Burns can be caused by hot water, steam, flame, current, laser, radiation, acid, alkali, phosphorus and other factors. The so-called or narrow sense of burn refers to the thermal burn caused by high temperature alone, which is more common in clinic. Burns caused by other factors are called cause burns, such as electric burns and chemical burns.
The area and depth of the burn.
1. The estimated area is expressed as a percentage of the burned area. The researchers put forward several estimation methods. There are China's new nine-point method and palm method in China, and the latter uses small area burns.
The new nine-point method classifies all parts of the human body as 9% of the right trunk, which is mainly suitable for adults; For children with bigger heads and fewer lower limbs, they should be slightly modified. See table1for specific methods; And can be drawn into a chart (figure 1) and attached to the medical record for marking.
Palm method is estimated according to 1% of the injured person's body surface area with one palm (fingers together).
2. Identification of concentration According to the grade of thermal damage tissue, burns are divided into 1, shallow II, deep II and III (Figure 2).
I'm burned: it's just the epidermis. Local redness, so it is also called erythema burn; There is pain and burning sensation, and the skin temperature is slightly higher. It can be improved and healed in 3 ~ 5 days, and desquamation does not leave scars.
Second degree burn: deep into the dermis, local blisters, so it is also called blister burn. ① Only superficial dermis was damaged in patients with degree ⅱ, and some mucosa remained healthy. Due to more exudation and full blisters, the wound surface exudes obviously after rupture; The bottom of the wound is red and swollen; Have severe pain and allergies; The skin temperature rises. If there are no complications such as infection, it can be cured in about 2 weeks. After healing, there is no scar, pigmentation can appear in a short time, and the skin function is good. ② The deep second degree injured the deep dermis, and there was still skin adhesion. Because the surface tissue turned south is slightly thicker, the blisters are smaller or thinner, the feeling is slightly dull, and the skin temperature can be slightly lower. After exfoliation, the wound surface is reddish or red and white, or reticular embolic blood vessels can be seen; There is little exudation on the surface, but the bottom is obviously swollen. If there are no complications such as infection, it can be cured in 3 ~ 4 weeks. Because there are some granulation tissues and scars in the middle of the repair process, the skin function is basically preserved.
Scar hyperplasia is a serious sequela of burn patients after wound healing, which is mainly caused by pathological changes during wound healing. According to statistics, 70-80% of the wounded with scar hyperplasia are under 30 years old; People of color and scar constitution tend to have excessive scar proliferation; Chemical burns and napalm burns often produce serious scars; The deeper the burn (deeper than the second-degree wound), the more obvious the scar hyperplasia; Wound infection usually increases the chance and severity of scar formation; Scar contracture and hyperplasia will seriously affect the quality of life of patients. Because the mechanism of scar formation is not clear, there is no specific drug to prevent and treat scar at present, but early prevention has a certain effect on scar hyperplasia and contracture. Preventive measures mainly include: infection should be prevented and controlled in deep wounds, and skin grafting should be carried out as soon as possible under general circumstances; Once the wound heals, insist on applying pressure with elastic bandage or elastic sleeve as soon as possible, and stick to it day and night when using, which can effectively reduce scar contracture and hyperplasia; Exercise as soon as possible to reduce the dysfunction caused by scar contracture. At present, early functional exercise is advocated in the process of burn treatment. If patients actively cooperate, they can often get ideal therapeutic effects.
What problems should be paid attention to in burn scars's rehabilitation?
The rehabilitation of burn scar is an important part of modern burn treatment. Timely and correct scar rehabilitation treatment can obviously improve the quality of burn healing and reduce the disability rate.
1, pay attention to skin cleanliness and hygiene. When the burn wound has just healed, there are still a small amount of secretions and scabs, so bacteria are easy to multiply quickly. In addition, the epidermis is thin and tender, the structure and function are not perfect, and it is easy to be infected and ulcerated. In the meantime, we can use neutral detergent for cleaning, and then use anti-scar drugs and other treatments after cleaning.
2. Avoid excessive friction and excessive activity. Due to the imperfect structure and function of scar epidermis, the epidermis is more vulnerable to injury, and some improper treatment may aggravate the injury. When applying anti-scar drugs, it is not advisable to massage excessively or for a long time, which will separate the epidermis from the fiberboard layer to form blisters or blood blisters, and excessive joint activity will also lead to the loosening and separation of the epidermis and blisters.
3. After lower limb burns, it is not advisable to move prematurely. Because the scar epidermis is fragile, the structure and function of the blood vessels below it are not perfect, which can not meet the internal pressure against gravity. The wound surface of lower limbs will turn purple or even bleed when standing, which will aggravate scar hyperplasia. Generally, it is more appropriate to go to the ground in about 3 months. It is best to use a pressure sleeve to protect before going to the ground, which can reduce scar congestion.
4, blisters should be timely drainage, avoid infection to form ulcers. Due to various stimuli, the new epidermis is easy to relax and form blisters. If blisters are not treated promptly and correctly, they are usually infected and form ulcers. After the blister appears, the skin can be disinfected with complex iodine, and the blister can be cut off with sterile scissors, resulting in water accumulation. Generally, anti-scar treatment should be implemented after the blisters subside and the ulcers heal.
5. Under the guidance of specialists, take comprehensive measures to control scar hyperplasia and prevent contracture. So far, there is no specific method to completely prevent scar hyperplasia after burn, and comprehensive treatment is still the main method of scar prevention and treatment.
6, early prevention, perseverance. The formation process of burn scar can be roughly divided into proliferative phase, stable phase and regression phase. The proliferation period lasts from 3 months to 2 years, and most of them are about half a year. However, due to various reasons such as ulcer, pain, impatience or improper methods, some patients often fail to adhere to scar rehabilitation treatment, resulting in scar hyperplasia and contracture.
7. Correctly grasp the timing of plastic surgery to prevent disability. Scar contracture of functional parts, such as hand scar, eye scar and jaw and neck scar, should be operated as soon as possible after the scar is stable, especially children, should be treated as soon as possible, and plastic surgery can be carried out in advance. Otherwise, it will cause abnormal development of joints and bones, shorten blood vessels and nerves, and lead to disability.
Professor He Quanyong, Department of Plastic Surgery, Xiangya Third Hospital, Central South University
Don't let the burn leave a scar.
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Article source: Beijing 777 Health Network