Originally Posted by Doc Dutch
All,
This has been a very interesting string on burns and I wish to add a couple of comments if I might. Let me share what I have gathered as an associate director of burns for roughly the last 5 years. Last year at our burn center we saw nearly 4900 burns of which over 920 were admitted while all the rest were outpatient or clinic follow-ups. Many simple and complex hand burn injuries presented at all hours of the day and night. Thank goodness many of the simple hand burns were self limiting, meaning that no matter what you do they will go on to heal with good basic wound care and a physician's vigilent eye. That is true if they do not get infected. Remember that burn injuries are essentially dead tissue. If the area is small enough the body can use its white blood cells to breakdown the small burn eschar and new skin will grow. We use silvadene, bacitracin and Aquacel Ag for different types of burn injuries for different reasons, all at different stages of healing to help expedite the process and to minimize discomfort. The healing skin has damaged nerve endings which in a first degree or second degree burn hurts tremendously. Again, third degree is total destruction of all nerves and tissues so is painless, except, as stated above, if there remains first or second degree burn around the third degree burn.
It is important to understand that bacteria loves dead tissue. That is why with the severely burned patients with third degree burns (hopefully, no fourth degree) and large surface area burns, infection is an enormous risk. Yes, even small area burns can get infected. I have had to admit small burns for raging cellulitis because the hand burn became infected. At times this has led to abscesses that required incision and drainage, worsening of the second degree burn to third degree burn and then on to skin grafting, joint involvement, tendon involvement, loss of motion, etc. The best thing that happened with this initial case is that the dead blister was debrided (or so it sounds), that the wound was bandaged and that ointment was applied frequently.
As for home remedies, they are "quick fixes" and have been tested by people throughout the centuries. Years ago, moms would grab butter sticks from the old ice box because butter was soothing and cool to a child's burn. Many of my patients from "south of the border" that get burned in the US smear toothpaste on their burns as it soothes their burns as well. How many of us have grabbed an ice cube from the frig and soothed a finger burn after we errantly touched the stove? The problem with anything ice cold is that it causes vasoconstriction and starves the area of burn from getting blood and can therefore extend the zone (or area) of injury, so please avoid putting burns in ice or iced water. If someone is barbequeing and they catch, yes, push them in the pool or spray them with the garden hose but usually swimming pools in July do not have ice cubes in them. They are luke warm and so it puts the fire out and cools the wound but does not make the wound ischemic. But also rememeber that hypothermia kills, so the burn victim gets dried off and wrapped in a blanket to keep warm as 911 is called.
The American Burn Association, which is the accrediating body for all US burn centers and is further given its accrediation by the American College of Surgery, recommends that all hand burns should be seen at a burn center. Hands are valuable and they are irreplaceable. They are often treated with disregard as we bang them around in our daily lives, but they are so invaluable to what every human does everyday. Today, hand surgery is its own defined subspecialty in medicine with its own training programs. So, we strongly urge that if you have a hand or finger burn, please come in to one of the 43 burn centers or one of the 120 burn units around the US. If you do not have a local one, go to the local emergency room and get advice from the ED physician. Many plastic surgeons and general surgeons have burn experience as well, but the wound should be seen by a physician. These are small injuries but they can be devastating if not cared for and followed. I have seen amputations of hands and digits due to too many carefree attitudes and the mindset that, "Well, it will be better tomorrow". There is something one of my professors taught me many years ago, and I quote, "You don't know what you don't know". He was right for as I study and see patients everyday I learn more all the time. That is why general surgeons train for 5 to 8 years after medical school and we still learn new things everyday (I did even today from your website and is the reason I joined).
Many diseases are self-limiting. Thank goodness this one sounds like it was. But be careful! Simple problems can sadly be the tip of the iceberg. If you use a home remedy remember it is not in place of sound medical advice.
Thank you,
Dutch
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