Generally speaking, there is no possibility of self-healing for third-degree burns, so we can only do escharectomy and skin grafting, and there will be scars after operation. If you don't plan to do skin grafting, it depends on your burn area. If it is less than one thousandth (the size of a small fingernail), it is reliable to treat it with ointment, otherwise the third-degree burn will not be fully recovered in half a year. If your burn area is narrow, you can treat it by stitching. If it is round, you can only do skin grafting.
In addition, third-degree burns can't heal themselves and new skin can't grow; It can heal itself slowly, but the scar will be very serious, especially on hands and feet, which will cause scar contracture deformity. Severe scar contracture will affect the growth and development of children, and may also cause muscle and even bone deformity. Therefore, I suggest that you must have surgery, not only now, but also with the growth of age, you need to have skin grafting for many times, so you must go to a regular burn plastic surgery specialist for treatment!
At present, China's skin grafting technology has developed rapidly and the effect is quite good. Generally, skin grafting can move freely within 2 weeks, as long as the affected area is well maintained in the future.
Hello, children with severe third-degree foot burns need skin grafting. Because the skin and its accessories were completely burned when severe third-degree burns occurred, there was no source of epithelial regeneration, and the skin could not grow on its own, so it could only be treated by skin grafting. But if it is only a very limited small area burn, crawling around healthy skin is likely to shrink and heal. I suggest you go to the hospital for treatment, and the doctor will give treatment according to your child's specific situation. I wish you good health!
Hello, burns are generally divided into three grades. First-degree burns only damage the surface layer of the skin, with slight redness and swelling, no blisters and obvious pain. Take off your clothes and socks immediately, soak the wound in cold water for half an hour, and then wipe the wound with sesame oil and vegetable oil.
Second-degree injuries and scalds are dermal injuries, local swelling and pain, and blisters of different sizes. For larger blisters, you can use disinfection needle to break the edge of the blister to release water, and then wrap it with scald cream, with moderate tightness.
The third-degree injury and scald are subcutaneous, and the fat, muscles and bones are all damaged, showing gray or reddish brown. At this time, wrap the wound with a clean cloth and send it to the hospital in time. Purple liquid medicine or ointment should not be applied to the wound surface, which will affect the observation and treatment of the disease.
Patients with severe injuries and burns may have shock or respiratory or cardiac arrest during transportation, so they should be given artificial respiration or chest massage immediately. When the wounded are thirsty, a small amount of hot tea or light salt water can be used, and it is forbidden to drink a lot of boiled water in a short time, which will lead to brain edema of the wounded.
Skin grafting is to take a part of skin from your healthy skin (donor area) and cover the area (recipient area) where scars have been removed. The skin at the donor site needs a new blood supply from the recipient site to survive. Generally, there is a great chance of successful autologous skin transplantation, but there is also the possibility that the skin graft will not survive. In addition, all skin grafts will leave scars in the donor area.
Indications for skin transplantation:
Skin defects caused by various reasons.
Physical changes caused by direct contact with high-temperature objects or strong thermal radiation. Injuries caused by flames, high-temperature solids and intense radiant heat are called burns. Burn is tissue damage caused by high temperature, chemicals or electricity. The degree of burn varies with temperature and action time. The local variation can be divided into four degrees. When burned, the amount of lactic acid in blood increases, and the pH value of arterial and venous blood decreases. With the aggravation of tissue capillary dysfunction, hypoxia becomes worse.
Combustion area calculation:
Nine-point method (adult): head and neck 9% (1 9%), upper limbs 18% (2 9%), trunk (including perineum 1%) 27% (3 9%) and lower limbs (including buttocks) 46% (5 9%). * * * is11x 9%+1%=100%. The nine-point method is also applicable to children: however, children with big head and small limbs vary with age, and the calculation is as follows: head and neck surface area (%)= 9%+( 12- age.
The severity of burns depends on the extent and depth of the injured tissue, which is divided into I, II and III degrees.
First degree burns are the lightest. Burn skin is red, painful, obviously tender, with exudation or edema. Gently press the injured part, it turns white locally, but there is no blister. Second degree burns are deep. The skin is blistered. The bottom of the blister is red or white and filled with clear and viscous liquid. Sensitive to tenderness and turns white when pressed. Third degree burns are the deepest. The burned surface can be white, soft or black and carbonized leather. People with white skin are often mistaken for normal skin, but they no longer change color after pressing. Damaged red blood cells can make the burned skin bright red with occasional blisters, and the hair in the burned area is easily pulled out, resulting in sensory loss. Generally, there is no pain in the third-degree burn area because the nerve endings of the skin are destroyed. It usually takes several days to distinguish deep second-degree and third-degree burns after burns.
The prognosis of burn wound: the symptoms of first-degree wound subsided in 2-3 days, healed in 3-5 days, desquamation and no scar; The superficial second-degree wound healed in 1-2 weeks without scar; Deep second-degree wounds usually heal in 3-4 weeks without leaving scars; Third-degree wounds desquamate in 3-4 weeks, and need to heal after skin grafting, leaving scars and deformities.
The necrotic tissue of burn wound provides a good culture medium for bacteria, and the wound is the main source of infection. Moreover, the damage of immune function after burn mostly returns to normal with the healing of wound or after escharectomy and skin grafting. Therefore, active treatment of wounds (including escharectomy and skin grafting, and local topical drugs to promote wound healing) is the key to prevent infection.
Take measures to prevent infection
1, debridement, aseptic operation and disinfection and isolation measures
burn
Although the pathogenic bacteria of systemic infection are not completely from the wound, the bacteria on the wound have a certain relationship with the infection, so measures should be taken to reduce the bacteria. The commonly used principles are debridement and aseptic operation. At the initial stage of admission, the patient should be debrided to remove pollutants and putrefaction on the wound, and the wound should be washed with 1‰ bromogeramine or 0.5% chlorhexidine, and finally with 20℃-35℃. In order to reduce the number of bacteria on the wound surface, aseptic operation and disinfection can not be ignored in the methods of preventing infection. Although it is not easy and generally unnecessary to put the patient in a sterile laminar flow room, it is very necessary to put the patient in a ward with disinfection and isolation conditions and all factors that may cause cross infection (such as appliances in the ward and things carried by medical staff). ) should be avoided. Sterility principle is the key to prevent iatrogenic infection.
2. Nutrition
Patients with extensive burns usually have malnutrition, low immune function and infection, which are mutually causal. The results showed that the conditioned reflex index, serum total protein, transferrin, C3 and IgG levels in the high protein treatment group were higher than those in the control group with sufficient heat supply. Strengthening nutrition and maintaining positive nitrogen balance can significantly reduce the incidence and mortality of invasive infection.
3. Immunotherapy
Immunological research on burn infection mainly focuses on immunotherapy of Pseudomonas aeruginosa infection. Immunotherapy can be divided into active immunity and passive immunity. At present, the active immunity is mainly Pseudomonas aeruginosa vaccine, and the passive immunity is Pseudomonas aeruginosa immunoglobulin or high-valent immune serum (or plasma).
The area of third-degree burn is small (diameter < 1 cm), which can be caused by the creeping of the epithelium at the edge of the wound. If the area is large, autologous skin transplantation must be carried out. The depth of third-degree burn reaches the whole cortex or deeper, and the skin color is pale or eschar is formed, and there is no pain. This kind of burn is difficult to heal itself. After two weeks, the eschar falls off to form granulation wound, and after healing, it forms atrophic scar, which often causes local deformity due to scar contraction. Third-degree burns can damage the entire skin layer and may involve subcutaneous tissue, muscles and even bones. Local wounds become eschar, hard and dry. There is no blister, and dendritic embolic vein branches can be seen. Generally, after 3-5 weeks, the eschar gradually separates and falls off, and granulation is formed on the wound surface. Small-area burns need healing for more than 1 month, and large-area third-degree burns need skin grafting to heal the wound, resulting in serious scars. Deformities often occur. The severity of burns is usually light, and the total area is less than 10%. The total area 1 1%-30% or the total area less than 10% is moderate. The total area is more than 3 1% or the third-degree burn area is 65438+. If there are respiratory tract burns and other combined injuries, they should be classified as severe or extremely severe burns. (1) systemic therapy: patients with limited or shallow second degree do not need systemic therapy, and those with pain can be given painkillers such as compound aspirin or valine as appropriate. Large areas with second or third degree depth should be transferred to surgery. Severe exogenous infection should be given tetanus antitoxin injection and antibiotics to prevent infection. If the burn area is large, we must pay attention to systemic treatment, such as anti-shock and anti-inflammation. Enhance physical resistance, etc. If the burn area is large, transplant autologous skin in time to reduce scar formation. (2) Local treatment: 1. First degree and second degree: After cleaning the wound with 75% alcohol, choose a cool emulsion for external application, or add 5% boric acid powder to the egg white, mix well and wrap it with vaseline gauze. If there is blister erosion, you can puncture the blister first and release the contents under aseptic conditions. Or topical zinc oxide ointment or 10% damato ointment to prevent secondary infection and promote epithelial recovery. You can also apply it locally with Jingwanhong ointment on the market, 1, 2-3 times a day. 2. In addition to surgical treatment, you can also use Zichuang Ointment and Huadu San Ointment externally. After removing carrion, the buds on the wound surface are fresh.