RE: Burns

Georgie Hollis — Wed, 17 Mar 2021 15:54:35 GMT

Thanks Natalie - the picture seems really small, can you share a bigger one? Or feel free to send to me by text/whatsapp at 07917562940

RE: Burns

Natalie Bennett — Wed, 17 Mar 2021 15:46:11 GMT

I was sent this photo yesterday from work. 8days post possible thermal exposure. I will be seeing in person tomorrow and can get more photos of progression.

RE: Burns

Georgie Hollis — Wed, 17 Mar 2021 11:03:45 GMT

Hi Natalie, i think the key is that they are painful initially (depending on depth of injury - the deeper they are the less painful - ie. total nerve damage = no pain - partial thickness = exposed nerve endings = VERY painful).

The question will be how long ago this happened as the wound just like normal wounds go through phases of healing that are predictable. This gives you visual and physical clues as to where the wound is and what it needs. Lets take it from immediate injury - inflammation will peak at 2 days, it will lead to sloughing of skin at the level of injury -(so either epidermis, dermis, or deeper layers depending on the depth of the damage. If the dead tissue remains in place the wound tends to continue in the inflammatory phase as it tries to shift the dead stuff through natural debridement - so it's the same as a normal wound - that removal of eschar/dead tissue will actually reduce the duration of inflammation compared to leaving it there. That is, on condition you use moist wound management after removal rather than relying on a new 'scab' to fill the gap. Wounds should progress to granulation at around day 4 after injury, but again this will be delayed if there is a lot of dead tissue as inflammation inhibits the formation of granulation tissue.

Bear in mind that many burns that may not have been picked up on the day of the incident will not be noticed until the area starts to slough or come away. It can take up to 10 days to know the extent of damage as tissue sloughs so consider than when trying to take a history and working backwards as to how and why it happened.

If the wound is only partial thickness and there are hair follicles left (you will see what looks like stubble in wound bed) then the wound will likely heal with a thin pink scar across the surface and will heal fairly quickly. If there is no stubble but granulation tissue then the wound will heal from the edges inwards. If the wound is in the inguinal area and full thickness it may be necessary to look for a surgical reconstruction option to close the deficit as the location is very mobile and while dressing it may seem a cheaper option, it may actually take a very long time and be frustrating.

A tie over dressing in these areas can save a lot of interference while the wound is healing. If you need info on what and how to do one just say... we have access to some papers we can share.

I'm not a fan of flamazine particularly but it is certainly the 'go-to' product for burns. I think the cleaning a flushing is going to be your best friend along with your pain relief until it begins to granulate.

Please do feel free to share an image if you can and it may give us some idea of options for you. best wishes, Georgie.