Burn Wound Care

• A wide variety of dressings is available for the treatment of partial thickness burn wounds, but none has strong evidence to support their use

First Aid

• If the patient arrives at the health facility without first aid having been given, drench the burn thoroughly with cool water to prevent further damage and remove all burned clothing.0If the burn area is limited, immerse the site in cold water for 30 minutes to reduce pain and oedema and to minimize tissue damage.
• If the area of the burn is large, after it has been doused with cool water, apply clean wraps about the burned area (or the whole patient) to prevent systemic heat loss and hypothermia.
• Hypothermia is a particular risk in young children.
• First 6 hours following injury are critical; transport the patient with severe burns to a hospital as soon as possible

Initial Treatment

• Initially, burns are sterile. Focus the treatment on speedy healing and prevention of infection.
• In all cases, administer tetanus prophylaxis.
• Except in very small burns, debride all bullae. Excise adherent necrotic (dead) tissue initially and debride all necrotic tissue over the first several days.
• After debridement, gently cleanse the burn with 0.25% (2.5 g/litre) chlorhexidine solution, 0.1% (1 g/litre) cetrimide solution, or another mild waterbased antiseptic.
• Do not use alcohol-based solutions.
• Gentle scrubbing will remove the loose necrotic tissue. Apply a thin layer of antibiotic cream (silver sulfadiazine).
• Dress the burn with petroleum gauze and dry gauze thick enough to prevent seepage to the outer layers.

Daily Treatment

• Change the dressing daily (twice daily if possible) or as often as necessary to prevent seepage through the dressing. On each dressing change, remove any loose tissue.
• Inspect the wounds for discoloration or haemorrhage, which indicate developing infection. Fever is not a useful sign as it may persist until the burn wound is closed. Cellulitis in the surrounding tissue is a better indicator of infection.
• Give systemic antibiotics in cases of haemolytic streptococcal wound infection or septicaemia.
• Pseudomonas aeruginosa infection often results in septicaemia and death. Treat with systemic aminoglycosides.
• Administer topical antibiotic chemotherapy daily. Silver nitrate (0.5% aqueous) is the cheapest, is applied with occlusive dressings but does not penetrate eschar. It depletes electrolytes and stains the local environment.
• Use silver sulfadiazine (1% miscible ointment) with a single layer dressing. It has limited eschar penetration and may cause neutropenia.
• Treat burned hands with special care to preserve function.

Healing phase

• The depth of the burn and the surface involved influence the duration of the healing phase. Without infection, superficial burns heal rapidly.
• Burn scars undergo maturation, at first being red, raised and uncomfortable. They frequently become hypertrophic and form keloids. They flatten, soften and fade with time, but the process is unpredictable and can take up to two years.
• In children, the scars cannot expand to keep pace with the growth of the child and may lead to contractures. 

Reference:

http://www.who.int/surgery/publications/Burns_management