Surgery in pediatric burn patients is a significant component of burn care that has the overall goal of eliminating or reducing burn morbidity, maximizing functional recovery, and thus, patients’ quality of life of children with burn injuries. Burns can be differentiated from superficial partial thickness to total thickness and depth, and the management depends on severity, depth, the age of the child, and comorbidities.
Accidents remain the major killer of children and are responsible for more deaths than all other causes put together. Pediatric population is particularly vulnerable to thermal injuries, burns constituting the fifth most frequent cause of non-fatal childhood injuries and third most frequent cause of pediatric accidental deaths. Burke et al reported in 2000 that there were direct costs only for managing pediatric burn that was more than 211 million US dollars.
Epidemiology
Incidence:
The rate of burn injury in children is not constant globally with low- and middle-income countries presented higher rates of the condition on average. Some causes are scalds, flammable liquid or gases, contacting burns, electrical burns, and burns due to chemicals.
Burns in children are primarily because of domestic accidents associated with hot fluids, fire, hot objects, and electrical equipment.
Age Distribution:
children below five years are more prone to the burns. This is because they are explorer, lack alertness, and have poor defence mechanisms over their bodies.
Anatomy
Pathophysiology
Burns can originate from heat, paper, chemicals, electrical sources, radiation, and other related sources.
Burns cause an immediate denaturation of proteins which leads to destruction of the cell and the skin, this makes the skin to become permeable to fluid and electrolyte.
Inflammation of tissues starts, cytokines are released, and immune cells are attracted to the site of burns.
Burn causes alterations in blood vessels; permeability increases, and fluid moves from the vascular space to the interstitial space.
Patients with extensive burns are affected by Systemic effects that manifests itself through a hypermetabolic state and muscle mass.
Burns lead to massive loss of fluids through the affected area and as such, hypovolemia and shock can occur thus the need for fluid replacement.
Wound healing has three phases, these are inflammatory, proliferative, and remodeling, on most occasions, debridement is used in removal of necrotic tissues.
Debridement involves cutting out part of the skin and muscle to avoid infection and obtain good grafting.
Essentially, skin grafting transplants healthy skins whereby skin functions as a protective barrier to enhance the patients healing and appearance.
Scar formation, when done surgically is planned technique to reduce the scar tissue and improve the scar healing.
Etiology
Scalds: Scalds by boiling water or oil splashes due to accidents in the kitchen or at home.
Flame Burns: Scalds from hot liquid, water, or steam from kettles or heated vessels, from hot surfaces or interfaces such as stove-top, electric heaters, fireplaces, or heaters.
Contact Burns: Scalding from hot liquids, contact with hot objects, and touching hot surfaces such as stoves or irons.
Electrical Burns: Scalds from a hot water tap or any hot and portable equipment.
Chemical Burns: Injury from exposure to hot water, corrosive materials such as detergents, spirits, or when somebody slips while handling acids.
Radiation Burns: Skin injuries occurring because of exposure to ultraviolet radiation, most often sunlight.
Hot Objects: Injuries from spilling hot liquids and contact with hot surfaces such as hot pots, pans or utensils with bare hands.
Child Abuse: Such types of burns occur deliberately and have a fireplace pattern.
Scalds from Steam or Hot Substances: Injuries from scalds or contact with hot water or any hot substance in the pot.
Fireworks or Fire-Related Incidents: Scalds from fireworks, matches, or other unsafe fire-related activities.
Genetics
Prognostic Factors
Burn Depth: The depth of burn injury can vary with concern being made between first to third degree burns.
Total Body Surface Area (TBSA) Affected: The degree of burn area needed for the body is very essential for the prediction of the condition of the patient.
Age of the Child: Physiological factors make young children especially the infants to be at a higher risk than the older ones.
Associated Inhalation Injury: The conditions arising from any inhalation of smoke or hot gases have an impact on prognosis.
Clinical History
Age Group:
Infants and Toddlers:
Hot liquid burns and Scald burns are frequent.
Scalds on hands and lower limbs from stove and boiling water.
The evaluation depends on the caregivers’ information and physical examination because the child cannot use spoken language.
School-Aged Children:
Higher chance to suffer flame burns, including from fire or filtrates from playing with fireworks.
Possible burns while cooking or during any burning experiment or with any of the domestic articles.
Adolescents:
Burn hazards from hot utensils and other kitchen use, as well as hot and flammable materials.
Physical Examination
Primary Survey
Airway
Breathing
Circulation
Disability
Exposure/Environment
Secondary Survey
General Appearance
Skin Examination
Head and Neck
Eyes
Ears
Oral Cavity
Neck
Chest and Abdomen
Back
Extremities
Hands and Feet
Neurovascular Assessment
Age group
Associated comorbidity
Respiratory Conditions
Malnutrition
Neurological Conditions
Associated activity
Acuity of presentation
Acute Presentation:
Recent burn injury with signs of inflammation.
Acute pain, redness, and blistering.
Delayed Presentation:
Older burns with signs of inadequate wound healing, infection, or scarring.
Potential complications like contractures or hypertrophic scars.
Differential Diagnoses
Burn Depth
Inhalation Injury
Infection
Compartment Syndrome
Hypertrophic Scarring
Joint Contractures
Nutritional Deficiencies
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Emergency Assessment and Stabilization: Assessment involving Airway and Breathing assessment, suction if necessary; circulation check, intubation if required; IV volume expansion in cases of severe burn cases.
Initial Burn Wound Care: Utilize dry sterile gauze, do not attempt to utilize wet gel packs or moist sterile towels, and do not allow the patient to become too cold to keep initiating hypothermia.
Assessment and Documentation: Contiguous history of the burn, a general physical examination, and concomitantly, evaluate the depth and spread of the burn; quantify the overall TBSA involved.
Medical Management: Relief of pain, nutritional management, and aseptic techniques in wound care.
Surgical Intervention: Burn excision and grafting for full thickness burns or deep second-degree burns.
Postoperative Care: Focus on complications, physical and occupational therapy, and counseling.
Scar Management: If necessary, surgeries of the scarred zones, skin dermo pressing using silicone sheeting, and pressure garments.
Long-Term Follow-up: Follow up visits for scar assessment, psychiatric, and or developmental checkup.
Reconstructive Procedures: If the condition was chosen as functional or aesthetic, consider for renewal.
Psychological Support: Through play to cooperate or convey feelings and the child’s concerns in burns patients; art and music to divert the child’s focus and to use them as tools to explain their feeling during recovery process.
Wound Care: Wound soaking and rinse in water therapy; the use of cold-water application in the treatment of pain and inflammation.
Physical Therapy: Daily exercises to keep joints mobile and functional to erase impairment in burn patients.
Nutritional Support: Provision of sufficient nutrition for development of tissue and enhance the immune system.
Education for Caregivers: Teaching wound care and infection signs will enable ensuring activities during the recovery process.
Assistive Devices: Specific orthoses for mobile support depend on the degree of burns.
Social Support: Peer programs for the provision of emotional support and combating loneliness in child burn survivors.
Scar Management: Pressure garments to prevent scarring by putting pressure on areas affected by the burn.
Environmental Modifications: They used to set temperatures to make the patients feel comfortable and improve on their healing process.
Role of Analgesics and Opioid Analgesics in Pain Management
Non opioid analgesics
Acetaminophen (Tylenol): An NSAID with actions in the CNS to antagonize prostaglandin synthesis; given for mild to moderate pain and fever.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Blocks COX enzymes to decrease prostaglandin synthesis; used for pain, inflammation, fever.
Opioid Analgesics:
Codeine and Tramadol: Codeine is metabolised to morphine and tramadol influences opioid receptors and serotonin/noradrenaline reabsorption for analgesia.
Advanced Wound Agents in Transforming Pediatric Burn Surgery
Growth Factors:
Epidermal Growth Factor (EGF): Causes skin to build new cells and create new tissue to replace skin tissue that has been damaged, which also aids in the rapid healing of wounds.
Platelet-Derived Growth Factor (PDGF): Promotes cells proliferation and angiogenesis, in clinical treatment it used in enhancing the healing of tissues in burn patients.
Collagen-Based Dressings: Maintain a moist wound environment, replicate the natural extracellular matrix, and serve as a scaffold for tissue regeneration.
Silver-containing Dressings: Utilize silver for its antimicrobial efficiency in prevention and remedy of infection in wounds that are burned.
Enzymatic Debridement Agents (Collagenase): Help to degrade necrotic tissue to prepare better wound beds and promote healing.
Negative Pressure Wound Therapy (NPWT) or Vacuum-Assisted Closure (VAC) Therapy: Utilizes sub-atmospheric pressure on the intended wound site, which effectively helps to decrease edema, enhance circulation and contribute to tissue deposition, this is useful in the treatment of complex burn injuries.
Role of Antibiotics for Surgical Treatment of Burns in Children
Broad-spectrum antibiotics cover a broad spectrum of bacteria when infection is suspected or confirmed.
Topical antibiotics for example silver sulfadiazine are used to be applied directly on the burn surfaces to inhibit bacterial reproduction and consequent burn infection.
Role of Anti-scarring Agents for Surgical Treatment of Burns in Children
Pressure Garments: Using pressure treatment methods, the scars become less raised and less complicated.
Silicone-based Products: Create a barrier over scars to maintain hydration and improve elasticity.
Corticosteroids: Impair collagen synthesis and inflammation in scar tissues but the use in children is limited.
Onion Extract (Allium cepa): Anti-inflammatory may help to thin the scar and decrease the degree of pigmentation.
Vitamin E: It is believed that with the help of antioxidant effect, one can enhance collagen remodelling to eradicate the problem of scaring.
Massage therapy: Increase tissue flexibility, increase circulation, and break down scar tissue.
Laser therapy: To treat scars, it targets blood vessels, reduces redness, and promotes collagen remodeling.
Wound Debridement: Removing dead or damaged tissue from burn wounds promotes healing, creates a clean wound bed, reduces infection risk, and aids in applying treatments or dressings.
Skin Grafting: Transplanting skin from one body area to cover burn wounds helps close wounds, minimize scarring, and improve appearance and function.
Escharotomy or Fasciotomy: Incising through dead tissue or fascia relieves pressure, enhances blood circulation, and treats circumferential burns to prevent complications like compartment syndrome.
Scar Revision Surgery: Surgical modification of scars improves appearance and function through techniques like excision, rearrangement, or grafting.
Nerve Decompression: Surgically releasing trapped nerves or scar tissue improves pain and sensory function in areas affected by burn scars.
Acute or Early Phase: Focuses approaches on wound evaluation, infection control, and early surgery.
Determine the degree and areas that have been burned.
There should be a practice of initial cleaning of any wound in the patients to remove any dead tissue.
Use relevant antiseptics on an area to avoid getting infected.
Perform necessarily surgery like excision and grafting for major burn injuries.
Surgery should be done to release the constricting dressing for circumferential burn.
Intermediate or Reconstructive Phase: It entails complex surgeries in a bid to achieve the best result concerning wound healing and functional outcomes.
Do the skin grafting for more significant injuries that require the technique.
Scar revision surgery to enhance the aesthetic feel of the area and overall functionality of tissue.
It is recommended to perform nerve decompression for patients suffering from severe pain. Rehabilitative or Long-Term Phase: Focuses on curative, restorative and also, on psychosocial care.
Administer exercises on physical therapy to enable the patient to bend their legs again.
Additionally, care for scars should be made by using pressure garments, silicone goods and anti-scarring agents.
Offer counseling to the child and the family especially when they are going through some problems. Follow-up and Maintenance Phase: This also entails follow up intervention since some complications may develop later and total patient health could remain fragile for a long time.
Make scar assessment visits with the patients frequently.
Ensure that the patients receive further rehabilitation services if and when required.
Inform and encompass the child and family in long-term care.
Thus, to enhance patient care experiences and provide late complication check-ups, the following strategies are recommended.
»
Home » CAD » Surgical Treatment of Burns in Children
Surgical Treatment of Burns in Children
Updated :
July 11, 2024
Surgery in pediatric burn patients is a significant component of burn care that has the overall goal of eliminating or reducing burn morbidity, maximizing functional recovery, and thus, patients’ quality of life of children with burn injuries. Burns can be differentiated from superficial partial thickness to total thickness and depth, and the management depends on severity, depth, the age of the child, and comorbidities.
Accidents remain the major killer of children and are responsible for more deaths than all other causes put together. Pediatric population is particularly vulnerable to thermal injuries, burns constituting the fifth most frequent cause of non-fatal childhood injuries and third most frequent cause of pediatric accidental deaths. Burke et al reported in 2000 that there were direct costs only for managing pediatric burn that was more than 211 million US dollars.
Incidence:
The rate of burn injury in children is not constant globally with low- and middle-income countries presented higher rates of the condition on average. Some causes are scalds, flammable liquid or gases, contacting burns, electrical burns, and burns due to chemicals.
Burns in children are primarily because of domestic accidents associated with hot fluids, fire, hot objects, and electrical equipment.
Age Distribution:
children below five years are more prone to the burns. This is because they are explorer, lack alertness, and have poor defence mechanisms over their bodies.
Burns can originate from heat, paper, chemicals, electrical sources, radiation, and other related sources.
Burns cause an immediate denaturation of proteins which leads to destruction of the cell and the skin, this makes the skin to become permeable to fluid and electrolyte.
Inflammation of tissues starts, cytokines are released, and immune cells are attracted to the site of burns.
Burn causes alterations in blood vessels; permeability increases, and fluid moves from the vascular space to the interstitial space.
Patients with extensive burns are affected by Systemic effects that manifests itself through a hypermetabolic state and muscle mass.
Burns lead to massive loss of fluids through the affected area and as such, hypovolemia and shock can occur thus the need for fluid replacement.
Wound healing has three phases, these are inflammatory, proliferative, and remodeling, on most occasions, debridement is used in removal of necrotic tissues.
Debridement involves cutting out part of the skin and muscle to avoid infection and obtain good grafting.
Essentially, skin grafting transplants healthy skins whereby skin functions as a protective barrier to enhance the patients healing and appearance.
Scar formation, when done surgically is planned technique to reduce the scar tissue and improve the scar healing.
Scalds: Scalds by boiling water or oil splashes due to accidents in the kitchen or at home.
Flame Burns: Scalds from hot liquid, water, or steam from kettles or heated vessels, from hot surfaces or interfaces such as stove-top, electric heaters, fireplaces, or heaters.
Contact Burns: Scalding from hot liquids, contact with hot objects, and touching hot surfaces such as stoves or irons.
Electrical Burns: Scalds from a hot water tap or any hot and portable equipment.
Chemical Burns: Injury from exposure to hot water, corrosive materials such as detergents, spirits, or when somebody slips while handling acids.
Radiation Burns: Skin injuries occurring because of exposure to ultraviolet radiation, most often sunlight.
Hot Objects: Injuries from spilling hot liquids and contact with hot surfaces such as hot pots, pans or utensils with bare hands.
Child Abuse: Such types of burns occur deliberately and have a fireplace pattern.
Scalds from Steam or Hot Substances: Injuries from scalds or contact with hot water or any hot substance in the pot.
Fireworks or Fire-Related Incidents: Scalds from fireworks, matches, or other unsafe fire-related activities.
Burn Depth: The depth of burn injury can vary with concern being made between first to third degree burns.
Total Body Surface Area (TBSA) Affected: The degree of burn area needed for the body is very essential for the prediction of the condition of the patient.
Age of the Child: Physiological factors make young children especially the infants to be at a higher risk than the older ones.
Associated Inhalation Injury: The conditions arising from any inhalation of smoke or hot gases have an impact on prognosis.
Age Group:
Infants and Toddlers:
Hot liquid burns and Scald burns are frequent.
Scalds on hands and lower limbs from stove and boiling water.
The evaluation depends on the caregivers’ information and physical examination because the child cannot use spoken language.
School-Aged Children:
Higher chance to suffer flame burns, including from fire or filtrates from playing with fireworks.
Possible burns while cooking or during any burning experiment or with any of the domestic articles.
Adolescents:
Burn hazards from hot utensils and other kitchen use, as well as hot and flammable materials.
Primary Survey
Airway
Breathing
Circulation
Disability
Exposure/Environment
Secondary Survey
General Appearance
Skin Examination
Head and Neck
Eyes
Ears
Oral Cavity
Neck
Chest and Abdomen
Back
Extremities
Hands and Feet
Neurovascular Assessment
Respiratory Conditions
Malnutrition
Neurological Conditions
Acute Presentation:
Recent burn injury with signs of inflammation.
Acute pain, redness, and blistering.
Delayed Presentation:
Older burns with signs of inadequate wound healing, infection, or scarring.
Potential complications like contractures or hypertrophic scars.
Burn Depth
Inhalation Injury
Infection
Compartment Syndrome
Hypertrophic Scarring
Joint Contractures
Nutritional Deficiencies
Emergency Assessment and Stabilization: Assessment involving Airway and Breathing assessment, suction if necessary; circulation check, intubation if required; IV volume expansion in cases of severe burn cases.
Initial Burn Wound Care: Utilize dry sterile gauze, do not attempt to utilize wet gel packs or moist sterile towels, and do not allow the patient to become too cold to keep initiating hypothermia.
Assessment and Documentation: Contiguous history of the burn, a general physical examination, and concomitantly, evaluate the depth and spread of the burn; quantify the overall TBSA involved.
Medical Management: Relief of pain, nutritional management, and aseptic techniques in wound care.
Surgical Intervention: Burn excision and grafting for full thickness burns or deep second-degree burns.
Postoperative Care: Focus on complications, physical and occupational therapy, and counseling.
Scar Management: If necessary, surgeries of the scarred zones, skin dermo pressing using silicone sheeting, and pressure garments.
Long-Term Follow-up: Follow up visits for scar assessment, psychiatric, and or developmental checkup.
Reconstructive Procedures: If the condition was chosen as functional or aesthetic, consider for renewal.
Prevention and Education: Learn and teach about burn prevention and make support resources available to the public consistently.
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Psychological Support: Through play to cooperate or convey feelings and the child’s concerns in burns patients; art and music to divert the child’s focus and to use them as tools to explain their feeling during recovery process.
Wound Care: Wound soaking and rinse in water therapy; the use of cold-water application in the treatment of pain and inflammation.
Physical Therapy: Daily exercises to keep joints mobile and functional to erase impairment in burn patients.
Nutritional Support: Provision of sufficient nutrition for development of tissue and enhance the immune system.
Education for Caregivers: Teaching wound care and infection signs will enable ensuring activities during the recovery process.
Assistive Devices: Specific orthoses for mobile support depend on the degree of burns.
Social Support: Peer programs for the provision of emotional support and combating loneliness in child burn survivors.
Scar Management: Pressure garments to prevent scarring by putting pressure on areas affected by the burn.
Environmental Modifications: They used to set temperatures to make the patients feel comfortable and improve on their healing process.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Non opioid analgesics
Acetaminophen (Tylenol): An NSAID with actions in the CNS to antagonize prostaglandin synthesis; given for mild to moderate pain and fever.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Blocks COX enzymes to decrease prostaglandin synthesis; used for pain, inflammation, fever.
Opioid Analgesics:
Codeine and Tramadol: Codeine is metabolised to morphine and tramadol influences opioid receptors and serotonin/noradrenaline reabsorption for analgesia.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Growth Factors:
Epidermal Growth Factor (EGF): Causes skin to build new cells and create new tissue to replace skin tissue that has been damaged, which also aids in the rapid healing of wounds.
Platelet-Derived Growth Factor (PDGF): Promotes cells proliferation and angiogenesis, in clinical treatment it used in enhancing the healing of tissues in burn patients.
Collagen-Based Dressings: Maintain a moist wound environment, replicate the natural extracellular matrix, and serve as a scaffold for tissue regeneration.
Silver-containing Dressings: Utilize silver for its antimicrobial efficiency in prevention and remedy of infection in wounds that are burned.
Enzymatic Debridement Agents (Collagenase): Help to degrade necrotic tissue to prepare better wound beds and promote healing.
Negative Pressure Wound Therapy (NPWT) or Vacuum-Assisted Closure (VAC) Therapy: Utilizes sub-atmospheric pressure on the intended wound site, which effectively helps to decrease edema, enhance circulation and contribute to tissue deposition, this is useful in the treatment of complex burn injuries.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Broad-spectrum antibiotics cover a broad spectrum of bacteria when infection is suspected or confirmed.
Topical antibiotics for example silver sulfadiazine are used to be applied directly on the burn surfaces to inhibit bacterial reproduction and consequent burn infection.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Pressure Garments: Using pressure treatment methods, the scars become less raised and less complicated.
Silicone-based Products: Create a barrier over scars to maintain hydration and improve elasticity.
Corticosteroids: Impair collagen synthesis and inflammation in scar tissues but the use in children is limited.
Onion Extract (Allium cepa): Anti-inflammatory may help to thin the scar and decrease the degree of pigmentation.
Vitamin E: It is believed that with the help of antioxidant effect, one can enhance collagen remodelling to eradicate the problem of scaring.
Massage therapy: Increase tissue flexibility, increase circulation, and break down scar tissue.
Laser therapy: To treat scars, it targets blood vessels, reduces redness, and promotes collagen remodeling.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Wound Debridement: Removing dead or damaged tissue from burn wounds promotes healing, creates a clean wound bed, reduces infection risk, and aids in applying treatments or dressings.
Skin Grafting: Transplanting skin from one body area to cover burn wounds helps close wounds, minimize scarring, and improve appearance and function.
Escharotomy or Fasciotomy: Incising through dead tissue or fascia relieves pressure, enhances blood circulation, and treats circumferential burns to prevent complications like compartment syndrome.
Scar Revision Surgery: Surgical modification of scars improves appearance and function through techniques like excision, rearrangement, or grafting.
Nerve Decompression: Surgically releasing trapped nerves or scar tissue improves pain and sensory function in areas affected by burn scars.
Anesthesiology
Dermatology, General
Pediatrics, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Acute or Early Phase: Focuses approaches on wound evaluation, infection control, and early surgery.
Determine the degree and areas that have been burned.
There should be a practice of initial cleaning of any wound in the patients to remove any dead tissue.
Use relevant antiseptics on an area to avoid getting infected.
Perform necessarily surgery like excision and grafting for major burn injuries.
Surgery should be done to release the constricting dressing for circumferential burn.
Intermediate or Reconstructive Phase: It entails complex surgeries in a bid to achieve the best result concerning wound healing and functional outcomes.
Do the skin grafting for more significant injuries that require the technique.
Scar revision surgery to enhance the aesthetic feel of the area and overall functionality of tissue.
It is recommended to perform nerve decompression for patients suffering from severe pain. Rehabilitative or Long-Term Phase: Focuses on curative, restorative and also, on psychosocial care.
Administer exercises on physical therapy to enable the patient to bend their legs again.
Additionally, care for scars should be made by using pressure garments, silicone goods and anti-scarring agents.
Offer counseling to the child and the family especially when they are going through some problems. Follow-up and Maintenance Phase: This also entails follow up intervention since some complications may develop later and total patient health could remain fragile for a long time.
Make scar assessment visits with the patients frequently.
Ensure that the patients receive further rehabilitation services if and when required.
Inform and encompass the child and family in long-term care.
Thus, to enhance patient care experiences and provide late complication check-ups, the following strategies are recommended.
Surgery in pediatric burn patients is a significant component of burn care that has the overall goal of eliminating or reducing burn morbidity, maximizing functional recovery, and thus, patients’ quality of life of children with burn injuries. Burns can be differentiated from superficial partial thickness to total thickness and depth, and the management depends on severity, depth, the age of the child, and comorbidities.
Accidents remain the major killer of children and are responsible for more deaths than all other causes put together. Pediatric population is particularly vulnerable to thermal injuries, burns constituting the fifth most frequent cause of non-fatal childhood injuries and third most frequent cause of pediatric accidental deaths. Burke et al reported in 2000 that there were direct costs only for managing pediatric burn that was more than 211 million US dollars.
Incidence:
The rate of burn injury in children is not constant globally with low- and middle-income countries presented higher rates of the condition on average. Some causes are scalds, flammable liquid or gases, contacting burns, electrical burns, and burns due to chemicals.
Burns in children are primarily because of domestic accidents associated with hot fluids, fire, hot objects, and electrical equipment.
Age Distribution:
children below five years are more prone to the burns. This is because they are explorer, lack alertness, and have poor defence mechanisms over their bodies.
Burns can originate from heat, paper, chemicals, electrical sources, radiation, and other related sources.
Burns cause an immediate denaturation of proteins which leads to destruction of the cell and the skin, this makes the skin to become permeable to fluid and electrolyte.
Inflammation of tissues starts, cytokines are released, and immune cells are attracted to the site of burns.
Burn causes alterations in blood vessels; permeability increases, and fluid moves from the vascular space to the interstitial space.
Patients with extensive burns are affected by Systemic effects that manifests itself through a hypermetabolic state and muscle mass.
Burns lead to massive loss of fluids through the affected area and as such, hypovolemia and shock can occur thus the need for fluid replacement.
Wound healing has three phases, these are inflammatory, proliferative, and remodeling, on most occasions, debridement is used in removal of necrotic tissues.
Debridement involves cutting out part of the skin and muscle to avoid infection and obtain good grafting.
Essentially, skin grafting transplants healthy skins whereby skin functions as a protective barrier to enhance the patients healing and appearance.
Scar formation, when done surgically is planned technique to reduce the scar tissue and improve the scar healing.
Scalds: Scalds by boiling water or oil splashes due to accidents in the kitchen or at home.
Flame Burns: Scalds from hot liquid, water, or steam from kettles or heated vessels, from hot surfaces or interfaces such as stove-top, electric heaters, fireplaces, or heaters.
Contact Burns: Scalding from hot liquids, contact with hot objects, and touching hot surfaces such as stoves or irons.
Electrical Burns: Scalds from a hot water tap or any hot and portable equipment.
Chemical Burns: Injury from exposure to hot water, corrosive materials such as detergents, spirits, or when somebody slips while handling acids.
Radiation Burns: Skin injuries occurring because of exposure to ultraviolet radiation, most often sunlight.
Hot Objects: Injuries from spilling hot liquids and contact with hot surfaces such as hot pots, pans or utensils with bare hands.
Child Abuse: Such types of burns occur deliberately and have a fireplace pattern.
Scalds from Steam or Hot Substances: Injuries from scalds or contact with hot water or any hot substance in the pot.
Fireworks or Fire-Related Incidents: Scalds from fireworks, matches, or other unsafe fire-related activities.
Burn Depth: The depth of burn injury can vary with concern being made between first to third degree burns.
Total Body Surface Area (TBSA) Affected: The degree of burn area needed for the body is very essential for the prediction of the condition of the patient.
Age of the Child: Physiological factors make young children especially the infants to be at a higher risk than the older ones.
Associated Inhalation Injury: The conditions arising from any inhalation of smoke or hot gases have an impact on prognosis.
Age Group:
Infants and Toddlers:
Hot liquid burns and Scald burns are frequent.
Scalds on hands and lower limbs from stove and boiling water.
The evaluation depends on the caregivers’ information and physical examination because the child cannot use spoken language.
School-Aged Children:
Higher chance to suffer flame burns, including from fire or filtrates from playing with fireworks.
Possible burns while cooking or during any burning experiment or with any of the domestic articles.
Adolescents:
Burn hazards from hot utensils and other kitchen use, as well as hot and flammable materials.
Primary Survey
Airway
Breathing
Circulation
Disability
Exposure/Environment
Secondary Survey
General Appearance
Skin Examination
Head and Neck
Eyes
Ears
Oral Cavity
Neck
Chest and Abdomen
Back
Extremities
Hands and Feet
Neurovascular Assessment
Respiratory Conditions
Malnutrition
Neurological Conditions
Acute Presentation:
Recent burn injury with signs of inflammation.
Acute pain, redness, and blistering.
Delayed Presentation:
Older burns with signs of inadequate wound healing, infection, or scarring.
Potential complications like contractures or hypertrophic scars.
Burn Depth
Inhalation Injury
Infection
Compartment Syndrome
Hypertrophic Scarring
Joint Contractures
Nutritional Deficiencies
Emergency Assessment and Stabilization: Assessment involving Airway and Breathing assessment, suction if necessary; circulation check, intubation if required; IV volume expansion in cases of severe burn cases.
Initial Burn Wound Care: Utilize dry sterile gauze, do not attempt to utilize wet gel packs or moist sterile towels, and do not allow the patient to become too cold to keep initiating hypothermia.
Assessment and Documentation: Contiguous history of the burn, a general physical examination, and concomitantly, evaluate the depth and spread of the burn; quantify the overall TBSA involved.
Medical Management: Relief of pain, nutritional management, and aseptic techniques in wound care.
Surgical Intervention: Burn excision and grafting for full thickness burns or deep second-degree burns.
Postoperative Care: Focus on complications, physical and occupational therapy, and counseling.
Scar Management: If necessary, surgeries of the scarred zones, skin dermo pressing using silicone sheeting, and pressure garments.
Long-Term Follow-up: Follow up visits for scar assessment, psychiatric, and or developmental checkup.
Reconstructive Procedures: If the condition was chosen as functional or aesthetic, consider for renewal.
Prevention and Education: Learn and teach about burn prevention and make support resources available to the public consistently.
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Psychological Support: Through play to cooperate or convey feelings and the child’s concerns in burns patients; art and music to divert the child’s focus and to use them as tools to explain their feeling during recovery process.
Wound Care: Wound soaking and rinse in water therapy; the use of cold-water application in the treatment of pain and inflammation.
Physical Therapy: Daily exercises to keep joints mobile and functional to erase impairment in burn patients.
Nutritional Support: Provision of sufficient nutrition for development of tissue and enhance the immune system.
Education for Caregivers: Teaching wound care and infection signs will enable ensuring activities during the recovery process.
Assistive Devices: Specific orthoses for mobile support depend on the degree of burns.
Social Support: Peer programs for the provision of emotional support and combating loneliness in child burn survivors.
Scar Management: Pressure garments to prevent scarring by putting pressure on areas affected by the burn.
Environmental Modifications: They used to set temperatures to make the patients feel comfortable and improve on their healing process.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Non opioid analgesics
Acetaminophen (Tylenol): An NSAID with actions in the CNS to antagonize prostaglandin synthesis; given for mild to moderate pain and fever.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Blocks COX enzymes to decrease prostaglandin synthesis; used for pain, inflammation, fever.
Opioid Analgesics:
Codeine and Tramadol: Codeine is metabolised to morphine and tramadol influences opioid receptors and serotonin/noradrenaline reabsorption for analgesia.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Growth Factors:
Epidermal Growth Factor (EGF): Causes skin to build new cells and create new tissue to replace skin tissue that has been damaged, which also aids in the rapid healing of wounds.
Platelet-Derived Growth Factor (PDGF): Promotes cells proliferation and angiogenesis, in clinical treatment it used in enhancing the healing of tissues in burn patients.
Collagen-Based Dressings: Maintain a moist wound environment, replicate the natural extracellular matrix, and serve as a scaffold for tissue regeneration.
Silver-containing Dressings: Utilize silver for its antimicrobial efficiency in prevention and remedy of infection in wounds that are burned.
Enzymatic Debridement Agents (Collagenase): Help to degrade necrotic tissue to prepare better wound beds and promote healing.
Negative Pressure Wound Therapy (NPWT) or Vacuum-Assisted Closure (VAC) Therapy: Utilizes sub-atmospheric pressure on the intended wound site, which effectively helps to decrease edema, enhance circulation and contribute to tissue deposition, this is useful in the treatment of complex burn injuries.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Broad-spectrum antibiotics cover a broad spectrum of bacteria when infection is suspected or confirmed.
Topical antibiotics for example silver sulfadiazine are used to be applied directly on the burn surfaces to inhibit bacterial reproduction and consequent burn infection.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Pressure Garments: Using pressure treatment methods, the scars become less raised and less complicated.
Silicone-based Products: Create a barrier over scars to maintain hydration and improve elasticity.
Corticosteroids: Impair collagen synthesis and inflammation in scar tissues but the use in children is limited.
Onion Extract (Allium cepa): Anti-inflammatory may help to thin the scar and decrease the degree of pigmentation.
Vitamin E: It is believed that with the help of antioxidant effect, one can enhance collagen remodelling to eradicate the problem of scaring.
Massage therapy: Increase tissue flexibility, increase circulation, and break down scar tissue.
Laser therapy: To treat scars, it targets blood vessels, reduces redness, and promotes collagen remodeling.
Anesthesiology
Dermatology, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Wound Debridement: Removing dead or damaged tissue from burn wounds promotes healing, creates a clean wound bed, reduces infection risk, and aids in applying treatments or dressings.
Skin Grafting: Transplanting skin from one body area to cover burn wounds helps close wounds, minimize scarring, and improve appearance and function.
Escharotomy or Fasciotomy: Incising through dead tissue or fascia relieves pressure, enhances blood circulation, and treats circumferential burns to prevent complications like compartment syndrome.
Scar Revision Surgery: Surgical modification of scars improves appearance and function through techniques like excision, rearrangement, or grafting.
Nerve Decompression: Surgically releasing trapped nerves or scar tissue improves pain and sensory function in areas affected by burn scars.
Anesthesiology
Dermatology, General
Pediatrics, General
Plastic Surgery and Anesthetic Medicine
Vascular Medicine
Acute or Early Phase: Focuses approaches on wound evaluation, infection control, and early surgery.
Determine the degree and areas that have been burned.
There should be a practice of initial cleaning of any wound in the patients to remove any dead tissue.
Use relevant antiseptics on an area to avoid getting infected.
Perform necessarily surgery like excision and grafting for major burn injuries.
Surgery should be done to release the constricting dressing for circumferential burn.
Intermediate or Reconstructive Phase: It entails complex surgeries in a bid to achieve the best result concerning wound healing and functional outcomes.
Do the skin grafting for more significant injuries that require the technique.
Scar revision surgery to enhance the aesthetic feel of the area and overall functionality of tissue.
It is recommended to perform nerve decompression for patients suffering from severe pain. Rehabilitative or Long-Term Phase: Focuses on curative, restorative and also, on psychosocial care.
Administer exercises on physical therapy to enable the patient to bend their legs again.
Additionally, care for scars should be made by using pressure garments, silicone goods and anti-scarring agents.
Offer counseling to the child and the family especially when they are going through some problems. Follow-up and Maintenance Phase: This also entails follow up intervention since some complications may develop later and total patient health could remain fragile for a long time.
Make scar assessment visits with the patients frequently.
Ensure that the patients receive further rehabilitation services if and when required.
Inform and encompass the child and family in long-term care.
Thus, to enhance patient care experiences and provide late complication check-ups, the following strategies are recommended.
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