What causes a burn to get infected
Acting quickly can save skin and life
In the case of first-degree burns, cooling the wound surface is sufficient. Blisters that appear in second-degree burns should be sterile punctured by a doctor. The skin of the bladder remains on the burn wound. It offers natural protection against the ingress of germs. After puncturing, a sterile hydroactive wound dressing is applied. Either hydrogel dressings or hydrocolloid wound dressings are suitable here. Antiseptic treatment with irrigation solutions or wound dressings containing silver is not necessary for these minor burns. If the burn wound is completely epithelialized, follow-up treatment with products that do not contain active ingredients or products that contain dexpanthenol is advisable. Sufficient lipid replenishment prevents the scar tissue from drying out and tearing.
Deeper burns and burns from grade 2b should be treated surgically as early as possible, depending on the overall condition of the injured person (necrosis removal, rapid skin transplantation). Open burn wounds must be cleaned and flushed with sterile isotonic solution. Dead tissue is removed either surgically or with the help of special wound dressings. The autolytic wound cleaning with hydrogel pads is suitable here. After the dead tissue has been removed, the wound must be closed if possible. Only wound dressings that do not stick to the wound should be used; Modern interactive wound dressings such as hydrocolloids and hydrogels are suitable, for example.
For burns of severity grade 2b or more, antiseptic therapy is indicated to prevent infections. Rinses and dressings containing octenidine or polyhexanide are suitable. Interactive wound dressings containing silver are also suitable for infection prophylaxis.
In the case of burns grade 3, surgical intervention is generally used. Burned non-vital tissue must be removed as it is considered the entry point for microorganisms. In addition, dead tissue initiates and sustains harmful inflammatory processes that influence the severity of the burn disease. As long as the damaged tissue is not removed, the cause of sepsis and multiple organ failure is not eliminated. Such interventions can have cosmetically and functionally disruptive consequences. But this must first take a back seat, because it is important to interrupt the progression of the burn disease.
In the case of large burn wounds, a skin transplant may be necessary and useful. Preventive treatment against infection is essential as any infection delays and complicates wound healing. Systemic administration of antibiotics and antiseptic or silver-containing wound dressings can prevent infections.
Don't forget aftercare
The most important thing in follow-up treatment is skin care. As a result of being burned or scalded, the skin has lost the ability to regulate its own oil and moisture content. Therefore, the epithelialized skin should be cared for several times a day with skin lotions and cream foams that are free of active ingredients and massaged carefully. This is a crucial measure to keep the newly formed skin elastic. For the active ingredient-containing products, either silicone or dexpanthenol-containing products are recommended. Herbal additives such as extracts from calendula or chamomile should not be used.
Uncreamed skin becomes flaky and cracked, easily injured, painful or itchy. Rubbing in the cream or lotion several times a day helps the scars ripen and reduces itching. Scars are ripe when they are no longer red, but light, soft and as even as possible. If the itching is particularly severe, antihistaminergic agents can be prescribed.
It is essential to avoid sun exposure of burned areas. In the first year after the injury, the scars must not be exposed to direct sunlight. The risk of sunburn is very high and the scars darken in the sun. This discoloration is permanent and makes the scars noticeable. It is recommended to protect scars with a sunblock with protection factor 50+. In addition, more and more clothing manufacturers are offering clothing, especially children's clothing, with sun protection.
Even after maturation, scars should always be protected with sun blockers. This is particularly recommended on the face and hands, i.e. areas that cannot be well protected by clothing. In the first year after the accident, vacation trips to countries with extreme sun should be avoided. Scars on the face can also be covered with make-up. For example, the Paulinchen initiative offers professional make-up courses.
After burns grade 2b and 3, the wearing of so-called compression clothing is recommended. This has to fit perfectly, because this is the only way to keep the scars light, soft and not proliferate. The scars have to be compressed until they are no longer active, that is, they no longer become lighter when pressed. Such pressure bandages are custom-made and must be worn day and night for one to two years. Compression clothing can also be useful for other scarring or swelling tendencies.
If the burns go over the joints or flexors (chin, neck, armpit), one must try to work through the lost functions through splints, physiotherapy and occupational therapy. The patient should regain good mobility. For this it is very important that the therapies take place consistently and regularly. Products containing silicone (plasters or gels) are suitable for further scar reduction, especially in the case of smaller defects.
When the scars are ripe, the doctor and patient can consider ways of correcting them. Corrective operations can be used to remove functional disabilities, but also to beautify disfiguring, psychologically stressful scars. Every corrective operation is followed by rehabilitation with compression, physiotherapy, skin care and protection.
High psychological stress
The entire treatment of a severe burn usually takes a long time and takes months or even years. The burden of fear and pain is enormous. Most patients experience the accident fully conscious. The treatment is extremely painful, the transplanted skin is very sensitive and the healing process is usually accompanied by severe itching. In physiotherapy and occupational therapy, the patient's pain limits are always reached and exceeded. Having to live with scars is a very great psychological burden. As a type of accident, burn injuries are a special feature because the person affected is also permanently damaged for their environment.
Children are particularly affected because the scar surfaces often do not grow with them and follow-up operations are sometimes necessary. Their personality is not yet established and therefore it is very difficult to deal with scars, especially in the development years. A well-considered and consistent therapy concept can achieve a good scar pattern, but the damage will always be visible. Children and their parents in particular therefore also need psychological support. Treatment of the child is finished at the earliest when the growth is complete.
In principle, a burn victim, including a child, can practice any sport. Exercise promotes wellbeing, especially in follow-up treatment, and improves both mobility and stamina. As soon as all wounds have healed, a person affected is allowed to go back to the swimming pool, including salt water pools. After every bath, the skin should be well moisturized. You can do without compression clothing during the bath.
Prevention before therapy
Many burn accidents could be avoided. The best therapy is therefore the prevention of burn injuries. Especially in the kitchen and household, parents with small children should be able to identify and eliminate sources of danger in good time with their eyes open.
The therapy of burn injuries is influenced by many confounding variables. Concomitant diseases and infections disrupt and complicate the healing process. Follow-up treatment for injuries is particularly important. The aim is not only to save the patient's life, but also to achieve an aesthetically satisfactory result as far as possible. From a severity of 2b, follow-up treatment of one year, sometimes longer, must be expected.
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