Severe burn injuries are usually life-threatening. Optimal medical care and close monitoring of patients are therefore particularly important.
It is not uncommon for permanent damage to remain, such as extensive scars or parts of the body with limited mobility. Burns to the hands, feet, face and neck in particular require early plastic surgery. Quick and professional treatment ideally ensures that the healing process is as successful as possible, sometimes even completely.
Depending on the severity of the burn, severely burned patients are in a life-threatening situation @ TommyStockProject /AdobeStock
The doctors in charge of a severe burn center are usually specialists in plastic and aesthetic surgery or specialists in surgery or trauma surgery. Dermatologists, internists, physiotherapists and psychotherapists are also frequently employed. Pediatricians, pediatric surgeons and child psychologists also work at a center for children with severe burn injuries.
The severity of a burn is determined by the burnt body surface area and the depth of the burn.
The burnt body surface area can be roughly estimated using the so-called rule of nine:
- the upper extremities and head with neck each comprise 9%,
- the lower extremities 18% each,
- the entire torso 36% and
- the genitals or the palm of the hand 1% of the body surface.
In addition to this rough estimate, the burned body surface area can be determined more precisely from special tables that further subdivide the body parts and also take into account the changes in body proportions associated with age.
In adults, doctors diagnose a severe burn injury when 15% or more of the skin is burned. According to the rule of nine, this would be both arms, a leg or the entire back, for example. If, in addition to the external injuries, there is also internal damage, for example from breathing in very hot air (inhalation trauma), even minor burns on the skin are sufficient for specialists to speak of a severe burn injury.
Burns to children are particularly dangerous, as they still have a larger ratio of body surface area to body mass. A burn of 10% of the skin already constitutes a severe burn.
The depth of the burn is defined by the degree of burn:
- In first-degree burns, only the upper layer of the skin (epidermis) is burned, the skin is slightly reddened (as in a sunburn), swollen and painful. These burns usually heal completely and do not require special treatment in a specialized center.
- In the case of second-degree burns, blisters form and severe pain occurs.
- With third and fourth degree burns, the patient no longer feels any pain as the nerve endings are also burned. In a grade 3 burn, the entire skin is affected; in a grade 4 burn, subcutaneous fatty tissue, muscles and bones are charred. Pathogens can penetrate through the severely damaged skin, which can lead to further complications.
Severe burn injury centers have burn intensive care units where severely burned patients are ventilated and placed in an artificial coma @ Vadim /AdobeStock
Whether a burn injury is treated as an outpatient, as an inpatient in a clinic or in a severe burn center depends in particular on the severity of the burn. The current 2018 guidelines recommend transfer to a major burn center for the following injuries or patients
- Second and higher degree burns of 10% or more body surface area
- Third and fourth degree burns
- Burns to the hands, face or genitals
- Burns caused by electricity, including lightning strikes
- Chemical burns
- Inhalation trauma
- Burn victims with other illnesses or injuries that make treatment more difficult
- Burn victims who require special psychological, psychiatric or physical care
In general, however, all patients with burns should be given the opportunity to be treated in a specialized center.
A severe burn center does not only treat burns caused by heat or fire. Although this is the most common cause of severe burns, they can also occur, for example, when the skin comes into contact with certain chemicals or an electric current or lightning strike.
A clinic for severely burned patients usually has a certification that distinguishes the center as a high-quality facility. In order to receive such a seal of quality, certain structural, equipment and personnel requirements must be met and a minimum number of severely burned patients must be treated each year.
As severe burn injury centers are therefore specifically designed for the care of patients with severe burns, they offer them optimal healing conditions.
The centers are characterized by the following special features, for example:
- Heated admission and shock room
- Possibility of maximum intensive therapy
- Own surgical wing, where, for example, the surgical removal of severely damaged tissue or skin transplants are carried out
- Possibility of hydrotherapy
- Possibility of continuous bacteriological diagnostics
- Possibility of continuous renal replacement therapy
Initial treatment of seriously injured patients takes place in the shock room @ ronnachaipark /AdobeStock
Even after the actual acute treatment, burn patients can continue to use the services of a severe burn center. Procedures such as microneedling or dermabrasion (the abrading of raised scars) can also be used years after the actual burn injury to minimize consequential damage and, above all, to alleviate the psychological stress of those affected.
Other services include conservative therapies such as scar massage or advice on camouflage or permanent make-up. Severe burn injury centers thus cover all treatment needs from acute care to rehabilitation and aftercare.
