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Thursday, November 21, 2013

Doc, is this burn healing well ?- 2nd degree superficial burn

Doc, I am sending you a picture of my son who had a burn on his chest twelve days back. I just want to be sure that things are fine and that we are on the right course. Do you think that this will result in a bad scar?

Jane, mumbai.

Thank you for the query, it appears that the burns are healing well. second degree burns are of two types- superficial and deep. The superficial one often heals well as seen above in this sweet child. The deep 2nd degree burn is the problem- because they may not heal and need additional procedures like skin grafting to heal the burn.

2nd degree superficial burns heal well usually don't form scars. However over some sites such as the chest wall and the shoulders the skin tension is high and possibility of scars are also high. If on follow up it seems that that scars may result then one must start scar treatment subsequently.


Wednesday, November 20, 2013

Scars and keloids

Scars are of different types. Some may be flat while others may be indent below the level of the normal skin.
Sometimes they start to grow in size and spread over the normal skin. They may cause pain, itching and even get infected because as they grow they cover the hair bases and sweat and sebaceous gland pores. Blocked pores tend to get infected. They may fail to settle and continue to grow in size for more that a year, at which time they start to be referred to as keloids scars rather than hypertrophic scars, as hypertrophic scars often settle down over time. Keloids  scars are most common on areas where the skin is normally under stretch or tension as over the shoulders and  anterior chest wall. They can also occur on other areas. While the exact causative factors are unknown, a positive family history, a tendency to form keloids, tissue loss and healing that occurs without the lost tissue being replaced, burns and  injuries on prone sites as mentioned above are some of the common causes. All the patients shown above developed keloids spontaneously from small lesions that started to itch and grow in size.
Scar treatment can be a complex affair as each scar must be treated on its own merits: each one must be individually analyzed to see which modality of treatment will help to resolve the scar.


Doc what do I do with these scars?

Some scars may be associated with a deformity as shown in the picture above. These scars have resulted from tissue loss of part of the nose and nostril. The body has made an attempt to heal the wounds by forming scar tissue which has resulted in a deformity. In treating these scars one must make an attempt to correct the deformity try to get the nose back to its normal state. Concomitantly one must think how the scar can be treated as well. Providing new tissue for the nose reconstruction will improve the quality of the scar tissue as well as some  of these scars will have to be removed and replaced with normal tissue using the principles of plastic and cosmetic surgery.


Monday, November 18, 2013

Is my burn infected?


I wanted to ask if my burn is infected? This burn is three days old. I spilled hot fryer grease on it. I was prescribed silver sulfadiazine creme and percocet for pain. I have been caring for it as i was told by the physician. Wash with mild soap and water twice daily apply creme and re bandage. Please respond asap. 

Thank you.
B. Ferrell
Dear ms Ferrell,
am sorry to hear you had a burn on  your foot. Though the burn is 3 days old it has the appearance of a burn which has been there for a longer time. Hot grease and oils can reach temperatures of 175 to 200 degree centigrade and therefore the burns are usually deep.  Your burn appears to be deep 2nd degree to 3rd degree. There does not seem to be any local signs of infection from the picture. Guess you have to keep on with your dressings, pain killers and watch for any signs of infection.  
please also read these  related articles from asktheburnsurgeon

Sunday, November 17, 2013

What is escharotomy, Electrical burns, high voltage burns, gangrene, treating deep circumferential 2nd degree and 3rd degree burns causing vascular compromise or reduction in blood supply to the limbs

Deep 2nd degree burns and 3rd degree burns need to be monitored and treated with great care especially if they are circumferential (burns all around the limb). This is because the burnt skin tends to constrict the limb slowly affecting the blood flow to the hand and fingers. If not treated immediately this can end up in gangrene or death of the distal part where the blood flow is limited or stopped due to the circumferential pressure. The patient shown above had deep burns of the forearm  and hand from high voltage electrical injury.This caused reduction in the blood flow to the hands and fingers.

What is escharotomy?
when blood flow to the limb is reduced from a circumferential burn, the offending eschar or deep burn tissue forming a constriction band needs to be cut open and released. If not done in the correct time the tissues will die from reduced oxygenation and blood flow and will end up in gangrene and amputation of the part. The picture above shows the escharotomy done in such a patient. The surgeon will cut open the eschar using the standard established lines of escharotomy protocols. 


Hypertrophic scarring, face burns, lip commisure contracture, mouth burns, 2nd degree deep and superficial burns

Face burns can be a tricky problem because superficial burns heal well but deep burns can end up in hypertrophic scarring. However the surgeon must be able to decide which burn he is going to skin graft and which he is likely to leave alone. The unfortunate child shown above had face burns over the cheek which were treated conservatively. The cheek burns have healed well but some hypertrophic scars have developed. One can see that the lips have been burnt as well. The oral commisure or junction of the upper and lower lip is burnt and contracted as well, pulling the oral commisure or  junction to the left. This deformity needs to be followed up and may need surgery using the principle of plastic and cosmetic surgery at a later stage.


forehead burns, face burns in children, role of plastic surgery and cosmetic surgery in burn care

Deep face burns are one of the most difficult burns to treat surgically because the surgeon has now to look at the aesthetic and cosmetic results that he is likely to end up with. This unfortunate child shown above was involved in a house fire where he could not be rescued in time. The parents had left him unattended while sleeping when the house caught fire. By the time the child was rescued he had suffered 70 percent burns- most of them deep and needing skin grafting. The forehead area which had deep burns were skin grafted with a sheet graft. The grafting was done keeping in mind the aesthetic units of the face using a single large sheet graft of skin. This case demonstrates the advantage of using the principles of plastic and cosmetic surgery in burn patients.


skin grafting and hypertrophic scars

Sometimes deep burn wounds may need to be skin grafted. Often they heal well but in some cases the junction of the normal skin and the skin graft may become thick reddened and painful- referred to as a hypertrophic scar. Such scars need to be treated as any hypertrophic scars with cream applications, pressure garments and other modes of scar treatment- whichever is considered best by the treating surgeon. Some of these may even need surgery if they form contractures, or scars that restrict movement. The patient shown above had a deep burn on the leg, ankle and foot which was treated by skin grafting (mesh graft was applied). Though the graft healed well, a small hypertrophic scar developed at the junction of the graft and the normal skin.