Burn wound: How it differs from other wounds?

ABSTRACT

Management of burn injury has always been the domain of burn specialists. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Even after complete epithelisation of burn wound, remodelling phase is prolonged. It may take years for scar maturation in burns. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds.

KEY WORDS

Burn injury - burn wound infection - pathophysiology

• 1 Mohil RS. Classification of wounds. In: Sarabahi S, Tiwari VK, editors. Principles and practice of wound care. 1 st ed. New Delhi (India): Jaypee Publishers; 2012. p. 42-52.
• 2 Bhattacharya S. Burns: Etiology and classification. In: Sarabahi S, Tiwari VK,Goel A, editors. Principles and practice of burn care. 1 st ed. New Delhi (India): Jaypee Publishers; 2010. p. 25-36.
• 3 Vartak A: Pathophysiology of Burn shock. In: Sarabahi S, Tiwari VK,Goel A, editors. Principles and practice of burn care. 1 st ed. New Delhi (India): Jaypee Publishers; 2010. p. 37-41.
• 4 Deodhar AK, Rana RE. Surgical physiology of wound healing: A review. J Postgrad Med 1997;43:52-6.
• 5 Ethridge RT, Leong M, Phillips L. Wound healing. In: Touensend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of surgery. The biological basis of modern surgical practice. 18 th ed. Philadephia: Saunders; 2009. p. 191-216.
• 6 Arturson G. Cross reference from ′Local effects: Principles and Practice of burn management. 1 st ed. Setle JAD, editor. New York: Churchill Livingstone; , 1996.
• 7 Werner S, Grose R. regulation of wound healing by growth factors and cytokines. Physiol Rev 2003;83:835-70.
• 8 Kumar V, Abbas AK, Fausto N, Aster JC. Tissue renewal, repair and regeneration. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbins and Cotran. Pathologic basis of diseases. 8 th ed. Pensylvannia: Saunders; 2009. p. 191-216.
• 9 Sephel GC, Woodward SC. Repair, regeneration and fibrosis. In: Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D, editors. Rubin′s pathology. Clinicopathologic foundations of medicine. 4 th ed. Philadephia: Lippincott Williams and Wilkins; 2001. p. 85-116.
• 10 Chandrakant SS. Medicolegal aspects in burn injuries. In: Sarabahi S, Tiwari VK,Goel A, editors. Principles and practice of burn care. 1 st ed. New Delhi (India): Jaypee Publishers; 2010. p. 516-23.
• 11 Caison′s JS. Treatment of burns. London: Chapman and Hall; 1981. p. 14-57.
• 12 Williams WG, Phillips L. Pathophysiology of burn wound. In: Herndon DN, editor. Total burn care. WB Saunders Co Ltd.; 1996. p. 64.
• 13 Jensen AR, Hughes WB, Grewal H. Secondary abdominal compartment syndrome in children with burns and trauma: A potentially lethal complication. J Burn Care Res 2006;27:242-6.
• 14 Greenhalgh DG, Warden GD. The importance of intra-abdominal pressure measurements in burned children. J Trauma 1994;36:685-90.
• 15 Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, D′Aiuto M. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000;49:387-91.
• 16 Hobson KG, Young KM, Ciraulo A, Palmieri TL, Greenhalgh DG. Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma 2002;53:1129-33; discussion 1133-4.
• 17 Latenser BA, Kowal-Vern A, Kimball D, Chakrin A, Dujovny N. A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil 2002;23:190-5.
• 18 Kumar P. Surgical excision of burn wound and skin grafting. In: Sarabahi S, Tiwari VK, editors. Principles and practice of wound care. 1 st ed. New Delhi (India): Jaypee Publishers; 2012. p. 196-207.
• 19 Verma PK. Anaesthesia for the thermally injured. In: Sarabahi S, Tiwari VK, editors. Principles and practice of wound care. 1 st ed. New Delhi (India): Jaypee Publishers; 2012. p. 208-22.
• 20 Gamer JP, Jenner J, Parkhouse DA. Prediction of upper airway closure in inhalation injury. Mil Med 2005;170:677-82.
• 21 Gueugniaud PY, Carsin H, Bertin-Maghit M, Petit P.Current advances in the initial management of major thermal burns. Intensive Care Med 2000;26:848-56.
• 22 Haponik EF. Respiratory injury. In: Haponik EF, Munster AM, editors. Smoke inhalation and burns. New York: McGraw-Hill Inc.; 1990.
• 23 Haponik EF, Summer W. Respiratory complications in burned patient: Pathogenesis and spectrum of inhalation injury. J Crit Care 1987;2:49.
• 24 Pruitt BA Jr. Advances in fluid therapy and the early care of the burn patient. World J Surg 1978;2:139-50.
• 25 Pruitt BA Jr. The diagnosis and treatment of infection in the burn patient. Burns Incl Therm Inj 1984;11:79-91.
• 26 Pruitt BA Jr, McManus AT. The changing epidemiology of infection in burn patients. World J Surg 1992;16:57-67.
• 27 Becker WK, Cioffi WG, McManus AT. Fungal burn wound infection. Arch Surg 1991;126:44-8.
• 28 Sarabahi S, Tiwari VK, Arora S,Capoor M, Pandey A. Changing pattern of fungal infection in burn in a large burn unit in Asia. Burns 2012;38:520-8.
• 29 Arturson G. Neutrophil granulocyte function in severly burned patients. Burns Incl Therm Inj 1985;11:309-19.
• 30 Schmidt K, Bruchelt G, Kistler D, Koslowski L. phagocytic activity of granulocyte anf alveolar macrophages after burn injury measured by chemiluminescence. Burns Incl Therm Inj 1983;10:79-85.
• 31 Stephan RN, Ayala A, Harkema JM, Dean RE,Border JR, Chaudhry IH. Mechanisms of immunosuppression following hemorrhage: Defective antigen presentation by macrophages. J Surg Res 1989;46: 553-56.
• 32 Zembola M, Uracz W, Ruggiero I. Isolation and functional characteristics of FcR+ and FcR- human monocyte subsets. J Immunol 1984;133:1293-9.
• 33 Daniels JC, Larson DL, Abston S, Ritzmann SE. Serum protein profiles in thermal burns. J Trauma 1974;14:137-52.
• 34 Munster AM, Hoacland HC, Pruitt BA Jr. The effect of thermal injury on serum immunoglobulin. Ann Surg 1970;172:965-9.
• 35 Teodorczyk JA, Sparkes BG, Peters WJ. Regulation of IgM production in thermally injured patients. Burns 1989;15:241-7.
• 36 Saffle R, Schnebly WA. Burn wound care. In: Richard RL, Staley MJ, editors. Burn care and rehabilitation: Principles and Practice. Chapter 7. Philadephia: FA Davis Company; 1994. , p. 119-67.
• 37 Monafo WF,Fredman B. Topical therapy for burns. Surg Clin North Am 1987;67:133-45.
• 38 Moncreif JA, Lindberg RB, Switzer WE, Pruitt BA. Use of topical antibacterial therapy in the treatment of burn wound. Arch Surg 1966;92:558-65.
• 39 Pruitt BA Jr. Diagnosis and treatment of infection in the burn patient: Presidential address. Arch Surg 1986;121:13-22.
• 40 Lindberg RB, Moncreif JA. The successful control of burn wound sepsis. J Trauma 1965;5:601-16.
• 41 Stone HH, Kolb LD, Petit J, Smith RB. The systemic absorption of antibiotic from the burned wound surface. Am Surg 1968;34:639-43.
• 42 Goel A. Post burn sequelae and their management. In: Sarabahi S, Tiwari VK, editors. Principles and practice of wound care. 1 st ed. New Delhi (India): Jaypee Publishers; 2012. p. 468-515.