Managing blisters is an important aspect of burn wound treatment. There are different approaches depending on the condition of the blisters.

Intact blisters

Most guidelines and studies suggest de-roofing the blister. De-roofing provides some pain relief. It also allows you to assess the burn wound adequately; sometimes a deep dermal partial thickness burn can be hidden under the vesicles of the blister.

However, in some cases it may be better to leave the blister intact. For example, you can leave small blisters (<6mm) that do not cause any discomfort intact.

Snip-open procedure

In settings where resources are limited and modern dressings are not available, the snip-open procedure may be an alternative to de-roofing.

To perform the procedure, snip the blister open and leave the walls to drop down and cover the area of raw skin underneath.

Re-evaluate the treatment strategy daily. A change in treatment may be necessary depending on the outcome of the burn wound (re)assessment.

Ruptured blisters

Remove large areas of loose tissue where blisters have ruptured using gauzes and/or sterile scissors or forceps.

Dressing the wound

1 When a blister is intact, apply a dry bandage to protect the wound or leave it open.

When wounds are dirty or contaminated, or in the case of late admission (>24 hours post-injury), change dressings more frequently.

2 After de-roofing a blister, first re-establish the depth of the burn. Next, treat the wound according to the depth.

Apply a membranous dressing like human allograft skin or an amniotic membrane (biological dressing) or a synthetic dressing (Aquacel, Suprathel or alginate wound coverings). Many of these dressings can be left on the wound until healing is complete.

3 For deep partial thickness wounds, or if you cannot establish the depth of the wound, Choose a topical antiseptic such as silversulfadiazine cream or Fucidin ointment. These wound coverings must be changed daily.

4. For mixed depth wounds, choose a dressing according to the deepest part of the wound.

5. After a snip-open procedure, the walls of the blister function as a ‘biological dressing’. On top of this, apply a Vaseline gauze followed by a bulky dressing or bandage. Leave this dressing in place until soaked, or until the ‘sniff test’ indicates an offensive smell. Continue in this fashion until healing is completed, up to a maximum duration of one week. After one week, if the wound has not completely healed, de-roof the blisters and dress accordingly.