Burns are among the most common domestic accidents worldwide. Some of them are minor and not life-threatening and can be easily treated, while others require special medical care and can be an emergency.
The role of the plastic surgeon in the treatment of patients with burns is substantial and long-term, from time 0, i.e. the clinical examination, in the initial phase of therapy, after discharge, and then, in the long term, in the case of patients with severe burns, in which healing it is done with retractile scars, amputated segments or other disabilities – to improve the function or aesthetic appearance of the affected area.
About the causative factors of burns, their classification and the methods of providing first aid, correctly and quickly, depending on the severity of the injuries, spoke surgeon Alexandru Varga, plastic and reconstructive surgery primary doctor and head of the plastic surgery department at the County Hospital of Buzău Emergency, in an interview given to the Press Office of the largest medical unit in the county.
Doctor, I would like you to tell us, first of all, what is a burn and how many types of burns are there?
Dr. Alexandru Varga: “The burn is defined as the first medical-surgical emergency of a patient, obviously correlated with its surface and depth. The larger the area, the more serious the situation increases exponentially. In the case of depth, again, we must take into account that a deep burn does a great deal of harm to the patient, in terms of the hope of survival. Burns, theoretically, are divided into three more groups, of which the second group has two subgroups in its turn. First degree burn, second and third degree burn (being the most severe), second degree burn is subdivided into II A and II B. It is a cataloging, simply, because depending on this classification, we have the possibility of to treat and treatment protocols depending on the burn, surface and severity of the situation. The most important thing to always know when dealing with a burn is that in a large burn, the patient suffers a large loss of water, the body tries to compensate for the burn, the damaged area, and in this way it displaces and mobilizes large capacities of water and electrolytes to compensate for the burn and loss from the new wound, so we need to compensate. That’s why I insist and tell all patients who burn on a large area of 10% – maybe the world doesn’t know what 10% means, as a guideline we can take 1% as the palm – it is mandatory to come to the hospital, in his favor, obviously. This, to be able to compensate for the losses and, subsequently, to make the healing as simple and easy as possible for the patient.”
What signs and symptoms indicate the severity of a burn?
Dr. Alexandru Varga: “The burn, in its most serious form – somewhere at 40% with a depth of the entire dermis, that III degree I was talking about earlier – is life-threatening! We often calculate the prognostic index for each patient, in which we also take into account the burn surface and its depth, but also the age of the patient and other associated comorbidities, other diseases of the patient. These can be diseases that contribute to a bad prognosis (diabetes, hypertension). All this is accumulated and this prognostic index is made. If a patient has other diseases in addition, it would be desirable for him to come to the hospital, because we can help him.”
What are the first aid measures, depending on the type of burn?
Dr. Alexandru Varga: ,,First of all, the element that caused the burn must be removed, if it is only a contact burn, quickly cooled with cold water, under a stream of cold water. If someone catches fire, the clothes must be extinguished. If the clothes are made of synthetic material, it stores the heat, melts on the skin and leads to a high degree of burn, to the third degree, most of the time. Burnt clothes must be removed, it often happens that they stick to the skin and can only be removed with the skin, which is very serious. In whatever situation we find ourselves, the patient must remove the source of excessive heat – be it boiling water, be it fire, be it a flame, be it contact with a hot object – and cool the body as quickly as possible. The solution at hand for everyone is cold water, regardless of the form or the offending factor, that it is a chemical burn, it must be washed with water until it is diluted, that it is a thermal burn, it must be cooled.”
Treatment options for burns. What is the surgical treatment for burns?
Dr. Alexandru Varga: ,,If we refer to surgical treatment, we reduce the spectrum a bit and only come to the discussion of IIB, III burns, their more serious part, in this case, most of the time the patient, after a deep burn, it closes with an eschar, white or black, paper-white or black skin remains, both are eschars and both are manifested by a lack of vascular flow at that level. Theoretically, the tissue is completely destroyed, it can no longer be vascularized. With no blood supply left, it cannot live. That tissue is what we have to get rid of, remove, until we get to a deep, bloody plane. The removal is done with an electrodermatome, we take successive slices, until we find the first layer bleeding, viable, in the desire not to go too far into the fat or get to the bones. The situation where we have burns of a limb, completely burned, there the option is only amputation, but let’s not think that far, people only face IIB even III burns, which, once admitted to the hospital, we can correct by electrolyte balance and surgery, with removal of burned tissue. If, following the burnt tissue removed, we do not find a viable layer, which has something left of the dermis, which in turn generates a scar, a new dermis, then we are obliged to graft. We take a piece of skin, perform a free skin transplant from other viable areas that were not affected by the burn, and then transplant, depending on the area. Recovery depends a lot on the patient, whether it is an elderly patient, whether it is a sick patient or a young patient. The physical resource and recovery capacity of the patient is what always comes first in the diagnosis, that’s why I was telling you earlier than the prognostic index: if he’s a young patient, he recovers quickly, and he doesn’t have any associated disease to keep him in place.”
In children, how does the burn manifest itself?
Dr. Alexandru Varga: “Children are a separate field from adults and the treatment of burns in children is different. There are other rebalancing formulas, a child has a large evaporation surface, the losses are much higher on a small burn compared to an adult, that’s why we send children’s burns to children’s hospitals, Grigore Alexandrescu Hospital, Plastic Surgery department. In principle, the same advice remains as for adults.”
Burns can sometimes lead to complications. What are the most common critical conditions of patients after burns?
Dr. Alexandru Varga: “As you said about the critical condition, it is very important to evaluate the burn of the airways, a burned patient with a burn of the airways has an unfavorable prognosis. Most of the time, airway burns can lead to patient suffocation and we (note – doctors) don’t realize it. An ENT evaluation is always mandatory. The airways must be visualized, the edema that accumulates at their level can block the trachea and prevent air from reaching the lungs, which leads to the death of the patient. In terms of first aid, the airway situation should always be assessed in the emergency room and, if necessary, the patient should even be intubated.”
We are in the cold season, many patients arrive at the emergency room with burns caused by either flame or hot liquid. What can you tell us about the number of admissions?
Dr. Alexandru Varga: “In the last month, the incidence of burns has increased, but it is seasonal. During the cold period, the number of cases of burns increases. The population needs to warm up. They are usually patients from rural areas, who, not having safe electronic systems, turn to the classic stove with a fire, and this is where the big problems arise. In autumn, there is another category, also in the countryside, of those who clean their yard and burn the garbage. A lot of people arrive at our ward, burning almost everything they find in the yard, flammable volatile substances, which simply explode and injure. It is a situation we frequently encounter.
Dr. Alexandru Varga
Finally, some recommendations for the population regarding burns?
Dr. Alexandru Varga: ,,Before arriving at the hospital, it is very important to move away from the heat source, whatever it may be, apply cold water, not egg yolks, mashed cabbage or any other remedies, excluded! Step number 2, presentation to the hospital and from there left to the specialists to do their work further. If it is a serious situation, complex teams (intensive care if needed) manage the case. If the situation is worse, the patient is transferred. In burns on an area of more than 40%, patients must be sent to burn centers or even outside the country, if the situation requires it. The situations below 40% are very well managed by us, and according to our statistics, in the last 3 years, we have not had a single burn death, which I consider a victory for the Plastic Surgery department. There are a lot of admissions, about 80 burns in the cold season. They are complex situations but they are manageable and therefore I recommend people not to neglect the burn. A neglected burn, kept at home, deepens, a burn not treated in time digs, deepens, and treatment is much more difficult. Even if we remove in deep areas, and even if we graft, the bed on which we graft is no longer as good, I repeat, presentation to the hospital is necessary.”
Interview conducted by the Press Office of the Buzau County Emergency Hospital (Adriana Bunilă)
2023-11-22 07:31:00
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