There are the common small household burns, which we will discuss here and can happen to anyone. There are also the large life-threatening burns associated with social deprivation, suicide, criminal activity and medical incapacity and are treated in the few regional burns units.

We classify all burns by depth because this determines the treatment and outcome.

Superficial Burns are the most common and many are scalds. They are characterised by redness and blisters. The epidermis or outer layer of skin is destroyed. They are painful but heal from the deeper viable layers within 10 days. Treatment is simply to avoid infection to allow natural healing. Patients are left with no scars, only minor skin colour changes.

Deep dermal burns are awkward. They will heal in 3 weeks, but with scarring which can be severe (hypertrophic or keloid). The burn extends deeper into the skin so that healing is from deeper sweat and sebaceous glands.

Full thickness burns are painless as the nerve endings are lost, but there are no live cells to allow healing from below. There is no blistering. They either heal very slowly from the edge with major scars or are properly treated with skin grafts or flaps.

Treatment, in general, is to minimise the depth by removing the burning cause. The higher the temperature and the longer the contact with heat the worse the outcome. This might mean cooling the wound in cold water, removing hot clothing, washing off chemicals or putting out flames.

The next priority is to keep the sterile burn free of infection, which would convert a superficial burn into a deep one.

Next, we need to achieve rapid healing to minimise infection, scarring and impact on the patient's life.

There are many ways to speed and improve healing scars.

We do not stop care with healing as even the scars can be helped by reconstructive surgery which may take place months or even years after the burn injury. Lasers, pressure garments and injections of medication all play a part.



Of course, we use the very latest technology. But our real skill is in knowing how and when to use it to suit each individual patient.


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