Burns itch

Post-burns itch, or pruritus, is one of the most common and distressing complications of burn injury. It typically begins in the first two weeks after the injury, and may last for several years. Post-burn pruritus can interfere with daily activities, and also complicate healing when scratched. This chapter outlines the causes, epidemiology, and biology of itching then provides an overview of therapies available. Assessment scales and the classification of types of pruritus are also outlined.

Principles of burn reconstruction

Burn reconstruction continues until either the maximal functional and aesthetic outcome has been achieved, or the patient and surgeon feel no further intervention is warranted. Communication with the patient about the limitations of outcome is vital. This chapter discusses the process of assessment of burn reconstruction and timing considerations.

Perineal and genital burns

Burns to the perineal area and genitals are normally found in the context of widespread burn damage, and are uncommon in isolation. Causes, challenges, and the initial management of genital burns are discussed.

Escharotomies

Following a significant thermal or electrical injury, tissues beneath the skin swell through fluid loss into the interstitial space. The increase in extravascular fluid together with the inelastic nature of the overlying burned skin compound to increase pressure within the affected limb. This increase in pressure can compromise the vascular supply distally in an affected limb or increase ventilatory pressures in those with circumferential burns of the chest and abdomen. This chapter will give guidance on when and how to perform escharotomies; however, the final decision is usually based on experience and clinical judgment. Figures illustrate detail markings and techniques for escharotomies and fasciotomies of the upper limb, lower limb, chest and abdomen.

Assessment of burn surface area

Assessment of total body surface area of a burn injured patient is a crucial step in managing burn injury. The chapter describes a number of techniques from using the size of the patient’s palm as an estimate of 1% to the gold standard Lund and Browder Chart. Key caveats are explained, copies of the charts included as well as the use of the CE certified app Mersey Burns.

Burns first aid

In the UK alone there are approximately 175,000 acute burn injuries /year. There is a great variation in the way these injuries are managed. Advances in our understanding of the pathophysiology and natural history of burn injuries have highlighted the importance of early intervention in minimizing later functional and cosmetic morbidity. Differences in beliefs and ethnic background have a large impact on the way that burns are initially dealt with, as we know that only a minority of patients presenting with burns are optimally managed pre-hospital. Lack of education and conflicting information about burns first aid is believed to be a major factor in the common occurrence of burnt patients presenting with a variety of domestic remedies being applied to their burns as first aid. Judicious application of simple burns first aid is the first step for soft tissue preservation, improvement of outcomes and a decrease in the need for operative management.

Tetanus

This chapter discusses Clostridium tetani infection and its relation to burns including presentation, immunization, tetanus-prone injuries, prophylaxis, and treatment.

Non-accidental injury (NAI) in children

This chapter explores the topic of non-accidental injury burns in children. It is important to consider the possibility of non-accidental injury and recognize injury patterns. The chapter gives a concise overview of the patient and parent characteristics, assessment of such patients and differential diagnoses to consider in the process of managing children in these situations. Patterns of injury in non-accidental burns are described.

Occupational and physiotherapy

Burns as a specialty requires a variety of therapeutic disciplines, and covers in-patient and out-patient care. The diversity of injury types, and subsequent therapeutic challenges, requires a unique approach to each patient. This chapter covers treatments and interventions and preventative methods.

Radiation burns

Radiation burns are caused by electromagnetic radiation (X-rays or gamma rays) or particle (alpha or beta) ionizing radiation. Ionization produces free radicals which cause DNA damage, cell death and malignant change. Burns may occur as a consequence of radiotherapy or medical imaging using beam energy. Radiation burns are generally rare and most commonly caused by isotopes (192Iridium or 60Cobolt) used for brachytherapy. Industrial accidents such as Fukushima can have catastrophic short and long-term sequelae but are rare. However, due to the constant threat of terror attacks, knowledge of the approach to a patient with radiation burns is important. This chapter discusses wound and general patient assessment as well as immediate treatment measures for a patient with radiation burns.