Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter III: Burn Injury
Wound Care
United States Department of Defense
Attention is directed to the burn wound only after hemodynamic stability and the previously mentioned aspects of patient care have been accomplished. General anesthesia is not required for burn wound debridement; in fact, during this period of vascular instability and hypovolemia, it is ill-advised. Intravenous analgesia will suffice for pain control during such a procedure. The body hair is shaved from the area of thermal injury and well back from the margins. The burns are gently cleansed with a surgical soap solution, and nonviable epidermal remnants are debrided. Bullae are excised, since the proteinaceous fluid contained within them is an ideal culture medium for bacteria. After this initial debridement, the patient may be placed in bed, on surgically clean sheets. During the period of active wound exudation. placing bulky dressings beneath the burned parts to absorb the serious exudate has been found helpful. These dressings should be changed as necessary and patients with circumferential burns should be turned on a scheduled basis to expose the burned areas on an alternating basis and to prevent maceration.
Patients with burns of the buttocks, perineum, and thigh do not require colostomy. The frequency of anal stricture is greatly increased by performance of such a procedure. Even when an ate. dominal operation is required to treat associated injuries, performing a colostomy is unwise solely for the treatment of buttock, perineal, or upper thigh burns. If a colostomy is indicated for other reasons, daily anal dilations are mandatory.
Fractures associated with thermal injury are best treated by skeletal traction or external fixation to permit exposure of the burns and their treatment with topical chemotherapy. The application of a cast over an area of thermal injury promotes suppuration and enhances the possibility of the development of invasive burn wound infection. Nevertheless, plaster is acceptable over areas of burn in preparation for and during evacuation, if the cast is bivalved and removed promptly when the patient arrives at the definitive treatment installation.