What dressings (as a generalistion) are used for burns?

[Susan to Vanc]

Hi,

Ive just had a read through losts of Burns posts to question and challenge my thoughts of what nursing burns would be like.

I come from a restoritive post-op plastic surgery background where we have all the wound incision, debridement, VAC dressings and laying skin grafts. I am moving overseas to Vancouver and the Plastics ward there also has burns patients in it. I am guessing that the dressings have similar principles compared to plastics.

what are the typical dressings you put on burnt skin, is part of the skin ever surgically removed, do all burns have skin grafts on them?

and I read about 'scrubbing' the skin, is this only done once to a patient, or with each dressing change (because it sounds something that would be very challenging and hard for me to morally do, I have doubts)

thanks for any input,

muchly appreciated

susan

[UMichSCN07]

The 'typical' burn dressing is silvadene (aka SSD), wrapped in Kerlex, then covered in burn net (elastic/cotton netting). Depending on any infections present, they may add Nystatin powder, or use sulfamylon in place of the SSD. Faces are usually done in bacitracin and ears are usually done in sulfamylon. Grafts typically get wrapped in xeroform impregnated with bacitracin. Donor sites get Aqua-cel, Acticoat, or dry Xeroform.

Surgical debridement usually is done in the case of full thickness burns (known to the public as 3rd degree), where there is a thick eschar of dead tissue that needs to be removed for healing. Sometimes, deeper partial thickness burns will develop eschar that will also need surgical debridement. Typically only areas requiring surgical debridement will require grafting (i.e.-any full thickness areas). Circumferential burns will also need escharotomies to prevent compartment syndrome and loss of function distal to the burn.

Yes, scrubbing is typically done during every dressing change, which is usually once a day, sometimes twice a day, rarely three times a day. If you don't scrub, the topical medications build up a pseudoeschar that prevents the healing process from continuing. It also helps to remove dead tissue that may contiue to develop as the burn wound evolves, and helps to combat infection, which is the biggest challenge facing any major burn.

For what it's worth, this may not be standard practice where you are; this is what we do on my unit, which is ABA accredited and part of a level one trauma center. Please feel free to PM me with any other burn care questions.

Mike in Michigan