Burns-Burn Review

Burn Review
Pdf Summary
The upper extremity is involved in approximately 90% of burns, with many of these patients requiring medical care. The dorsal side of the hand has thin skin with tendons, joints, and blood vessels located superficially, while the palmar side has thick skin with subcutaneous fat and septae. Severity of burns is determined by temperature and duration of exposure, with flame burns tending to be worse. Thermal injuries cause coagulation, protein denaturation, and result in distinct zones of coagulation, stasis, and hyperemia. Adequate resuscitation can reverse the zone of stasis. Burns greater than 20% total body surface area (TBSA) can lead to systemic inflammation and decreased perfusion. The Lund and Browder chart is commonly used to estimate TBSA in adults, while in infants, the head is counted as 18% and both legs as 28%.<br /><br />A severely burned patient should have a thorough trauma evaluation, and a low threshold for intubation if there are signs of thermal injury to the airway. Burns can be classified as superficial, partial thickness, full thickness, or fourth-degree. Criteria for transfer to a burn center include the percentage of TBSA affected, burn location, type of burn, and concomitant trauma or medical conditions.<br /><br />Treatment for burns involves emergent procedures such as fasciotomy and escharotomy. Initial care includes washing the burns with antibacterial soap and removing soot and superficial nonviable tissue. Wound care protocols differ, but dressing changes are typically initiated immediately. Surgical treatment options include excision and skin grafting, with tangential and fascial excision methods used depending on the depth of the burn. Rehabilitation involves using thermoplastic splints and compression to prevent contractures while healing. Secondary reconstruction may be needed to address burn scar contracture.<br /><br />Overall, burns require comprehensive evaluation, classification, and treatment to promote healing and minimize complications.
Keywords
upper extremity
burns
medical care
thermal injuries
TBSA
burn center
wound care
surgical treatment
rehabilitation
burn scar contracture