IncinerationT30.0

Depending on the duration and intensity of the damage, a distinction is made between 1st to 4th degree burns:

• 1st degree burn (Combustio erythematosa): damage to the upper epidermal layers with erythema, oedema, burning pain.
• Burning 2a. Combustio bullosa: erythema followed by subepidermal blistering, erosion by tearing of the blister cover and incrustation. Painful.
• Burns 2b. (Combustio necroticans): Destruction of epidermis, dermis, skin appendages and possibly deeper layers (muscles, fascia, fatty tissue and bones). Analgesia, necroses. Rejection of the necroses leads to ulcer formation.
• 3rd degree burn (charring): destruction of all skin layers and deeper structures. Analgesia, necroses.

• First-degree burns: Rinse with cold running water. Cold, moist compresses for at least 10 minutes or as long as the patient still feels pain. Glucocorticoids as lotio or cream R030 R120 or lotio alba, possibly wound gauze and light dressing (e.g. Oleo-Tuell, Jelonet). Wait for spontaneous healing.
• 2nd degree burn: With closed skin: Initially cooling moist compresses or cooling under running water (at least 10 minutes), glucocorticoids as lotion, cream or foam to prevent oedema (e.g. Dermatop, R030 R120 ).
  For erosions: disinfection with polyvidon-iodine solution (e.g. Betaisodona Lsg.), removal of hair and skin shreds, blisters are opened sterilely. Use wound gauze (e.g. Oleo-Tuell, Jelonet) and sterile dressings or gauze grids with antibiotic additives (e.g. Bactigras). Store the patient on Metalline foil. Cave!Secondary bacterial colonization. Continuous smear checks (especially for gram-negative bacteria).
• Application of antibacterial external preparations (e.g. Betaisodona ointment), if necessary in combination with a simple sterile wound gauze or alone. Alternatively: sterile dressing with antibiotic-containing ointment grids (e.g. Bactigras) or sulfadiazine-silver (e.g. Flammazine). Sterile dressings are applied to the wound surfaces, spontaneous healing can be awaited.
  If the burn area is more than 10-15%, admit the patient to the hospital. For transport cover the wounds with Metalline foil or aluminium foil.
  Besides wound treatment volume substitution (adults 4 ml Ringer's lactate/kg bw/% of burnt KO/24 hrs, 50% of which in the first 8 hrs, children 8 ml Ringer's lactate/kg bw/% of burnt KO/24 hrs), fluid balancing, pain treatment.
• 3rd degree burns: Local therapy as for second-degree burns, closed wound treatment with antibiotic-containing gauze grid (e.g. Bactigras) and sterile dressings. Systemic antibiotic treatment after antibiogram as required. Pay attention to pronounced oedema formation after burn injuries. Caution! Edema of the tractus respiratorius. Otherwise surgical intervention: Initial necrectomy, debridement, tangential excision according to Janzekovic, later transplantation e.g. split skin grafts, mesh graft, allograft or xenograft.
  Intensive medical care, if necessary by burn center. Also: pain relief, volume electrolyte substitution, parenteral nutrition, tetanus prophylaxis. S.a.u. burn shock.
  Internal glucocorticoids are controversial and rather reserved.

• 2nd degree burns on the face, hands/feet or genito-anal region
• 2nd to 3rd degree burns of > 10-15% of KO, in children 5-10% KO
• 3rd degree burns or extensive 2nd degree burns
• If complications are to be expected, especially on the respiratory tract side (sedentary transport!)
• Burns caused by electric current
• Injuries caused by chemicals.

• First-degree burns: After a few days healing with desquamation.
• 2nd degree: Restitutio ad integrum after 2-4 weeks.
• 3rd degree: Scarred healing. Tendency to keloid formation.

Extent of combustion: rule of nine according to Wallace

1. Cornish P et al (2003) Cost of medications in patients admitted to a burn center. At J Clin Dermatol 4: 861-867
2. Counce JS et al (1988) Surgical complications of thermal injury Am J Surg 156: 556-557
3. Eisenbud D et al (2003) Hydrogel wound dressings: where do we stand in 2003? Ostomy Wound Manage 49: 52-57
4. Geyik MF et al (2003) Epidemiology of burn unit infections in children. At J Infect Control 31: 342-346
5. Monson JR et al (1991) Early burn excision and systemic response to endotoxin. Surgery 110: 119-120
6. Navar PD et al (1985) Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Am J Surg 150: 16-20
7. Still J et al (2003) The use of a collagen sponge/living cell composite material to treat donor sites in burn patients. Burns 29: 837-841
8. Varghese TK et al (2003) Frequency of burn-trauma patients in an urban setting. Arch surgeon 138: 1292-1296