Wound Management of Pediatric Burns

Abstract

The goal for treating pediatric burns is to allow the patient to heal with as little scarring as possible. Compared to older children and adults, very small children have anatomic differences that alter their treatment. They have thinner skin that leads to a higher risk for full-thickness burns. Children also tend to freeze when touching a hot item, so that the prolonged contact also leads to deeper burns. Two healing strategies are needed to treat these wounds. One must optimize reepithelialization in superficial burns to reduce scarring. Deeper burns require skin grafting, but there are techniques, such as the use of “sheet” autograft skin that lead to excellent outcomes. Strategies to treat the massive pediatric burn will also be covered. Finally, there are instances where different strategies are needed to cover exposed bone or tendon. The ultimate goal is to return the skin to as normal a state as possible.

Keywords

children - burns - wound healing - scarring - skin grafts

Publikationsverlauf

Artikel online veröffentlicht:
04. April 2024

• References

• 1 Moritz AR, Henriques FC. Studies of Thermal Injury: II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol 1947; 23 (05) 695-720
• 2 Greenhalgh DG, Lawless MB, Chew BB, Crone WA, Fein ME, Palmieri TL. Temperature threshold for burn injury: an oximeter safety study. J Burn Care Rehabil 2004; 25 (05) 411-415
• 3 Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: physiology, development, and care. Clin Dermatol 2015; 33 (03) 271-280
• 4 Oranges T, Dini V, Romanelli M. Skin physiology of the neonate and infant: clinical implications. Adv Wound Care (New Rochelle) 2015; 4 (10) 587-595
• 5 Seidenari S, Giusti G, Bertoni L, Magnoni C, Pellacani G. Thickness and echogenicity of the skin in children as assessed by 20-MHz ultrasound. Dermatology 2000; 201 (03) 218-222
• 6 Derraik JG, Rademaker M, Cutfield WS. et al. Effects of age, gender, BMI, and anatomical site on skin thickness in children and adults with diabetes. PLoS ONE 2014; 9 (01) e86637
• 7 Saitoh A, Aizawa Y, Sato I, Hirano H, Sakai T, Mori M. Skin thickness in young infants and adolescents: applications for intradermal vaccination. Vaccine 2015; 33 (29) 3384-3391
• 8 Van Mulder TJS, Van Nuffel D, Demolder M. et al. Skin thickness measurements for optimal intradermal injections in children. Vaccine 2020; 38 (04) 763-768
• 9 Greenhalgh DG, Barthel PP, Warden GD. Comparison of back versus thigh donor sites in pediatric patients with burns. J Burn Care Rehabil 1993; 14 (01) 21-25
• 10 Greenhalgh DG. Management of burns. N Engl J Med 2019; 380 (24) 2349-2359
• 11 Greenhalgh DG, Bridges P, Coombs E. et al. Instant cup of soup: design flaws increase risk of burns. J Burn Care Res 2006; 27 (04) 476-481
• 12 Palmieri TL, Alderson TS, Ison D. et al. Pediatric soup scald burn injury: etiology and prevention. J Burn Care Res 2008; 29 (01) 114-118
• 13 Hummel III RP, Greenhalgh DG, Barthel PP. et al. Outcome and socioeconomic aspects of suspected child abuse scald burns. J Burn Care Rehabil 1993; 14 (01) 121-126
• 14 McBride JM, Romanowski KS, Sen S, Palmieri TL, Greenhalgh DG. Contact hand burns in children: still a major prevention need. J Burn Care Res 2020; 41 (05) 1000-1003
• 15 Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J. Hypertrophic burn scars: analysis of variables. J Trauma 1983; 23 (10) 895-898
• 16 Chipp E, Charles L, Thomas C, Whiting K, Moiemen N, Wilson Y. A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts. Burns Trauma 2017; 5: 3
• 17 Woodley DT, Bachmann PM, O'Keefe EJ. The role of matrix components in human keratinocyte re-epithelialization. Prog Clin Biol Res 1991; 365: 129-140
• 18 Woodley DT, Chen JD, Kim JP. et al. Re-epithelialization. Human keratinocyte locomotion. Dermatol Clin 1993; 11 (04) 641-646
• 19 Rousselle P, Braye F, Dayan G. Re-epithelialization of adult skin wounds: cellular mechanisms and therapeutic strategies. Adv Drug Deliv Rev 2019; 146: 344-365
• 20 Rousselle P, Montmasson M, Garnier C. Extracellular matrix contribution to skin wound re-epithelialization. Matrix Biol 2019; 75–76: 12-26
• 21 Rashaan ZM, Krijnen P, Klamer RR, Schipper IB, Dekkers OM, Breederveld RS. Nonsilver treatment vs. silver sulfadiazine in treatment of partial-thickness burn wounds in children: a systematic review and meta-analysis. Wound Repair Regen 2014; 22 (04) 473-482
• 22 Holmes JH. A brief history of RECELL® and its current indications. J Burn Care Res 2023; 44 (Suppl. 01) S48-S49
• 23 Schwanholt C, Greenhalgh DG, Warden GD. A comparison of full-thickness versus split-thickness autografts for the coverage of deep palm burns in the very young pediatric patient. J Burn Care Rehabil 1993; 14 (01) 29-33
• 24 Archer SB, Henke A, Greenhalgh DG, Warden GD. The use of sheet autografts to cover extensive burns in patients. J Burn Care Rehabil 1998; 19 (1 Pt 1): 33-38
• 25 Barnes LA, Marshall CD, Leavitt T. et al. Mechanical forces in cutaneous wound healing: emerging therapies to minimize scar formation. Adv Wound Care (New Rochelle) 2018; 7 (02) 47-56
• 26 Harn HI, Ogawa R, Hsu CK, Hughes MW, Tang MJ, Chuong CM. The tension biology of wound healing. Exp Dermatol 2019; 28 (04) 464-471
• 27 Hosseini M, Brown J, Khosrotehrani K, Bayat A, Shafiee A. Skin biomechanics: a potential therapeutic intervention target to reduce scarring. Burns Trauma 2022; 10: tkac036
• 28 Greenhalgh DG, Palmieri TL. Zigzag seams for the prevention of scar bands after sheet split-thickness skin grafting. Surgery 2003; 133 (05) 586-587
• 29 Greenhalgh DG. Management of facial burns. Burns Trauma 2020; 8: tkaa023
• 30 Cole JK, Engrav LH, Heimbach DM. et al. Early excision and grafting of face and neck burns in patients over 20 years. Plast Reconstr Surg 2002; 109 (04) 1266-1273
• 31 Housinger TA, Lang D, Warden GD. A prospective study of blood loss with excisional therapy in pediatric burn patients. J Trauma 1993; 34 (02) 262-263
• 32 Greenhalgh DG, Hinchcliff K, Sen S, Palmieri TL. A ten-year experience with pediatric face grafts. J Burn Care Res 2013; 34 (05) 576-584
• 33 Martens S, Romanowksi K, Palmieri T, Greenhalgh D, Sen S. Massive pediatric burn injury: a 10-year review. J Burn Care Res 2023; 44 (03) 670-674
• 34 Porter C, Tompkins RG, Finnerty CC, Sidossis LS, Suman OE, Herndon DN. The metabolic stress response to burn trauma: current understanding and therapies. Lancet 2016; 388 (10052): 1417-1426
• 35 Heimbach DM. Early burn excision and grafting. Surg Clin North Am 1987; 67 (01) 93-107
• 36 Sheridan RL, Tompkins RG, Burke JF. Management of burn wounds with prompt excision and immediate closure. J Intensive Care Med 1994; 9 (01) 6-17
• 37 Hart DW, Wolf SE, Chinkes DL. et al. Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. J Trauma 2003; 54 (04) 755-761 , discussion 761–764
• 38 Hart DW, Wolf SE, Beauford RB, Lal SO, Chinkes DL, Herndon DN. Determinants of blood loss during primary burn excision. Surgery 2001; 130 (02) 396-402
• 39 Holmes IV JHT, Molnar JA, Shupp JW. et al. Demonstration of the safety and effectiveness of the RECELL^® System combined with split-thickness meshed autografts for the reduction of donor skin to treat mixed-depth burn injuries. Burns 2019; 45 (04) 772-782
• 40 Concannon E, Damkat-Thomas L, Rose E, Coghlan P, Solanki N, Wagstaff M. Use of a synthetic dermal matrix for reconstruction of 55 patients with nongraftable wounds and management of complications. J Burn Care Res 2023; 44 (04) 894-904
• 41 Silk JA, Taupin P. Serial application of meshed collagen-chondroitin silicone bilayer matrix to obtain full coverage over bone and tendon in challenging situations and medically compromised patients: a small case series. Wounds 2023; 35 (01) 18-25