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Burn – it is a lesion of body tissues under the action of high temperatures, electric current, an ionizing substance or certain chemicals.
- According to WHO (World Health Organizationa) the frequency of thermal lesions, under the action of high temperatures, is six percent of the total number of injuries.
- According to statistics, in about 50% of cases, burns in people occur under the influence of a flame, the temperature of which can reach 2000 – 3000 degrees Celsius. Most often it is a flame of a fire, stove, in case of fire, ignition of gasoline or fumes. About 20% of burns are caused by scalding with hot liquids and steam. Burns that occur due to contact with hot objects or due to other factors are observed in about 10% of cases.
- More often (about 75%) burns affect the upper limbs and hands.
- According to statistics, every third child is burned.
- Combustiology is a special section of medicine that studies burn injuries.
- A person who has suffered a thermal injury is called burnt.
- In the Middle Ages, in order to stop the bleeding, they deliberately cauterized the damaged place with a red-hot iron. In modern medicine, the cautery method is also used to stop the blood, but nowadays it is carried out with the help of electricity.
The skin is the outer cover of the body, which protects a person from the effects of the external environment and plays an important role in the process of thermoregulation, water-electrolyte balance, as well as the protection of the body from bacteria and infections.
The skin consists of the following layers:
- epidermis (outer skin);
- dermis (connective tissue skin);
- hypodermis (subcutaneous tissue).
This layer is superficial, providing the body with reliable protection against pathogenic environmental factors. Also, the epidermis is multi-layered, each layer of which differs in its structure. These layers provide continuous skin renewal.
Epidermis consists of the following layers:
- basal layer (provides the process of reproduction of skin cells);
- prickly layer (provides mechanical protection against damage);
- granular layer (protects the underlying layers from water penetration);
- shiny layer (involved in the process of keratinization of cells);
- stratum corneum (protects the skin against the introduction of pathogens into it).
This layer consists of connective tissue and is located between the epidermis and the hypodermis. The dermis, due to the content of collagen and elastin fibers in it, gives the skin elasticity.
The dermis consists of the following layers:
- papillary layer (includes capillary loops and nerve endings);
- mesh layer (contains blood vessels, muscles, sweat and sebaceous glands, as well as hair follicles).
The layers of the dermis are involved in thermoregulation and also have immunological protection.
This skin layer consists of subcutaneous fat. Adipose tissue accumulates and retains the nutrients that make the energy function. Also, the hypodermis serves as a reliable protection of internal organs from mechanical damage.
For burns, the following skin lesions occur:
- superficial or complete damage to the epidermis (first and second degrees);
- superficial or complete lesion of the dermis (third A and third B degrees);
- damage to all three layers of the skin (fourth degree).
With superficial burn lesions of the epidermis, the skin is completely restored without scarring, in some cases a barely noticeable scar may remain. However, in the case of a lesion of the dermis, since this layer is not capable of recovery, in most cases, rough scars remain on the surface of the skin after healing. With the defeat of all three layers, complete deformation of the skin occurs with the subsequent violation of its function.
It should also be noted that with burn lesions, the protective function of the skin is significantly reduced, which can lead to the penetration of microbes and the development of an infectious-inflammatory process.
The circulatory system of the skin is very well developed. Vessels passing through the subcutaneous fatty tissue reach the dermis, forming a deep skin-vascular network on the border. From this network, blood and lymphatic vessels move upward into the dermis, feeding nerve endings, sweat and sebaceous glands, as well as hair follicles. A second superficial skin-vascular network is formed between the papillary and reticular layers.
Burns cause impaired microcirculation, which can lead to dehydration due to the massive movement of fluid from the intravascular space into the extravascular. Also, due to tissue damage, fluid begins to flow from small vessels, which subsequently leads to the formation of edema. With extensive burn wounds, the destruction of blood vessels can lead to burn shock.
Causes of burns
Chemical burns occur as a result of harsh chemicals on the skin (for example, acids, alkalis). The degree of damage depends on its concentration and duration of contact.
Burns due to chemical exposure may occur due to the effect on the skin of the following substances:
- Acids. The effect of acids on the surface of the skin causes shallow lesions. After exposure to the affected area, a burn crust is formed in a short time, which prevents further penetration of acids into the skin.
- Caustic alkali. Due to the influence of caustic alkali on the surface of the skin, its deep damage occurs.
- Salts of some heavy metals (eg silver nitrate, zinc chloride). Skin lesions with these substances in most cases cause superficial burns.
Electrical burns occur on contact with conductive material. Electric current is distributed through tissues with high electrical conductivity through blood, cerebrospinal fluid, muscles, and to a lesser extent through skin, bones, or adipose tissue. Dangerous to human life is the current when its value exceeds 0.1 A (ampere).
Electrical injuries are divided into:
- low voltage;
- high voltage;
In the event of an electric shock, there is always a current mark on the victim’s body (entry and exit points). Burns of this type are characterized by a small lesion area, but they are quite deep.
There is also a classification of burn degrees according to Kreibich, which singled out five degrees of burn. This classification differs from the previous one in that the III-B degree is called the fourth, and the fourth degree is called the fifth.
The depth of damage caused by burns depends on the following factors:
- the nature of the thermal agent;
- temperature of the active agent;
- duration of exposure;
- the degree of warming of the deep layers of the skin.
According to the self-healing ability, burns are divided into two groups:
- Superficial burns. These include first, second and third degree burns. These lesions are characterized by the fact that they are able to heal fully without surgery, that is, without the formation of a scar.
- Deep burns. These include third-and fourth-degree burns, which are not capable of complete self-healing (a rough scar remains).
Note: In most cases, with burns, the extent of the lesion is often combined. However, the severity of the patient’s condition depends not only on the degree of burn, but also on the area of the lesion.
Burns are divided into extensive (lesion of 10 – 15% of skin and more) and non-extensive. With extensive and deep burns with superficial skin lesions of more than 15–25% and more than 10% with deep lesions, a burn disease may occur.
Burn disease is a group of clinical symptoms associated with thermal lesions of the skin, as well as surrounding tissues. It occurs with massive destruction of tissues with the release of a large number of biologically active substances.
The severity and course of a burn disease depends on the following factors:
- age of the victim;
- burn location;
- degree of burn;
- lesion area.
There are four periods of burn disease:
- burn shock;
- burn toxemia;
- burn septicotoxemia (burn infection);
- convalescence (recovery).
Acute burn toxemia is caused by exposure to toxic substances (bacterial toxins, breakdown products of protein). This period starts from the third to the fourth day and lasts for one to two weeks. Characterized by the fact that the victim has an intoxication syndrome.
The following signs are characteristic of intoxication syndrome:
- increase in body temperature (up to 38 – 41 degrees with deep lesions);
- decreased appetite;
This period conditionally begins from the tenth day and lasts until the end of the third – fifth week after the injury. It is characterized by adherence to the affected area of infection, which leads to the loss of proteins and electrolytes. When negative dynamics can lead to depletion of the body and the death of the victim. In most cases, this period is observed with third-degree burns, as well as with deep lesions.
The following symptoms are characteristic of burn septicotoxemia:
- sleep disturbance;
- Yellowness of the skin and sclera (with liver damage);
- increase in pulse (tachycardia).
Determination of the burn area
In assessing the severity of a thermal lesion, in addition to the depth of the burn, its area is important. In modern medicine uses several ways to measure the area of burns.
There are the following methods for determining the area of the burn:
- the rule of nines;
- palm rule;
- Postnikov method.
Rule of nines
The “rule of nines” is considered to be the simplest and most accessible method for determining the burn area. According to this rule, almost all parts of the body are conventionally divided into equal sections of 9% of the total surface of the whole body.
Burn First Aid
Elimination of the source of the current factor
Cooling baked areas
It is necessary to treat the burn site with running water as quickly as possible for 10 to 15 minutes. Water should be the optimum temperature – from 12 to 18 degrees Celsius. This is done in order to prevent damage to healthy tissue in the vicinity of the burn. Moreover, cold running water leads to a spasm of blood vessels and to a decrease in the sensitivity of nerve endings, and therefore, has an anesthetic effect.
Note: for third and fourth degree burns, this first aid event is not performed.
Before applying an aseptic dressing, it is necessary to carefully cut off clothing from the burned areas. In no case should you try to clean the burned areas (remove scraps of clothing adhering to the skin, tar, bitumen and
Dry and clean handkerchiefs, towels and sheets can be used as an aseptic dressing. Aseptic dressing must be applied to the burn wound without prior treatment. In the event that the fingers or toes were affected, it is necessary to lay additional fabric between them to prevent the parts of the skin from sticking together. To do this, you can use a bandage or a clean handkerchief, which before imposition must be wetted with cool water, and then squeezed out.
It is used in the case of treatment of superficial burns, and this therapy is used before and after surgery in the case of deep lesions.
Conservative treatment of burns includes:
- closed method;
- open way.
Closed wayThis method of treatment is characterized by applying dressings with a medicinal substance to the affected skin.
Open way For this method of treatment is characterized by the use of special equipment (for example, ultraviolet radiation, air cleaner, bacterial filters), which is available only in the specialized departments of burn hospitals.
The open method of treatment is aimed at the accelerated formation of a dry burn crust, since a soft and moist scab is a favorable medium for the reproduction of microbes. In this case, two or three times a day, various antiseptic solutions are applied to the damaged skin surface (for example, brilliant green (Zelenka) 1%, potassium permanganate (potassium permanganate) five%), after which the burn wound remains open. In the ward where the victim is, the air is continuously purified from bacteria. These actions contribute to the formation of a dry scab within one to two days.
In this way, in most cases, burns to the face, neck and perineum.
There are the following advantages of the open treatment method:
- promotes the rapid formation of a dry scab;
- allows you to observe the dynamics of tissue healing.
There are the following disadvantages of the open method of treatment:
- loss of moisture and plasma from a burn wound;
- high cost of treatment used.
For burns, the following types of surgery can be applied:
- staged necrotomy;
- limb amputation;
- skin transplantation.
NecrotomyThis surgical intervention consists in the dissection of the formed scab with deep burn lesions. Necrotomy is performed urgently to ensure the blood supply to the tissues. If this intervention is not performed in a timely manner, necrosis of the affected area may develop.
Necrotomy Necrotomy is performed with third-degree burns in order to remove non-viable tissues with deep and limited lesions. This type of operation allows you to thoroughly clean the burn wound and prevent suppurative processes, which subsequently contributes to the rapid healing of tissues.
Stage necrotomy This surgical intervention is performed with deep and extensive skin lesions. However, staged necrosectomy is a more benign method of intervention, since the removal of non-viable tissues is carried out in several stages.
Amputation of the limb Amputation of the limb is performed in case of severe burns, when treatment by other methods did not bring positive results or necrosis developed, irreversible changes in tissues with the need for subsequent amputation.
These methods of surgical intervention allow you to:
- clean the burn wound;
- reduce toxicity;
- reduce the risk of complications;
- reduce the duration of treatment;
- improve the healing process of damaged tissues.
The presented methods are the primary stage of surgery, and then proceed to further treatment of a burn wound using skin transplantation.
Skin transplantation Skin transplantation is done to close large burn wounds. In most cases, autoplasty is performed, that is, the patient’s own skin is transplanted from other parts of the body.
Currently, the most widely used methods of closing burn wounds are:
- Plastic local tissue. This method is used for deep burn lesions of small size. In this case, borrowing to the affected area of the adjacent healthy tissue occurs.
- Free skin plastics. It is one of the most common methods for skin transplantation. This method lies in the fact that using a special tool (dermatome) at the victim from a healthy part of the body (eg thigh, buttock, belly) The necessary skin flap is excised, which is subsequently applied to the affected area.
Physiotherapy procedures are used in the complex treatment of burn wounds and are aimed at:
- the suppression of the activity of microbes;
- stimulation of blood flow in the area of exposure;
- acceleration of the regeneration process (recoverya) damaged skin area;
- prevention of post-burn scar formation;
- stimulation of body defenses (immunity).
The course of treatment is prescribed individually depending on the degree and area of the burn lesion. On average, it may involve ten to twelve treatments. The duration of physiotherapy usually varies from ten to thirty minutes.