Treatment of superficial burns requiring hospital admission
- Mayer Tenenhaus, MD, FACS
Mayer Tenenhaus, MD, FACS
- Professor of Plastic and Reconstructive Surgery
- University of California at San Diego Medical Center
- Hans-Oliver Rennekampff, MD
Hans-Oliver Rennekampff, MD
- Professor of Plastic Surgery
- Klinikum Leverkusen
Superficial injuries to the skin, most commonly thermal injuries, can often be managed in an outpatient setting. When large areas of skin are affected or specialized anatomic sites are involved, management in an inpatient setting, often at a burn center, is recommended.
Superficial burns are managed by maintaining a moist wound healing environment and protecting the wound from shear, tearing, and further injury while promoting reepithelialization. Dressings are chosen to help to manage wound drainage and are changed according to the manufacturer's recommendations (eg, daily, or every second or third day) .
Superficial skin loss from other types of injury, such as chemical burns, or skin loss from toxic epidermal necrolysis (TEN) is managed using similar principles. However, there are some differences. As an example, superficial skin loss from TEN is characterized by wounds that are not often challenged by problems of exudate management but may suffer from complicated superinfection. In addition to wound care, the underlying pathophysiologic cause needs to be specifically addressed. Chemical burns may require additional therapies to neutralize deleterious local or systemic effects. (See "Stevens-Johnson syndrome and toxic epidermal necrolysis: Management, prognosis, and long-term sequelae" and "Topical chemical burns".)
The management of patients with superficial skin loss requiring hospitalization (predominantly thermal burns), the management of potential complications, and follow-up care are reviewed here.
Treatment of minor burns (not requiring hospital admission) and treatment of deep partial-thickness and full-thickness burns are reviewed separately. (See "Treatment of minor thermal burns".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hartford CE, Kealey GP. Care of outpatient burns. In: Total Burn Care, Third edition, Herndon, DN (Eds), 2007. p.67.
- Deitch EA, Wheelahan TM, Rose MP, et al. Hypertrophic burn scars: analysis of variables. J Trauma 1983; 23:895.
- Cubison TC, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns 2006; 32:992.
- Hospital and prehospital resources for optimal care of patients with burn injury: guidelines for development and operation of burn centers. American Burn Association. J Burn Care Rehabil 1990; 11:98.
- Committee on Trauma. Guidelines for the operation of burn units. In: Resources for Optimal Care of the Injured Patient, American College of Surgeons, Chicago 1999. p.38.
- Connor-Ballard PA. Understanding and managing burn pain: part 1. Am J Nurs 2009; 109:48.
- Connor-Ballard PA. Understanding and managing burn pain: Part 2. Am J Nurs 2009; 109:54.
- Ulmer JF. Burn pain management: a guideline-based approach. J Burn Care Rehabil 1998; 19:151.
- Meyer III WJ, Patterson DR, Jaco M, et al. Management of pain and other discomforts in burned patients. In: Total Burn Care, 3rd ed, Herndon DN (Ed), Saunders Elsevier, 2007 2007. p.797.
- Palmieri TL, Greenhalgh DG. Topical treatment of pediatric patients with burns: a practical guide. Am J Clin Dermatol 2002; 3:529.
- http://emedicine.medscape.com/article/213595-overview (Accessed on June 13, 2010).
- Wasiak J, Cleland H. Topical negative pressure (TNP) for partial thickness burns. Cochrane Database Syst Rev 2007; :CD006215.
- Wasiak J, Cleland H, Campbell F. Dressings for superficial and partial thickness burns. Cochrane Database Syst Rev 2008; :CD002106.
- Neely AN, Brown RL, Clendening CE, et al. Proteolytic activity in human burn wounds. Wound Repair Regen 1997; 5:302.
- Klasen HJ. A review on the nonoperative removal of necrotic tissue from burn wounds. Burns 2000; 26:207.
- Rosenberg L, Lapid O, Bogdanov-Berezovsky A, et al. Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report. Burns 2004; 30:843.
- Ozcan C, Ergün O, Celik A, et al. Enzymatic debridement of burn wound with collagenase in children with partial-thickness burns. Burns 2002; 28:791.
- Sargent RL. Management of blisters in the partial-thickness burn: an integrative research review. J Burn Care Res 2006; 27:66.
- D'Avignon LC, Saffle JR, Chung KK, Cancio LC. Prevention and management of infections associated with burns in the combat casualty. J Trauma 2008; 64:S277.
- Kesting MR, Wolff KD, Hohlweg-Majert B, Steinstraesser L. The role of allogenic amniotic membrane in burn treatment. J Burn Care Res 2008; 29:907.
- Ramakrishnan KM, Jayaraman V. Management of partial-thickness burn wounds by amniotic membrane: a cost-effective treatment in developing countries. Burns 1997; 23 Suppl 1:S33.
- Pham C, Greenwood J, Cleland H, et al. Bioengineered skin substitutes for the management of burns: a systematic review. Burns 2007; 33:946.
- Klein MB, Moore ML, Costa B, Engrav LH. Primer on the management of face burns at the University of Washington. J Burn Care Rehabil 2005; 26:2.
- Leon-Villapalos J, Jeschke MG, Herndon DN. Topical management of facial burns. Burns 2008; 34:903.
- Kamel A, Kamel Ah, El Oteify M. Early management of the burned auricle. Annals of Burns and Fire Disasters 2004; 17:197.
- Skedros DG, Goldfarb IW, Slater H, Rocco J. Chondritis of the burned ear: a review. Ear Nose Throat J 1992; 71:359.
- http://emedicine.medscape.com/article/798696-overview (Accessed on June 02, 2010).
- Merle H, Gérard M, Schrage N. [Ocular burns]. J Fr Ophtalmol 2008; 31:723.
- Lou RB, Hickerson WL. The use of skin substitutes in hand burns. Hand Clin 2009; 25:497.
- Kamolz LP, Kitzinger HB, Karle B, Frey M. The treatment of hand burns. Burns 2009; 35:327.
- Luce EA. The acute and subacute management of the burned hand. Clin Plast Surg 2000; 27:49.
- Scott JR, Costa BA, Gibran NS, et al. Pediatric palm contact burns: a ten-year review. J Burn Care Res 2008; 29:614.
- Rutan RL. Management of perineal and genital burns. J ET Nurs 1993; 20:169.
- Bell PL, Gabriel V. Evidence based review for the treatment of post-burn pruritus. J Burn Care Res 2009; 30:55.
- Anzarut A, Olson J, Singh P, et al. The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. J Plast Reconstr Aesthet Surg 2009; 62:77.
- SUPERFICIAL BURNS
- INPATIENT ASSESSMENT
- INITIAL CARE
- Pain management
- Parenteral antibiotics
- LOCAL BURN CARE
- Our approach
- Cleansing and debridement
- - Burn blisters
- Burn wound dressings and topical therapy
- Special anatomic sites
- - Face
- - Ears
- - Ocular area
- - Hands
- - Feet
- - Perineum
- Reassessment of burn wounds
- - Burn wound depth
- - Assessing for burn wound infection
- OUTPATIENT FOLLOW-UP MANAGEMENT
- Burn wound pruritus
- Restoring form and function
- SUMMARY AND RECOMMENDATIONS