The incidance of keloid scar varies among different races, it’s more common among blacks, hispanics and Asians and less common in Caucasians for unknown reasons. Both genetic and enviromental factors play a role in the formation of keloid scar. Keloid scar may form following skin inflamation such as acne vulgaris or skin injury such as second and third degree burns. Keloid may happen may appear months after skin inflammation or trauma but may take up to a year to develop.

Keloid scar can present as a firm nodule which can be skin coloured, hypopigmented (lighter in colour) or erythematous (red in colour) and is often located at the site of the injury (such as burn), wound which could be surgical or non-surgical or other lesion. Most common locations of keloid scar include the shoulders, , chest, sternal area, earlobes and back of the neck. Symptoms of keloid scar may include pain, itching and mobility limitalion if it is located over a joint area.

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Published on: July 2, 2013

Silver Sulfadiazine

By Larry Kramer

Trade names include Silvadene, SSD AF, Thermazene.

Silver Sulfadiazine topical cream is a sulfa drug that is used in the prevention or treatment of skin infections in patients with second and third degree burns; it can also be used for other conditions that will be determined by your doctor. Silvadene has anti-bacterial and anti-fungal properties that work by killing bacteria or fungi and is for external use only.

Before using this drug tell your doctor:

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Published on: June 28, 2013

Burn Scars and Pressure Garments

By Larry Kramer

Some burns can heal without leaving any scars while other burns can leave wound scars after healing. Among the factors that determine the formation of scars is wound severity, superficial minor burns leave no scars when healing while deep severe burns such as second and third degree burns may leave scars after healing. when scars are formed whether they are hypertrophic or Keloids they may be difficult to treat. Cosmetic appearance of the scar form the patient’s main concern despite that hypertrophic scars and keloids may also cause pain, pruritus and pressure and/or contractures.

Treatment of scsars:

Treatment of scars may not be easy and there is a possibility of recurrance of scars even after treatment. Theraputic methods may include:

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Published on: June 26, 2013

Skin Grafting in the Treatment of Third Degree Burns

By Larry Kramer

Skin graft is the process by which a non healing wound or a burn wound is covered by a piece of skin taken either from the patient himself/herself or from cadavers or animls. this procedure is done surgically. Skin graft is either used a temporary wound cover or a permanent one. Some wounds such as third degree burns if left to heal on their own can lead to scarring and contractions.

As the skin is the largest organ in the body and among its functions is playing a major role in protecting the body from fluid loss and help in preventing harmful micro organisims such as bacteria and varuses from entering the body and causing infections therefore its important to cover third degree burns with skin graft as soon as possiblee as uncovered third degree burns are more liable for wound infections and fluid loss from the burn area .

Skin graft is a surgical procedure that is not used for wounds that can heal on itself such as first and second degree burns, it’s used for large and non healing wounds. The skin used for grafting can be taken from another area of the patient body if there is enough undamaged healthy skin available and if the general condition of the patient permit to undergo an additional surgery. This type of graft is call autograft. Another type of skin graft is called Autograft where the skin is obtained from another person who is usually a donor cadaver in which the skin is frozen and stored to be available for use. The last last type of skin graft is called Xenograft where the skin is obtained from an animal which is usually a pig. Autograft can be used as a perminant covering to the damaged area while Allograft and Xenografts are temporary ones as they will be rejected by the immune system of the patient after a short period of time and need to be replaced by Autograft.

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