Home Burn Injury and Care

What is Burn Injury?

Burn Injury and Care

Unlike most forms of trauma, burn injury is something the vast majority of the population can claim to have some experience of, even if in a very mild form. Almost all of us have suffered a small contact burn from a hot surface or a minor scald. As a consequence we have an understanding of the unpleasantness of such injuries. It perhaps also gives us some inclination as to the pain and suffering the involvement of a larger area of skin must generate. Indeed, in the severest forms, burn injury is felt to be the most severe form of trauma that is survivable. If survived, such an injury alters an individual's life in all aspects; their appearance, their ability to function independently in society and consequently their psychological well-being.

One of the difficulties in describing burn injury is conveying the huge variation in causation and variability of injury severity that is seen. The injury occurs in all age groups, and may range from the most trivial; such that self treatment is sufficient, through to the most severe, where the highest levels of intensive care and radical surgery are required. The very variability of this type of trauma is what attracts many clinical graduates into the specialty. Imagination and wide ranging skills are needed to tailor care to the individual.

Looking at the causes of burn injury, the vast majority are thermal injuries, the largest proportion of which are scalds, particularly in the paediatric population. There are also contact, flame and flash thermal injuries. Complex injuries are produced by chemical and electrical injuries which may involve a small area of skin but can create deeply destructive wounds and life threatening systemic effects. A burns service may also deal with large and severe sunburns in children as a subset of radiation injury, and occasional cold injury, such as frostbite. Finally there are a group of diseases, the vesiculo-bullous skin disorders, which may involve only a small area of the skin, or may affect the entire skin surface area. In the severest form these conditions may require the sufferer to be transferred to a burn service for successful management of these massive wounds.

Following thermal injury the ability of an individual to survive depends largely on two variables; the proportion of the body surface area involved (total burn surface area or TBSA) and the age of the individual. From statistical analyses, the age of the individual becomes crucial in the under one year or over 56 year age groups. Indeed, it is in the elderly population that no significant improvement in burn injury survival rates have been seen in the last twenty years, whereas survival rates in some other age groups have improved dramatically.

Other features that markedly influence survival after burn injury include; the presence of an airway injury from smoke, vapours or heat and the pre-existence of medical conditions affecting the ability of the individual to respond to trauma. Limitations in the cardiovascular and respiratory systems are particularly important. The presence of significant associated injuries such as fractures or other forms of trauma also contribute to the total trauma ‘load’ and have an effect on recovery and mortality.

Treatment Goals

Apart from the survival of the individual, the goal of treatment is to recover the individual to the pre-injury state and for them to return to their place in society with unaltered potential. The nature of burn injury often makes this impossible, but the goal remains. The intention is to maximise the recovery in terms of:

  • Form; restoring the aesthetic characteristics of the injured area as much of possible in terms of skin contour, texture and colouration.
  • Function; maximising the recovery of the ability to perform activities relating to home life, work and leisure. This often means working specifically to maintain the range of movement of joints and in making reconstructive surgical efforts to protect and restore vital structures.
  • Feeling; facilitating psychological recovery following a traumatic and destructive injury. Working to help individuals and families through the often painful and distressingly prolonged periods of treatment. For the injured, this not infrequently involves coming to terms with bereavement, following the loss of family members and friends.