Practice ABC of wound healing

Burns

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7542.649 (Published 16 March 2006) Cite this as: BMJ 2006;332:649

This article has a correction. Please see:

  1. Alex Benson, specialist registrar in plastic surgery,
  2. William A Dickson, consultant burns and plastic surgeon,
  3. Dean E Boyce, consultant hand and plastic surgeon
  1. Mersey Regional Plastic Surgery Unit, Whiston Hospital, Liverpool
  2. Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea.

    About 250 000 people are burnt each year in the United Kingdom. Of these, almost 112 000 attend an accident and emergency department and about 210 die of their injuries. At least 250 000 others attend their general practitioner for treatment of their injury. A burn results in loss of epidermal integrity of the skin; this article discusses the aetiology and management of various types of burn injury.

    View this table:

    Aetiology of burn injuries (percentage)

    Mechanisms of burn

    Thermal injury

    Flame—Accelerants such as petrol, lighter fluid, or natural gas are often involved. The depth of flame burn is typically full or partial thickness.


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    Clockwise from top left: Full thickness flame burn to the right arm, torso, and face and neck (not shown); “pull over” scald (hot tea) to a toddler; flash burn and erythema to face (note sparing of skin creases); full thickness contact burn (patient was alcoholic and fell unconscious against a portable heater)


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    Scald—60% of burns in children are from scalds. Non-accidental injury is rare but should be considered if there are delays in presentation, inconsistencies in history, or an unusual pattern of injury.

    Contact—Contact burns often present as small burns on extremities, but they can be serious in those not able to remove themselves from the source of injury, such as elderly people, children, disabled people, and those incapacitated by drugs, alcohol, fit, or faint.

    Flash—Flash burns are usually to the face and upper limbs and are caused by an explosive ignition of a volatile substance. They are often due to use of accelerants to light a fire or gas explosions.

    Electrical injury

    Low voltage—The energy imparted from 240 V usually gives a deep burn in the form of a small entry and exit wound. Such burns are commonly seen on the hands. If alternating current crosses the myocardium, arrhythmias may …

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