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Burns and Scalds

The skin is the seamless shell of the body. It is composed of two layers:

1. The epidermis,
2. The dermis, below which is the subcutaneous fatty tissue (subcutis)

Depending on the depth of the injury we talk of first, second, or third degree burns or scalds.

First degree (reddening) and superficial second degree (blistering) burns usually heal without surgery. Deep second degree and third degree burns require surgery. Thin layers of skin are removed from healthy parts of the body, placed on the injured sites and fixed so that they grow on (skin grafting).

Depending on the extent of the burns (the palm of one hand corresponds to 1 percent of the body surface area in adults), it takes more or less time to cover the injured areas.

Once all the open areas are covered with skin and healed, pressure, i.e. compression has to be applied to the transplanted skin so that the scars become pale and soft and do not proliferate. For this, compression bandages are tailor made and have to be worn twenty-four hours a day for one to two years.

If the burns go over joints or flexion points (chin, neck, shoulder), splints and physiotherapy and occupational therapy are essential for trying to regain lost functions.

When the scars are mature, i.e. no longer red, but pale, soft and as flat as possible, options for correction can be considered. Corrective surgery is aimed at remedying functional disabilities, but also at improving the appearance of disfiguring and psychologically damaging scars. Each corrective operation is again followed by rehabilitation with compression, physiotherapy, etc.

The total treatment time is always long and takes months or years.

The burden of fear and pain after burns is enormous. Most patients experience the accident in a fully conscious state. The treatment is extremely painful, the transplanted skin is very sensitive and the healing process is usually accompanied by intense itching. Physiotherapy and occupational therapy always have to reach and go beyond the pain threshold in order to restore what is lost.

The psychological burden of having to live with scars is great. Burn injuries are unusual in that the people affected suffer permanent damage which is also visible for those around them. Children are especially affected because the scarred areas often do not continue to grow with them, and require subsequent operations. Their personalities are not yet settled and they therefore find it very difficult to deal with scars, especially in their formative years.

By means of a well-thought out and consistent treatment plan, good scarring can be achieved, but the scars will always be visible.

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