Editing Burns (section)

=== '''Principles of dressings:''' ===

* Protect the damaged epithelium
* Minimise bacterial and fungal colonisation
* Provide splinting action to preserve function, as needed
* Should be occlusive to reduce evaporative heat loss and minimise cold stress
* Should provide comfort over the painful wound


'''Superficial'''

* Usually need an absorptive dressing for first 72 hours
*

'''Superficial partial thickness:'''

* Cover with either
** Daily dressings with topical antibiotics, gauze, tubigrip OR
** Longer-lasting silver dressings (ActiCoat)
*** More useful in contamination, clinical infection, deeper burns, or burns with large surface area
* Wounds expected to take >3 weeks for re-epithelialisation would benefit from surgical excision and grafting
* Partial thickness scald burns, especially in children, generally can have a trial of conservative management, although they should be reviewed at 24 hours in case of worsening. Gentle debridement of dead skin in bath, solugel or paraffin on top maybe, and good oral analgaesia.
*

'''Deep partial thickness/full thickness:'''

* "There is no advantage to unexcised eschar"
* Will need prompt surgical excision and wound closure, usually with autograft
* Depth of excision is below the dermis. Absence of bleeding identifies necrotic subcutis.
* True invasive burn wound infection with bacteria or mould may require amputation/wide debridement
* Initial dressing is aimed at holding bacterial proliferation in check, and completely occluding until the operation is performed