Minor burns

The aims of minor burn wound management include:

• Optimising wound management to promote timely healing and minimise cosmetic deformity
• Minimise pain and the risk of infection
• Preserve physical function 

Burns wounds are unique in that they evolve and change with time. As the burn changes through the process of healing, so too will the dressing requirements. 

A thorough patient assessment is required that includes:

• Co-morbidities
• Other injuries
• Tetanus immunisation status
• Drug allergies

Burn injury assessment:

• Mechanism of injury
• Cause of injury eg. chemical, scald, flame
• Any prior treatment for injury i.e adequate first aid (20min cool water within 3hrs of injury)
• Is this burn accidental?

Non–accidental burn injury particularly in children and elderly should be suspected when there is inconsistency between the history of the incident and the visible appearance of the injury. These types of injuries should prompt a referral to a burns service for further management and investigation.

Pathophysiology

The vast majority of superficial burn injuries should heal in 10 – 14 days without complication. They heal by a process of re-epithelialization as surviving keratinocytes in the dermis proliferate to restore the epidermal barrier (regeneration).

Minor burn wounds are classified as being superficial in depth, small in surface area and uncomplicated in mechanism. They are usually painful, have good capillary return and should heal within 14 days with good wound management. Burns which heal within 14 days have a low risk of scar formation, although scar formation is multifactorial.

Burns wounds are dynamic, they change over time as the wound goes through the stages of healing. Dressings should be reviewed for appropriateness and dressing products selected according to the aims of wound healing principles. The diagram below provides an overview of the overriding wound management principles as the wound moves beyond the acute phase through the stages of healing.

Minor burns phases of healing

Inflammatory phase (0-3 days)

• Absorb exudate
• Protect viable tissue
• Manage oedema

Destructive Phase (4-8 days)

• Debride slough/non viable tissue
• Hydrate if required
• Minimise risk of infection

Healing Phase (9-12 days)

• Protect healing tissue
• Moisture balance
• Avoid re-trauma

Maturation Phase (>14 days)

• Sun protection/moisturiser
• Scar management
• Itch management