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Clinic for Rehabilitation and Regenerative Medicine

What are burns?

Burns are a type of painful wound caused by thermal, electrical, chemical, or electromagnetic energy. Smoking and open flames are the main causes of burns in older adults. Scalds are the main cause of burns in children. Both infants and older adults are at greatest risk for burns.

What are the different types of burns?

There are many types of burns caused by thermal, radiation, chemical, or electrical contact.

  • Thermal burns. These burns are due to sources of heat that increase the temperature of the skin and tissues and cause tissue cells to die or char. Hot metals, scalding liquids, steam and flames can cause burns on contact with the skin.

  • Radiation burns. These burns are due to prolonged exposure to ultraviolet rays from the sun or other radiation sources such as X-rays.

  • Chemical burns. These burns are caused by strong acids, alkalis, detergents, or solvents that come in contact with the skin or eyes.

  • Electrical burns. These burns are caused by electrical current, either alternating current (AC) or direct current (DC).

The skin and its functions

The skin is the body's largest organ and has many important functions. It consists of several layers, each layer having a specific function:

Epidermis

The epidermis is the thin outer layer of the skin with many layers including:

  • Stratum corneum (Hornschicht)
    This layer is made up of cells that contain the protein keratin. it keeps the body fluid in the body and keeps external substances out. As the outermost layer, it peels off continuously.

  • Keratinocytes (squamous cells)
    This layer is made up of living cells that mature and move to the surface to become the stratum corneum.

  • Basal layer
    In this layer, new skin cells divide to replace the old cells that were shed on the surface.

The epidermis also contains melanocytes, which are cells that Melanin (Hautpigment).

Dermis

The Dermis is the middle layer of the skin. The dermis contains the following:

The dermis is made up of a protein called. held together Collagen made by fibroblasts. This layer also contains nerve endings that carry pain and touch signals.

Subcutaneous tissue

The Subcutaneous tissue is the deepest layer of skin. The subcutis, made up of a network of collagen and fat cells, helps to retain body heat and protects the body from injury by acting as a 'shock absorber'.

The skin not only serves as a protective shield against heat, light, injuries and infections, but also:

What are the burn classifications?

Burns are classified as first, second, or third degree depending on how deep and how deeply they penetrate the surface of the skin.

  • First degree (superficial) burns
    First degree burns affect only the epidermis or the outer layer of skin. The burn site is red, painful, dry, and blister free. A slight sunburn is an example. Long-term tissue damage is rare and usually involves an increase or decrease in skin color.

  • Second degree burns (partial thickness)
    Second degree burns affect the epidermis and part of the dermis layer of the skin. The burn site appears red, has blisters, and can be swollen and painful.

  • Third degree burns (full thickness)
    Third-degree burns destroy the epidermis and dermis. Third-degree burns can also damage the underlying bones, muscles, and tendons. If bones, muscles, or tendons are also burned, it can be referred to as a fourth degree burn. The burn area appears white or charred. There is no feeling in the area as the nerve endings are destroyed.

More severe and extensive burns require special treatment. Because the age of a burn victim and the percentage of body surface area burned are the most important factors influencing the prognosis of a burn injury, the American Burn Association recommends that burn patients who meet the following criteria be treated as soon as possible at a specialized burn center:

  • Individuals with partial thickness burns of more than 10% of the total body surface (TBSA)

  • Any age with full skin burns

  • Burns to the face, hands, feet, or groin or genital area, or burns that extend around part of the body

  • Burns accompanied by an inhalation injury that affects the airways or lungs

  • Burn patients with existing chronic diseases such as diabetes, high blood pressure, heart disease, kidney disease or multiple sclerosis

  • Suspected child or elderly abuse

  • Chemical burn

  • Electrical injury

The effects of burns

A severe burn can be a seriously devastating injury - not just physically, but emotionally as well. It can affect not just the burnt offering, but the whole family. Those with severe burns can leave behind a loss of certain physical skills, including loss of limbs, disfigurement, loss of mobility, scarring, and recurring infections because the burned skin has reduced its ability to fight off infection. In addition, severe burns can penetrate deep layers of the skin and cause muscle or tissue damage that can affect any system in the body.

Burns can also cause emotional problems such as depression, nightmares, or flashbacks from the traumatizing event. The loss of a friend or family member and possessions in the fire can add to the emotional impact of a burn.

The fire rehabilitation team

With so many functions and systems in the body being affected by severe burns, the need for rehabilitation becomes even more important.

Many hospitals have a specialized burn department or center, and some facilities are dedicated solely to burn rehabilitation. Burn patients require the highly specialized services of health professionals working together in a multidisciplinary team, including the following:

  • Physiotherapists

  • Plastic surgeon

  • Internists

  • Orthopedic surgeons

  • Infectious Disease Specialists

  • Rehabilitation nurses who specialize in burns

  • Psychologists/Psychiatrist

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  • Physiotherapists

  • Occupational therapists

  • Respiratory therapists

  • Nutritionist

  • Social worker

  • Fallmanager

  • Recreational therapists

  • Career counselor

The burn rehabilitation program

Burn rehabilitation begins in the acute treatment phase and can take days to months or years, depending on the extent of the burn. Rehabilitation is designed to meet the specific needs of each patient; Therefore every program is different. One of the goals of a burn rehabilitation program is to help the patient regain the highest possible level of function and independence while improving the overall quality of life - physically, emotionally, and socially.

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To achieve these goals, burn rehabilitation programs can include:

  • Complex wound care

  • Pain therapy

  • Physiotherapy for positioning, splinting and movement

  • Occupational therapy to support activities of daily living (ADLs)

  • Cosmetic reconstruction

  • Skin graft

  • Advice on how to deal with common emotional reactions during convalescence, such as depression, grief, anxiety, guilt, and insomnia

  • Education and advice for patients and relatives

  • Nutritional advice

Advances in burn understanding and management, state-of-the-art burn units and facilities, comprehensive burn rehabilitation services, and integrated medical care have all contributed to increasing burn patient survival and recovery.

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