Introduction

Accurate assessment of burn depth on admission is important in making decisions about dressings and surgery. However, the burn wound is a dynamic living environment that will alter depending on both intrinsic factors (such as release of inflammatory mediators, bacterial proliferation) and extrinsic factors (such as dehydration, systemic hypotension, cooling). It is therefore important to review the wound at regular intervals until healing.

Optimum treatment of the wound reduces morbidity and, in larger injuries, mortality. It also shortens the time for healing and return to normal function and reduces the need for secondary reconstruction.

When epithelialisation is delayed beyond three weeks, the incidence of hypertrophic scarring rises. Hypertrophic scars occur in 60% of burnt children aged under 5 years. Early grafting of those burns that have not healed at three weeks has been shown to improve the result, but because of delays in the referral process, all injuries, which show no sign of healing by 10 days, should be referred for assessment.

Flame injury showing all burn depths

Treatment