Burn Injury Resource Center

When the skin is burned, contracture scars may form, these contracture scars will affect the range of motion in the affected area and one of the methods used for scar treatment is Z-plasty.

Z-plasty is a surgical procedure used to improve the functional and/or cosmetic appearance of the scars.

Cosmetic Z-plasty is the repositioning the scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable.

Functional Z-plasty is the lengthening of the scar to relieve the tension caused by that scar. This procedure can be used as one of the treatment methods for burn contracture scars.

Z-plasty procedure is done by making a Z shape incision in a way that the part of the scar that needs lengthening or re-aligning is running with the central limb of the Z shape. The flaps of skin formed by the other line of the Z are rotated and sewn into a new position.

Z-plasty may be used in other conditions such as closing cutaneous defects, correcting stenosis such as external auditory canal stenosis and other conditions.

Complications of Z-Plasty may include wound infection, necrosis (death) of the flap, formation of haematoma under the flap and others.

Several factors may affect the success of Z-plasty procedure one of which is the medical history of the patient. Patients with risk factors that affect the blood supply to the skin like diabetes, or other medical problems relating to the skin may preclude Z-plasty as an option.

Scars left after Z-plasty procedure may take a long time to reach their final appearance. You have to keep in mind that when Z-plasty is used for cosmetic reasons, it will not make the scar go away but it will make it less obvious.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

Laser hair removal is one of the medical procedures used to remove unwanted hair from the skin. Laser simply works by distinguishing color differences between the hair and the skin, it goes and hits the darker color area which is the hair, leading to heating of the hair follicle and destroying it making it unable to grow new hair.

This procedure has become more popular over the years, and although laser hair removal is relatively safe in the hands of an experienced technician, side effects may occur. These side effects may range from skin swelling and redness to skin burns and even scaring (replacement of normal skin with fibrous tissue).

Skin burns occur either due to the prolonged use of the laser on specific areas or may result when the intensity of heat is too high. The skin will absorb the laser energy which may lead to skin burns. These burns are usually minor burns but severe burns may also occur (second and third degree burns). Seek medical attention if the burn doesn't heal or it takes a long time healing.

Other side effects of laser hair removal may include:

Redness, swelling, slight pain, infection, bleeding, color change in the form of darkening of the skin (hyperpigmentation) or lightening of the skin (hypopigmentation).

Before going through a laser hair removal procedure, make sure you discuss all the other options available. You should discuss all the concerns and questions you have with a laser specialist, he/she should be able to answer all your questions, explain all the risks associated with the procedure and tell you if you are an appropriate candidate for the procedure. The success of the procedure depends on how much experience and training the technician/specialist has.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

One of the most common causes of hospital admission of pediatric patients is burns. Most pediatric burns occur at home. The most common cause of burns in young children is exposure to hot liquids (scald injury) such as hot water. Contact with hot objects is the second most common cause of burn in young children. Pediatric burns differ from adult burns in many aspects.

Their skin is more sensitive and less resistant to heat and because it is harder for them to escape from the burning object, this may lead to longer exposure which may increase the burn severity.

Pediatrics have a smaller body size than adults with a greater body surface area in relation to their weight. Fluid loss is proportionally greater in young children when compared to the same percentage of burn in adults because of their smaller circulating volume and different distribution of body fluids leading to more rapid onset of fluid and electrolyte disturbance and imbalance. Therefore pediatrics especially infants develop hypovolemic shock faster and fluid replacement should be started as soon as possible which is calculated according to certain formulas.

Small children are at a greater risk to have a decrease in body temperature (hypothermia) due to the insufficiency of their thermoregulatory system, they are less tolerant to changes in temperature (see regulation of body temperature).

In case there is a burn to the genital area and the child is still wearing diapers, special attention should be taken as the burned area may be contaminated easily making it more susceptible for infection.

Pediatric patients with burns are harder to cannulate (insert a cannula) than adults and the smaller the child is the harder it is. Airway intubation is also harder in pediatrics than adults and the smaller the child is, the harder it is to intubate especially after burns that affect the airways. That is why trachiostomy is sometimes needed.

One of the things that differentiate small children from adults is the inability of small children to speak and express what they feel. The parents play a major role in this case because they know their child better than anyone else and know when there is something wrong with him/her. Therefore when your child is to be discharged you have to make sure that your child is feeling well.

Prevention of scald burns:

• Water heater thermostat should not be set higher than 120 degrees.
• Bathtub water should be checked before putting the child in the tub.
• Never leave the child in the bathtub alone as he/she might turn on the facet or the water may become too hot and lead to scaled injury.
• Keep hot liquids out of the reach of children like turning pot handles on the stove out of the reach of children.
• Avoid carrying hot object while carrying the child.

According to the Consumer Product Safety Commission a child exposed to hot tap water of 140 degree for three seconds develops a third degree burn.

According to the National Center for Health Statistics between 2001 and 2005, each year approximately 116,600 children are treated for fire/burn injuries. Fires and burns are the third leading cause of unintentional death among children aged 1-14 years in 2004.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

Tissue expansion is a procedure that allows the body to grow extra skin. It is done by inserting a silicone balloon expander under the skin near the area to be repaired (such as scars happening after burns) and then gradually filling the balloon with salt water over time causing the skin to stretch and grow (keeping the skin under tension causes new cells to form).

Tissue expansion is used in conditions such as breast reconstruction surgery, repairing burns, scars, large birth marks, hairy areas such as the scalp (the extra skin is still able to grow hair).

After the skin stretches the scaring is surgically removed and the expanded skin is extended to meet healthy un-scarred skin.

The advantage of this procedure is that it provides a good match of color, texture and hair bearing quality. The expanded skin has a smaller risk of dying because the skin remains attached to the donor's area blood and nerve supply. Scars are often less apparent because the skin is not removed from one area and transferred to another.

The main disadvantage of the procedure is related to the length of time needed to grow/stretch the skin which may be as long as three to four months. The expander during the expansion process appears as a bulge. Frequent visits to the surgeon are required for salt water injection to expand the balloon. There are risks related to the anesthesia and the surgery such as infection and bleeding.

The silicone balloon expander is inserted by a plastic surgeon under the skin in an initial surgery followed by salt water injection through a period of time than the expander is removed and the new tissue is put in place. During this process most patients feel temporary discomfort which can be controlled by medication prescribed to you by your physician.

You should contact your physician if you see any indication of wound infection, see (wound infection). You have to avoid applying any undue pressure to the area around the tissue expander such as poking it or wearing tight clothes over the area.

Tissue expansion can be an effective method to make scars that result from burns less noticeable; it is not a replacement for skin graft. Skin grafts are usually done when the tissue is destroyed in severe burns.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

Flash burns to the eye:

A flash burn to the eye occurs when the person is exposed to a bright ultraviolet light. Causes of flash burn to the eye may include:

• Welding torch.


• Direct sunlight.


• Some types of lamps like halogen lamps.


• Sunlamp in a tanning salon.


• Lightning.

• Usually both eyes are affected.
• Pain that may be mild to very severe.
• Sensitivity to light.
• Redness and watery eye.
• Blurred vision.
• Feeling that there may be something in the eyes.

Seek medical advice and follow the physician's orders, place pads over both eyes until medical help is available.

Prevention:

• Wear sun glasses that protect against ultraviolet light.
• Wear safety goggles to protect the eye.
• When welding always wear a welder's mask.

• In children with burned eyes applying first aid may be harder depending on the age of the child and his/her ability to cooperate. You need to stay calm and may need to have another adult help you with holding the child to facilitate flushing the eyes (if appropriate).
• It may take up to 24 hours after the burn to determine the seriousness of the eye injury.
• Some problems such as infection do not show up right away and that is why it is important to follow up with your doctor to make sure that the eyes are healing properly.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

Burns to the eyes can be caused by many different things such as chemicals, hot air, steam, sunlight, welding equipments etc.

Chemical burns:

They can be caused by solid chemicals, liquid chemicals, chemical fumes or powdered material. Damage to the eyes may be minimized if they are washed quickly. The most dangerous chemical burns involve strong acids or alkali (base) substances.

Signs and symptoms:

• Severe pain: because the pain is so severe, the patient tend to keep the eye closed and by keeping it closed this will keep the substance in contact with the eye for a longer period of time which may increase and worsen the damage.
• Redness and swelling of the eye.
• Inability or reluctance of opening the eye.
• Tears from the eye.
• Scarring and perforation of the eye.
• Inability to see.

Treatment of chemical burns of the eye should be done immediately even before medical help arrives. Open the eye and flush it with cool water for at least 10 minutes. Quickly flushing and diluting the chemical substance reduces the chance of permanent eye damage. Make sure to avoid contaminating the good eye by avoiding the contaminated water from falling into it. Hold a sterile pad across the eye until you arrive at the hospital where further treatment will be initiated as needed.

Bursts of flames or flash fires from explosives or stoves may cause injury to the eyes and the lids. Hot air or steam can burn the eyes as well as the face. First aid treatment for heat burns to the eyes or the area around the eye involve flushing the eye with cool water and seeking medical attention.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

Burns are one of the most devastating experiences an individual can have. Un- like having an illness or disease that has been diagnosed after a battery of tests and examinations, no one expects to suffer a burn. Who expects the cold water to turn boiling hot without warning while taking a shower? Who would imagine that an old woman scalds herself in the bath tub resulting in a devastating injury which causes enormous physical and mental suffering? Who goes to sleep safe in their bed only to wake up in the midst of a blazing fire? Firemen face the risk of being burned every time they respond to a call. These are some of the real life stories witnessed by a retired Chaplain who has served in one of our nation's top metropolitan burn centers. She has witnessed the worst of the worst, the miracles of modern medicine, the incredible strength of the human spirit and the ability of the body to heal. She will share what she has learned, what she has seen, and what other burn survivors have gone through. You are invited to share your personal story as well.

It is important to determine the severity of the burn as this will determine the type of treatment that is necessary and where the burned patient should receive treatment. Minor burns may be treated at home or in a doctor's office. These are defined as first- or second-degree burns covering less than 15 percent of an adult's body or less than 10 percent of a child's body, or a third-degree burn on less than 2 percent BSA. Moderate burns should be treated at a hospital. These are defined as first- or second-degree burns covering 15 percent to 25 percent of an adult's body or 10 percent to 20 percent of a child's body, or a third-degree burn on 2 percent to 10 percent BSA. Critical, or major, burns are the most serious and should be treated in a specialized burn unit. These are defined as first- or second-degree burns covering more than 25 percent of an adult's body or more than 20 percent of a child's body, or a third-degree burn on more than 10 percent BSA. In addition, burns involving the hands, feet, face, eyes, ears, or genitals are considered critical.

NOTE: these are only guidelines. Classification of the type and extent of a burn should be done only by medical professionals. It is best to err on the side of caution and seek medical attention. What you may consider minor may in fact be severe.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

A burn is an injury to the tissue; it can be caused by heat, chemicals, electricity, radiation or friction.
Burns can be classified according to the depth of burn: first degree, second degree and third degree burns. It can also be classified into superficial partial thickness which is the first degree, deep partial thickness which is the second degree and the full thickness area which is the third degree burns.
The severity of burn is affected by many factors which are:

1. The degree (depth) of burned area: first, second and third degree burn.


2. The total body surface area (percentage) affected: burns are measured as a percentage of the total body surface area affected; one of the ways used is the rule of nines which divides the body into sections of 9 percent. This rule is adjusted for children and infants because they have a larger head and neck surface area and smaller limbs surface area.


3. Location of burn: there are certain areas in the body that require special care when they are affected, if the face is affected there will be a risk of breathing problems because of swelling and inflammation. If the hands and feet are affected there is a risk of having limitation of movement because of scarring. If the perineum (the area of the body extending from the anus to the genitals) is affected, there is a risk of having contractures (tightening of skin) and infection. Circumferential burn (one that goes around a finger, toe, arm, leg, neck, or chest) is considered more severe than a non circumferential one because it can have a tourniquet effect on circulation or breathing (compress the vessels or airways). Eye burns are also important as they may cause blindness.


4. The age of the person: toddler aged children have more damage to their skin than similar burns in older children and adults because they have thinner skin.


5. Associated injuries like fractures or pre-existing medical conditions like heart conditions and immune suppression.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

According to an article in the New England Journal of Medicine in December 2006, there was a 66 percent reduction in central-line associated blood stream infections after 67 hospitals in Michigan implemented a checklist developed by Peter Pronovost, M.D, Ph.D. Health and Human Services Secretary Kathleen Sebelius called on all hospitals across America to use the checklist to reduce central-line infections in ICUs by 75 percent over the next three years, this check list includes:

• Washing hands before and after examining a patient or inserting, replacing, accessing, repairing and dressing the catheter (line).
• Disinfecting the skin of the patient before inserting the catheter and during dressing changes.
• Maintaining aseptic technique by wearing a mask, cap, sterile gown, and a steril gloves when inserting the line.
• Avoiding placing the catheter in the groin because the groin area is hard to keep clean. A subclavian site is preferred.
• Removing unnecessary catheters.

Under new laws 27 states are disclosing infection rates or will have to while five years ago only four states did reported hospital infection rates.

Reporting infection rates in hospitals and making them public help people decide which hospital is better and which hospital to go to, therefore it is important to search and see whether or not your hospital provides information about its infection rate. In case your hospital's infection control rate is not good and you don't have the option of changing it then you, your family member should make sure that the hospital staff taking care of you are following measures necessary to prevent infection including washing the hands, using gloves, and using disinfectants. If a central line is needed, make sure that the staff is following the Pronovost checklist. You also play a role in reducing the chance of infection by following all the instructions given to you by your healthcare providers.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

A central venous line (central line, central venous catheter) is a long, thin, soft plastic tube that is introduced through a small cut in the skin into a large vein in the neck (internal jugular vein), arm ( arm vein), chest (subclavian vein) or groin (femoral vein). It is used to administer fluids, blood products, nutrients and medications over an extended period of time.

A central venous line is often placed in patients who require care in the intensive care unit to provide nutrition, medication and fluids. Infection can be one of the complications associated with the use of a central venous catheter. Blood stream infection can happen when bacteria and/or fungi enter the blood stream. Other complications may include bleeding, pain, blockage, kinking or shifting of the catheter, air embolism and lung collapse.

As the central venous line is introduced through an opening in the skin, bacteria can grow in this line making the patient more susceptible for blood born infection. Infections associated with a central venous line can be very serious as the bacteria causing these infections can multiply and spread quickly to the entire blood stream causing septicemia which can be fatal.

A Consumer Reports analysis of newly released data revealed that central line infections account for 15 percent of all hospital infections but are responsible for at least 30 percent of the 99000 annual hospital-infection-related deaths according to the best estimates available. Hospitals that are following simple hygienic steps have virtually eliminated those infections but many others are failing to act. Research shows that putting the catheter in the subclavian vein is best for infection control.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

As the burn wound heals a scar will form. A scar is a fibrous tissue that will replace the normal tissue that was damaged by the burn injury. Depending on the severity of the injury a hypertrophic scar may form.

Scar massage can be used in the treatment of a hypertrophic scar in combination with other modalities of treatment. Scar massage can be started once the burn scar is mature enough to tolerate sheering forces, it stretches the scar and breaks down the fibrous bands, and this allows the scar to be more elastic and stretchy. Scar massage can also help in cases of contracture scars.

Heat and lubricants may be used with scar massage to increase tissue flexibility. It is found that scar massage can decrease itching and is also used for pain desensitization. Scar massage will be performed by your therapist, it may be painful in the beginning but with time your scar will become better and you will be happier. You and/or your family will be taught how to perform scar massage. Scar massage is performed twice or more a day (3-5 times is preferred). You have to follow the instructions given to you by your therapist who will frequently assess the condition of the scar and the progress of treatment.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

One of the life threatening complications of severe burns is acute renal (kidney) failure (ARF). ARF is a sudden loss of the kidney's ability to excrete waste, concentrate urine and conserve electrolytes.

According to a study done in Helsinki burn Center between 1988 and 2001, the mortality of ICU patients with ARF was 44.1% where as patients without ARF was only 6.9%. It is shown that the severity of the burn, the presence of smoke inhalational injury and the age of the patient are among the factors that play a role in the incidence of ARF. According to Holm and colleagues (Acute Renal Failure in Severely Burned Patients), if ARF occurs within the first 5 days after the burn injury it's early ARF, decrease blood pressure due to inadequate fluid replacement and the presence of myoglobin (muscle protein) in urine due to the destruction of muscle tissue as a result of burn, are common causes. If ARF occurs after 5 days of injury, it is late ARF; sepsis (severe infection spreading through the blood stream) is the most common cause.

ARF is treated with dialysis. As burns associated with ARF will worsen the prognosis, early preventive measures taken to reduce this complication include proper fluid replacement, infection prevention, early wound debridement, and excision of dead tissue.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

In April of 1984, Jerry White, lost his right leg in a landmine accident, he outlines in his book "I Will Not Be Broken" five steps to cope with disasters and achieve strength and hope.

1. You have to face the facts: a person must accept the facts and the reality that this thing has happened and you can't change it no matter what, you can't set the clock back to the time before that incident. Sometimes suffering results from attachment to ideas and things more than the loss itself.
2. Choosing to live: look at the future and say yes to it, look at your life and choose it to go in a positive way, don't surrender to what happened, let go of the resentment and look always forward and not backward.
3. Reaching out: after the incident there may come times of isolation and loneliness, break these times by reaching out to friends, family and people who have been through similar circumstances, don't wait for someone to reach you, it's up to you to reach to someone.
4. Get moving: take steps to move on with your life, step out of your house to generate motion, take responsibility for your actions, see what steps you can take to return back to your normal life.
5. Giving back: sharing your experience, skills and talents with others to inspire them to do the same. Survivors are in a special position to help and encourage others to heel and fulfill their potential. With the right support all survivors can heal and thrive. Ralph Waldo Emerson said "It's one of the most beautiful compensations of life that no man can sincerely try to help another without helping himself."

From the book "I Will Not Be Broken" by Jerry White

Survivor X was setting into his new work as an aid worker in Rwanda. His team was held hostage and shot by insurgent. He was the only one who survived after losing three of his colleagues. In order to save his life, his leg had to be amputated above the knee. He says that looking at the mirror and seeing himself different from before was one of the hardest things for him. He had to learn to be ok with who he was. He had to face the fact that he lost his leg and take care of the things that needed to be done.

Losing a body part was his worst fear in life as he says and it became true, but it wasn't so bad. His next worst fear was to learn to walk again and it wasn't that bad either. He found that life wasn't that bad and he had the courage to laugh after facing his fears.