Skip to main content

Burn Wound Management

  • Chapter
  • First Online:
Essential Burn Care for Non-Burn Specialists

Abstract

Burn etiology, patient age, and burn size predict patient prognosis. The initial burn wound assessment determines the type of burn, burn extent and depth, and additional injuries. These factors play a significant role determining burn treatment strategy. This chapter outlines some of the initial steps of burn wound management that emergency physicians, medical teams, and burn specialists might follow when treating burn wounds to guide best burn care management. Once percent total body surface area (% TBSA) burned is determined, triage may begin. Burn patients with less than 20% TBSA are generally treated as short-term inpatients or outpatients, whereas those with burns covering more than 20% TBSA are considered major with long inpatient stays expected such patients are best treated in dedicated burn centers when possible. Patients with major burns may experience sepsis and undergo many operations for wound closure. Before transfer to a burn center, an assessment for escharotomy to assure safe transport should be conducted to prevent circulatory and pulmonary complications. Many excision and grafting techniques are available to treat patients properly according to their specific injuries, prevent complications, and improve outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Majno G. The healing hand : man and wound in the ancient world. Harvard University Press; 1975.

    Google Scholar 

  2. Gurlt EJ. Geschichte der Chirurgie und ihre Ausubung, Vol. 1. Berlin, Hirschwald; 1898.

    Google Scholar 

  3. Bull JP, Fisher AJ. A study of mortality in a burns unit: a revised estimate. Ann Surg. 1954;139(3):269–74. https://doi.org/10.1097/00000658-195403000-00002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Wolf SE, Rose JK, Desai MH, Mileski JP, Barrow RE, Herndon DN. Mortality determinants in massive pediatric burns. An analysis of 103 children with > or = 80% TBSA burns (> or = 70% full-thickness). Ann Surg. 1997;225(5):554–65; discussion 565–559. https://doi.org/10.1097/00000658-199705000-00012.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Zulkowski K. Wound terms and definitions [Guide]. WCET J. 2015;35:22–7. https://www.colleaga.org/sites/default/files/attachments/wcet20wound20terms2020definitions201.pdf

    Google Scholar 

  6. Wallace HA, Basehore BM, Zito PM. Wound healing phases. In StatPearls; 2021. https://www.ncbi.nlm.nih.gov/pubmed/29262065

  7. Coger V, Million N, Rehbock C, Sures B, Nachev M, Barcikowski S, Wistuba N, Strauss S, Vogt PM. Tissue concentrations of zinc, iron, copper, and magnesium during the phases of full thickness wound healing in a rodent model. Biol Trace Elem Res. 2019;191(1):167–76. https://doi.org/10.1007/s12011-018-1600-y.

    Article  CAS  PubMed  Google Scholar 

  8. World Health Organization. Management of burns; 2007. https://www.who.int/surgery/publications/Burns_management.pdf

  9. Hudspith J, Rayatt S. First aid and treatment of minor burns. BMJ. 2004;328(7454):1487–9. https://doi.org/10.1136/bmj.328.7454.1487.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tenenhaus M, Rennekampff H-O. Treatment of superficial burns requiring hospital admission; 2021. https://www.uptodate.com/contents/treatment-of-superficial-burns-requiring-hospital-admission#H2893372665

  11. UC San Diego Health. About burns; 2022. https://health.ucsd.edu/specialties/burn-center/pages/about-burns.aspx

  12. Greenhalgh DG. Sepsis in the burn patient: a different problem than sepsis in the general population. Burns Trauma. 2017;5:23. https://doi.org/10.1186/s41038-017-0089-5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Baxter CR, Waeckerle JF. Emergency treatment of burn injury. Ann Emerg Med. 1988;17(12):1305–15. https://doi.org/10.1016/s0196-0644(88)80356-1.

    Article  CAS  PubMed  Google Scholar 

  14. Zhang L, Labib A, Hughes PG. Escharotomy. In: StatPearls; 2021. https://www.ncbi.nlm.nih.gov/pubmed/29489153

  15. Schaefer TJ, Nunez Lopez O. Burn resuscitation and management. In: StatPearls; 2021. https://www.ncbi.nlm.nih.gov/pubmed/28613546

  16. Pruitt BA Jr, Dowling JA, Moncrief JA. Escharotomy in early burn care. Arch Surg. 1968;96(4):502–7. https://doi.org/10.1001/archsurg.1968.01330220018003.

    Article  PubMed  Google Scholar 

  17. White CE, Renz EM. Advances in surgical care: management of severe burn injury. Crit Care Med. 2008;36(7 Suppl):S318–24. https://doi.org/10.1097/CCM.0b013e31817e2d64.

    Article  PubMed  Google Scholar 

  18. Tiong W. On scene first aid and emergency care for burn victims. Int Public Health J. 2012;4:3–24. https://www.researchgate.net/publication/269701993_On_Scene_First_Aid_and_Emergency_Care_for_Burn_Victims

    Google Scholar 

  19. Barret JP, Herndon DN. Effects of burn wound excision on bacterial colonization and invasion. Plast Reconstr Surg. 2003;111(2):744–50; discussion 751–742. https://doi.org/10.1097/01.PRS.0000041445.76730.23.

    Article  PubMed  Google Scholar 

  20. Chamania S, Patidar GP, Dembani B, Baxi M. A retrospective analysis of early excision and skin grafting from 1993-1995. Burns. 1998;24(2):177–80. https://doi.org/10.1016/s0305-4179(97)00117-4.

    Article  CAS  PubMed  Google Scholar 

  21. Committee IPG, Steering S, Advisory S. ISBI practice guidelines for burn care. Burns. 2016;42(5):953–1021. https://doi.org/10.1016/j.burns.2016.05.013.

    Article  Google Scholar 

  22. Edmondson SJ, Ali Jumabhoy I, Murray A. Time to start putting down the knife: a systematic review of burns excision tools of randomised and non-randomised trials. Burns. 2018;44(7):1721–37. https://doi.org/10.1016/j.burns.2018.01.012.

    Article  PubMed  Google Scholar 

  23. Engrav LH, Heimbach DM, Reus JL, Harnar TJ, Marvin JA. Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: a randomized prospective study. J Trauma. 1983;23(11):1001–4. https://doi.org/10.1097/00005373-198311000-00007.

    Article  CAS  PubMed  Google Scholar 

  24. Israel JS, Greenhalgh DG, Gibson AL. Variations in Burn excision and grafting: a survey of the american burn association. J Burn Care Res. 2017;38(1):e125–32. https://doi.org/10.1097/BCR.0000000000000475.

    Article  PubMed  Google Scholar 

  25. Munster AM, Smith-Meek M, Sharkey P. The effect of early surgical intervention on mortality and cost-effectiveness in burn care, 1978-91. Burns. 1994;20(1):61–4. https://doi.org/10.1016/0305-4179(94)90109-0.

    Article  CAS  PubMed  Google Scholar 

  26. Nitescu C, Calota DR, Florescu IP, Lascar I. Surgical options in extensive burns management. J Med Life. 2012;5(Spec Issue):129–36. https://www.ncbi.nlm.nih.gov/pubmed/31803300

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Browning JA, Cindass R. Burn debridement, grafting, and reconstruction. In: StatPearls; 2021. https://www.ncbi.nlm.nih.gov/pubmed/31869181

  28. Goswami P, Sahu S, Singodia P, Kumar M, Tudu T, Kumar A, Sinha PK. Early excision and grafting in burns: an experience in a tertiary care industrial hospital of eastern India. Indian J Plast Surg. 2019;52(3):337–42. https://doi.org/10.1055/s-0039-3402707.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Steven E. Wolf .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

South, P.J., Ozhathil, D.K., El Ayadi, A., Wolf, S.E. (2023). Burn Wound Management. In: Lee, J.O. (eds) Essential Burn Care for Non-Burn Specialists. Springer, Cham. https://doi.org/10.1007/978-3-031-28898-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-28898-2_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-28897-5

  • Online ISBN: 978-3-031-28898-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics