Burn injuries can vary and include exposure to flames, scalding, explosion-related injuries, contact injuries, chemical, electrical, friction, reverse thermal(cold) burns and radiation exposure.
Burns and Burn Management
Depending on severity, burns could be epidermal (1st degree), superficial partial thickness (2nd Degree), deep partial thickness (2nd Degree) or full thickness burns (3rd Degree).
Epidermal burns are characterised by blisters and are usually painful. The burns heal spontaneously within 3-7 days with moisturiser or protective dressings.
Superficial partial thickness are also characterised by blisters, but are usually dark pink in colour with a sluggish capillary return. These burns will heal within 2 weeks.
Deep partial thickness are heterogeneous, have variable depths, are blotchy red and white and have a sluggish to absent capillary refill. They usually take more than 3 weeks to heal, and would scar badly unless there is surgical intervention.
Full thickness burn are characterised by underlying dead tissue and may be white, brown, red or black, without any capillary refill. Surgery is mandatory, and would involve excising the affected skin and applying a skin graft, followed by long-term scar management required.
Referral to Specialist Burns Unit
As burns range in severity, they will need to be assesssed on a case by case basis. Minor burns may be treated by a GP, whereas serious burn injuries will be referred to a specialist burns unit and treated as soon as possible:
- Children up to the age of 16 should be referred to the Children's Hospital at Westmead.
- Pregnant Women in their second or third trimester should be referred to Royal North Shore Hospital where comprehensive obstetric services are available, should they be required. Referral of women in their first trimester should be decided on an individual basis, with consideration given to burn severity and predicted length of stay.
- Spinal injury Adult patients with spinal cord injuries or suspected spinal cord injuries should be referred to Royal North Shore Hospital where the acute specialist Spinal Unit is situated.
- Multi-trauma Adult patients with multiple-trauma and burn injuries should be transferred Royal North Shore Hospital which is a NSW designated Major Trauma Service.
Plastic Surgery and Burns
Normally, minor burns heal to relative normality with the right treatment. However, when a large amount of tissue is affected the surrounding normal skin pulls together in an attempt to cover and heal the damaged area. Tightening of the skin in this manner is called contracture. Contractures are the most common post burn deformity and can also cause complications with tightness when close to muscles, ligaments, tendons and joints.
Some of the post-burn surgeries Dr Tew can aid with include:
• Scar release surgery
• Skin grafting
• Split-thickness skin graft
• Full-thickness skin graft
• Flap surgery
• Free flap/microsurgery:
• Tissue expansion
Treatment of burn deformities are assessed on a case-by-case basis and normally spaced over a period of years through multiple surgeries.