Conservative treatment for specific burn areas
The location of the burn wound is an important factor in how to approach conservative treatment. This page summarizes the specific considerations for burns to different parts of the body.
Patient comfort is important when treating facial burns. Vaseline is often used for superficial burns. For patient comfort, treat deeper facial burns with Cerium Nitrate–Silver Sulfadiazine (Ce-SSD).
Upon admission, start by rinsing the burn wound with water and subsequently apply Ce-SSD (within 24 hours of injury) once daily, for at least 48 hours (maximum 72 hours) post-injury. Following this, wash the wound daily with chlorhexidine (or running water), rinse with running water and leave the wound open until healed or treated surgically. If Ce-SSD is not available, use Silver Sulfadiazine. However, this has more disadvantages for the patient. For example, when using Silver Sulfadiazine, a full daily dressing change is required, which is less comfortable for the patient.
Ear and nose
During the daily dressing change, remove all topical agents and apply a proper dressing to prevent the cartilage from drying out and to prevent chondritis. It is most important to minimize pressure on the ear when treating these wounds.
Irrigate chemical burns with copious amounts of running water. When burns surround the eye, use an eye ointment to prevent the eye from becoming dry. Keep other topical agents and bandage materials clear of the eyes.
Leave any crusts around the mouth intact to prevent discomfort, bleeding, infection and scarring. For burns on the lips, use Vaseline frequently to prevent crust formation.
Burns of the scalp require special attention. The skin over the scalp is thick, has multiple epithelial layers in the hair follicles, including deep matrixes, and has a rich blood supply. Therefore, even deep dermal partial thickness burns have good healing potential.
However, hair follicles may harbor a large bacterial load that can cause infection and delay spontaneous wound healing. Therefore, prevention of infection and prevention of scab formation are key to allowing uncomplicated wound healing.
In order to fully expose the burn, shave all the hairs of the scalp fully as this will reveal hidden burns, so you can evaluate the extent and depth of the burn. To shave the scalp, use a fresh, simple, disposable razor blade. Apply a local antiseptic, such as SSD, to keep the wound moist.
If the burn wound is neglected or contaminated, the preferred agent to treat (neglected) deep dermal partial thickness burns of the scalp is Eusol in Paraffin, as this reduces the invasion of the wound by commensal bacteria from the hair follicles.
During every dressing change, clean the wound extensively.
SSD causes hypergranulation when used for more than a week, so after about 7 days, use a different local antiseptic, such as povidone-iodine. Continue to shave the scalp carefully on a weekly basis.
In cases of delayed referral with an infected scalp burn, hypergranulation and/or scab formation, clean the wound thoroughly. The patient may require sedation or even general anesthesia, as all hairs and granulation tissue must be removed. Once you have cleaned the wound extensively, administer the initial treatment with daily application of Eusol, replaced later on with a local antiseptic such as povidone-iodine.
Limit the use of dressings to allow movement of the neck and prevent stiffness. Apply a soft collar to prevent contracture formation. Ensure that both the head and neck are positioned in a neutral position, for example by not using a pillow in bed.
Create a T-shirt-like dressing to prevent the dressing from moving and becoming loose. Use thin wound-dressing material to enable adequate breathing and movement.
Due to gravity, breasts have continuous traction on them, which delays wound healing. Therefore the breasts should be supported with a bra-like dressing to reduce traction.
Upper extremities and shoulders
Limit the use of dressings over joints to allow movement and prevent stiffness. During the day this permits exercise, and during the night splints can be applied. Elevate limbs to prevent the formation of edema.
In the case of (semi-)circumferential burns, leave the fingertips uncovered in order to evaluate capillary refill. This is especially important during the first 24 hours post-injury. Limit the use of dressings over joints to allow movement and prevent stiffness.
Dress each digit separately with a Vaseline gauze and the preferred topical agent. However, if this is not feasible, for example in small children, apply a dressing to each digit and then make a wand-like dressing. Always leave the thumb free to enable movement and prevent stiffness.
In some cases, you may choose to wrap the hand in a plastic bag with ointment, enabling movement. This technique helps to avoid the use of a tight dressing, especially in the first few days post-injury.
Always elevate the hands (and arms if they are included in the burn injury) by placing them on a pillow, to reduce edema formation.
Burns of the genital area are prone to infection, therefore use a semi-open dressing technique and change the dressing when soaked. For children, put the dressing into a diaper – no further fixation is required. If the burn impedes urinary flow, place a urinary catheter.
Limit the use of dressings to allow movement and prevent stiffness, and apply a splint during the night to prevent contracture formation.
Burns of the feet are prone to infection, as not all patients wear shoes and socks to keep the dressing clean. Ask the patient to wear shoes or sandals, or provide a plastic bag once the wound has been dressed. Apply a Vaseline gauze, with the preferred topical agent, between each digit to prevent them from sticking together. Limit the use of dressings over joints to allow movement and prevent stiffness.