Cleaning and debridement of burn wounds
Cleaning and debridement are essential aspects of burn wound treatment. Whether performed at the emergency room or later in the treatment process, they prevent infection and facilitate wound healing.
Before you start, ensure the patient’s pain is managed properly.
First, clean the burn wound. This is commonly done using a hand-held shower head to remove dirt gently through irrigation and wiping. The aim is to remove loose, dead skin and other dirty elements that may adhere to the wound, such as dust and remnants from previous topical treatment.
What is debridement?
Debridement is the medical removal of dead, damaged, or infected tissue. It is also a form of cleaning, specifically ‘medical cleaning’. It may involve specific medical techniques, which can be:
- Enzymatic (e.g. Nexobrid)
- Biological (e.g. maggot therapy)
This is the conservative mechanical removal of loose material without the use of sharp surgical tools or other techniques. It involves removing the dead tissue, which has already been loosened by autolytic processes, by gentle rubbing with gauzes soaked in diluted aqueous chlorhexidine (0.1/0.2%), 0.9% saline or soap and water. Do not use alcohol-based solutions.
You can use mechanical debridement to support dermal burns to heal by themselves.
Full thickness burns require grafting. If feasible, early surgical debridement and grafting is recommended. However, when early surgical escharectomy is not possible, you can remove the entire eschar by daily soaking, gentle rubbing and rinsing. This may take as long as two to three weeks and should be followed by delayed grafting when the burn wounds and the general condition of the patient are fit for surgery.
In burn surgery, an escharectomy is a debridement in which the eschar (the dead skin in a full thickness burn) is removed surgically until a healthy wound bed is achieved. This can be done with a scalpel, electrosurgery or hydrosurgery.
You should perform surgical debridement in the operating theatre with adequate anesthesia.
Escharectomy is recommended for deep burns at an early stage, after the burn injury grafting, during the same procedure. In specific situations, such as in resource-constrained settings, the escharectomy is not performed at an early stage and/or may not be followed by immediate skin grafting. The skin grafting may be delayed until the patient is in a better condition.