Rehabilitation after 3rd degree burns (English)

Under the influence of chemicals, high temperatures, radiation and electricity, burn tissue damage occurs on the skin. To treat this condition, a number of factors must be considered. Restoration of skin after a burn can be carried out using physiotherapeutic methods.

To provide adequate first aid, you need to know about the cause of the burn:

Thermal burns result from exposure to flames, hot objects, steam or liquids.
Chemical burns are caused by acids, alkalis and heavy metal salts.
Radiation burns occur as a result of exposure to light (including solar) and ionizing radiation.
Electrical injury: A burn injury occurs where current enters and exits.
With the complex impact of several of the listed damaging factors, combined burns occur, and with a concomitant other lesion (fracture), combined injuries occur.

The severity of the lesion is determined by the depth and area of the traumatic effect on the body tissue.

Burn degrees

There are 4 degrees of burn based on the depth of tissue damage:

Redness and swelling of the skin. A radiation burn occurs with a dose of gamma radiation of 8-12 Gy.
Formation of blisters with transparent white-yellow contents (thermal burns) or necrotic scab. Radiation dermatitis occurs with a dose of gamma irradiation of 12-30 Gy.
Damage to all layers of the skin and its necrosis. Radiation burn occurs at a radiation dose of 30-50 Gy.
Complete destruction of the skin, subcutaneous fat, muscle layer, tendons and bones with charring of tissue. Radiation burn occurs when irradiation exceeds 50 Gy.

Burn area

It is important to determine not only the depth of tissue damage, but also its area. These indicators make it possible to assess the severity of the patient’s condition and the volume of pre-hospital and specialized medical care.

Wallace's method, or "rule of nines"

According to this technique, the area of certain parts of the body is 9%:

head – 9%;
hand – 9%;
breast – 9%;
belly – 9%;
back – 18%;
thigh – 9%;
shin – 9%;
genitals and perineum – 1%.

In children, the affected area is calculated using different percentages.

Child under 1 year:

head area – 21%;
hands – 9.5% each;
legs – 14% each;
body – 16% (one side).

Child under 4 years old:

head – 19%;
hands – 9.5% each;
legs – 15% each;
body – 16% (one side).

Child under 14 years old:

head – 15%;
hands – 9.5% each
legs – 17% each;
body – 16% (one side).

Child over 14 years of age: calculations are carried out according to an adult’s scheme (“Rule of Nines”).

Glumov method, or “rule of the palm”

The victim's palm is equal to 1% of the body surface. By covering the part of the skin affected by the burn, you can calculate the area of damage.

Skitsy Vilyavina

This is an image of the front and back surfaces of the human body with a square grid applied to it. By shading this diagram with different colors (depending on the depth of the wound) according to the patient’s lesion, the area of the burn is calculated. Such schemes are used in hospitals. When changes occur in the patient's condition, appropriate changes are made to the skits.

In addition to the above methods for determining the area of a burn lesion, there are instrumental methods:

Using a graduated film, which is applied to the affected area of the skin and the area of damaged tissue is calculated.
Postnikov tables: dependence of the lesion area on the patient’s age.
Special scales are used for children.

Complications

A severe complication of the injury in question is the development burn disease. This condition is considered the body’s reaction to severe painful stimulation by a traumatic agent. Burn disease occurs:

With stage 1 damage, more than 30% of the body area of an adult and 15-20% in children.
With stage 2 damage, more than 20% of the body area in an adult and 10% in children.
With grade 3-4 damage, more than 10% of the body area in an adult and 5% in children.

In patients with a weakened body, this severe complication can occur with grade 3-4 damage to 3% of the body area.

The main pathogenetic mechanism for triggering the shock reaction is a large loss of blood plasma through damaged skin, the destructive effects of toxic substances and tissue breakdown products, including myoglobin. It clogs the kidney tubules, causing kidney failure and death.

First aid

It is important to know and be able to provide first aid to a burn victim.

First, it is necessary to eliminate the cause, i.e., stop the impact of the traumatic factor.

Clothing is cut off from the victim, and any that stick to the burn area are left to prevent additional damage to the skin. Additional trauma to the skin provokes loss of blood plasma and also increases the possibility of infection.

But nevertheless, it is necessary to remove metal jewelry, because they continue to have a thermal effect on the fabric.

In case of thermal burns, it is very important to cool the skin as quickly as possible: cover it with ice or snow, place it under running cold water for 15 minutes. For minor burns and rapid application of cold, blisters can be avoided. If there are open blisters or wound surfaces, you must first place a clean cloth or wrap it in film on the affected area, and then place it under running water.

Exceptions:

burns with hydrochloric acid, because when interacting with water, a large amount of heat is released;
quicklime burns.

Both types of burn lesions are treated with a weak soap solution. In case of a burn caused by the action of phosphate, it is necessary to immerse the affected area in water, since phosphorus flares up in air.

The victim should be given a lot to drink to replenish lost fluid.

In the absence of allergic reactions, the injured person must be given a painkiller: for an adult - 2-3 tablets of analgin, for a child - 1 tablet of analgin or Nurofen.

Treatment of extensive burns should only be carried out in specialized burn centers. Regular hospitals cannot provide the necessary treatment to such severely ill patients.

It is forbidden!

Pop bubbles. The contents of the bubbles are blood plasma, which after some time will return to the vascular bed.
Apply brilliant green and iodine to the affected skin, as well as sprinkle with flour, etc. This makes inspection and diagnosis difficult.
Treat affected skin with alcohol.
Lubricate with fatty media: oils, creams. This will increase skin damage by disrupting heat exchange, and will also create an excellent breeding ground for bacteria.
Bandage the burn area tightly. It is enough to gently wrap it with a clean cloth.
Pour liquids into the mouth of an unconscious victim or give tablets.

Treatment

Treatment of burns is a difficult and complex process that requires specialized assistance from combustiologists, resuscitators, surgeons and other specialists as indicated.

After 1st degree burn the damage goes away on its own within a few days.

After 2nd degree burn drug therapy is required; restoration of the skin occurs within 2 weeks. A new epithelium forms under the plasma bubble. The plasma returns back to the bloodstream. The walls of the bladder will be torn away, revealing new skin underneath. After 2-3 weeks, it will return to its normal color and will not differ from the surrounding uninjured tissue.

During the phase of the formation of blisters, an infection can enter the damaged area with the development of a purulent process, which causes the formation of scars.

After burns of III and IV degrees urgent hospitalization and long-term treatment are required.

From day 10, the rejection of necrotic tissue begins. Then healing occurs by epithelization from the edges of the wound and granulation in the area of its bottom. In case of stage III damage, 3 months after healing of the skin, pigmentation gradually disappears and skin color evens out. After a fourth degree burn, restoration of the skin is possible only through scarring. When the tissue defect is large, a long-term non-healing ulcer is formed, requiring surgical treatment.

Extensive burn wounds are treated with surgical techniques in several stages: first, the burn scab is removed, and then the tissue defect is repaired. There are several surgical methods to restore the skin.

Skin grafting is used quite widely, but in case of deep defects or destruction of a significant area of the dermal layer, it is not always possible to use them.
In these cases, the developments of scientists specializing in cell biology are used. Then transplantation of human epidermal keratinocytes is performed.
An alternative to this method is to grow skin cells on collagen carriers to form a dermal equivalent.
Collagen matrix in the form of a sponge for transplantation of fibroblasts and keratinocytes.
The fibrin matrix is in good contact with the bottom of the wound.
Transplantation of cultured fibroblasts.

Scarring

Scars left after a burn injury are treated in several ways: special regenerating creams, ointments, sprays, peeling of fruit acids, laser resurfacing, ultrasound therapy (or phonophoresis of enzymes).

Large post-burn scars are treated surgically: excision of excess keloid tissue and application of a thin cosmetic suture, as well as plastic surgery with a skin flap.

Rehabilitation

Restoration activities should begin as early as possible.

Physiotherapeutic methods of treatment after burns are aimed at improving blood supply, accelerating tissue regeneration, preventing (or treating) purulent complications, pain relief, and removing necrotic tissue. In addition, physical therapy helps fight scar tissue changes, promotes the healing of the skin flap, and is used in other cases.

Ultraviolet irradiation in an erythema dose helps accelerate tissue repair and regeneration, stimulates the immune system, and relieves inflammation.
Electrotherapy: SMT and diadynamic therapy, electrophoresis, transcranial electroanalgesia (therapeutic sleep) promote pain relief, improve blood circulation, have bactericidal properties, and stimulate the rejection of necrotic tissue (depending on the substance administered). General franklinization has an anti-stress effect.
Ultrasound therapy and phonophoresis accelerate the resorption of scar tissue, improve blood circulation and relieve pain (depending on the drugs administered).
UHF therapy relieves inflammation and stimulates blood circulation.
Laser therapy in red mode has anti-inflammatory activity and stimulates tissue regeneration. UV laser irradiation of blood gives positive results in the form of stabilization of the condition in patients with a questionable and favorable prognosis.
Darsonvalization is carried out to stimulate tissue repair and regeneration, as well as to prevent purulent inflammation.
Magnetic therapy is done to stabilize the psycho-emotional state of the victim (transcranial technique), as well as to improve blood supply and recovery processes in the area of damage, biostimulation.
Photochromotherapy in the red spectrum has a reparative effect on the dermis, while in the green spectrum it calms and balances.
Aeroionotherapy improves skin permeability. Ions penetrate through damaged and undamaged surfaces of the skin and reduce pain sensitivity. With aeroiontophoresis of analgesics, this therapeutic effect is enhanced.

Treatment of burns should be carried out comprehensively, with the involvement, if necessary, of related specialists, including psychologists. Often, a burn injury is a strong psycho-emotional factor, and the consequences of injury can cause depression and suicidal thoughts.

Modern methods of treatment and rehabilitation are able to minimize the residual effects of a burn injury, allowing the victim to return to his usual active life.

Degrees of burns and restoration of the dermis after them: creams and ointments

Burns belong to the category of injuries that occur under the influence of an external factor. Destruction of the integrity of the dermis can occur as a result of contact with chemicals and fumes, electric current, exposure to radioactive radiation, or as a result of thermal effects on areas of the skin. They are classified depending on the severity of the destruction of the skin by degrees, according to which the desired type of treatment and medications are prescribed.

Thermal burns occur when careless handling of open fire, steam, hot objects and liquids, which destroy the skin upon close contact.
Electrical burns are caused by exposure to electrical current or electrical discharge, including lightning.
A chemical burn can be caused by synthetic substances with increased toxicity or other aggressive effects that are used in production and at home.
Radioactive burns occur due to exposure to ultraviolet radiation on exposed skin as a result of contact with devices or objects emitting background radiation.

The most popular medicinal substances for restoring areas of the dermis affected by burns are complex preparations made in the format of gels, ointments and creams. Depending on the degree and type of injury, they are divided into antiseptics, analgesics, anti-inflammatory and wound healing.

1st degree

Skin erythema with 1st degree burns without serious destruction of the stratum corneum, recovers on its own in 3-4 days, provided there is no destruction of the dermis and a small scale of injury. In case of serious scale of the burn and deterioration of the person’s condition due to dehydration and thermoregulation, treatment is prescribed in which the majority of the healing substances are ointments prepared on the basis of aloe, vitamin supplements and preparations made in gel format. For the treatment of 1st degree burn injury, the following is used:

Some of the drugs have side effects in the form of itching and allergic reactions, since the medicinal substance that is present in it eliminates not only pain syndromes, but also localizes inflammatory processes, promotes rapid healing of wounds and regeneration of damaged areas.

2nd degree

With 2nd degree burns, the damage to the dermis is more significant than in the first case: in addition to swelling and hyperemia, there is detachment in the form of blisters filled with liquid on the upper layers. With unopened vesicles, repair of the dermal cell occurs in 2-3 weeks; if the integrity of the blisters is damaged, the healing time increases depending on the characteristics of the disease. If an infection develops in the wound, skin cell regeneration may take up to a month to complete the treatment period.

To speed up the healing process of 2nd degree burns, the following medications are prescribed in the form of creams and ointments:

Actovegin 5% (ointment).
Thymogen (cream).
Solcoseryl (gel).
Reparef (antimicrobial ointment).
Wundehil (ointment).
Traumeel S (ointment).
Metaluracil (ointment).

In addition to the listed drugs, in order to stimulate the restoration of the dermis, Derinat (sodium deoxyribonucleate solution) and regenerants in the form of tablets (Xymedon) are prescribed.

3rd degree

3rd degree burns are complex and long-term types of injuries in which the affected areas of the skin initially die and only then, after the rejection process, the skin cell is restored. Treatment of such wounds requires 3 or more months, depending on the extent of the lesion and the general condition of the patient.

In some cases, skin grafting (grafting) is required on the affected areas, which can be replenished by autografting (scraps of the patient's skin) or xenografts. For this purpose, also during the recovery process, in addition to treating medications, ointments are used to eliminate scars by resorption. For the treatment of 3rd degree burns the following is used:

Hydrocortisone ointment.
Contractubex (gel).
Heparin ointment.
Zeraderm ultra.

In addition, to the listed drugs for the treatment of third-degree burn wounds, a complex of various physiotherapeutic measures is prescribed, which help not only restore the integrity of the skin, but also improve the functioning of joints and other organs.

Additional articles on anti-burn ointments

Methods of recovery after a 4th degree burn

Grade 4 skin lesions from burns require immediate hospitalization of the victim in special medical institutions, where the patient will remain for the entire duration of treatment. The course of treatment for such wounds is divided in stages:

Surgical removal of scab from a wound as a consequence of a burn.
Replenishment of defective areas by transplantation or other means.
Elimination of post-burn scars using plastic surgery.
Rehabilitation.

During the treatment process, after a certain period of time (10-15 days), in areas damaged by the burn, the dead areas of the dermis are rejected independently or surgically removed, after which the edges and other areas of the wound begin to heal. The appearance of scars in 4th degree burns means that the patient is recovering.

Surgical

The consequences that 3rd and 4th degree burns leave behind require surgical intervention, which may differ in the method of treatment. The following surgical interventions are used to treat 4th degree burns:

A skin graft that is taken from the patient.
Transplantation of dermal keratinocytes in cases where there are deep lesions.
Growing dermal cells.
Use of collagen matrices for the purpose of transplantation of keratinocytes and fibroblasts.

Scar removal procedures

To eliminate the consequences of burns, which manifest themselves in the form of scars, the following treatment methods are used:

Grinding using a laser beam.
Therapy using ultrasound equipment.
Treatment of fruit acids using peeling.
The use of various types of balms and creams with a restorative effect.

Restoration of the skin using physiotherapeutic methods

It is advisable to prescribe procedures for recovery after burns at the earliest stages of treatment. The rehabilitation period includes the restoration of blood supply, rapid regeneration with the elimination and prevention of decay in areas where there was necrosis of the dermis. To accelerate the therapeutic effect, the following methods of rehabilitation after burns are used:

Magnetotherapy. Helps restore affected areas, activates blood supply, stabilizes the general condition of the patient.
Ultraviolet irradiation. Accelerates skin repair, inhibits inflammation, strengthens the immune system.
Aeroionotherapy. By treating the affected areas with ionization, it increases the permeability of the skin.
Photochrome therapy, laser therapy. Both types of treatment help to restore skin areas faster due to irradiation, which enhances the effect.
Dorsonval. A preventive method for preventing ulcers.
Phonopharesis, ultrasound, UHF. Helps resolve scars, improves blood circulation, resists inflammation and decay.
Electrotherapy. Several types of treatment are used (transcranial electroanalgesia, electropheresis), which enhance antibacterial properties, restore blood supply, and promote regeneration of cellular tissues.

ethnoscience

In folk medicine, there are a number of recipes for substances that help restore skin cells, increase blood circulation, have whitening properties, relieve inflammation and treat decay.

Potato. Finely grated raw potatoes are used as compresses for minor burns, to relieve pain and treat the dermis (redness, swelling).
Parsley. The plant (leaves) must be chopped as finely as possible and the substance applied to the burn-affected skin for 20-30 minutes.
Cucumber. The juice is extracted from the plant and used to make compresses.
Nourishing and moisturizing masks. Beeswax (1 part) and butter (2 parts), melted in a water bath, mixed together until smooth and, adding a little lemon juice, used as a mask.
Sea buckthorn oil. The substance is applied to the affected areas several times a day to reduce spots on the skin that appear as a result of burns.
Aloe. An excellent antiseptic, analgesic, and anti-inflammatory agent. Both the pulp and juice of the plant are used.

Professor of the Department of Pediatric Surgery, Russian National Research Medical University named after. N.I. Pirogova, pediatric surgeon, Department of Surgery of Newborns and Prematures, Children's Clinical Hospital No. 13 named after. N.F. Filatova.

Member of the Association of Pediatric Surgeons of Russia, member of the Russian Association of Prenatal Medicine Specialists, member of IPEG.

Co-author of more than 100 published works and 5 monographs on pediatric surgery. Member of the problem commission “Newborn Surgery” at the Russian Academy of Medical Sciences.

Laureate of the competition “Best Doctor of the Year 2010” in the category of pediatric surgery, laureate of the All-Russian Prize in the field of perinatal medicine “First Persons 2014” in the category technology of the year for the development of early diagnosis of congenital malformations.

The scope of surgical activity is neonatal surgery, antenatal diagnosis of congenital malformations.

Rehabilitation after 3rd degree burns