Burn Surgery

B

• Burn Center Referral Criteria

  Know ABA referral criteria: ≥10% TBSA partial‑thickness, any full‑thickness, critical areas (face, hands, feet, genitalia, perineum, major joints), electrical/chemical/inhalation injury, pediatric and comorbid patients.
• Burn Center Referral — Criteria and Transfer

  Use standardized criteria for referral to verified centers; stabilize, control pain, begin fluids, cover wounds, and arrange safe transfer with early communication.
• Burn Escharotomy — Indications and Technique

  Relieve circumferential burn induced vascular compromise or ventilatory restriction with timely escharotomy guided by exam and Doppler.
• Burn Wound Care — Initial Cleansing and Dressings

  Irrigate and gently debride, manage blisters thoughtfully, select moisture balanced dressings, and optimize analgesia.

C

• Carbon Monoxide & Cyanide Poisoning in Burns

  CO and cyanide are common in enclosed‑space fires. High‑flow O₂ (or hyperbaric in select CO cases) and empiric hydroxocobalamin for suspected cyanide toxicity are key.
• Chemical Burns — Alkali vs Acid Management

  Immediate, copious irrigation is the cornerstone. Alkali burns penetrate and saponify; acids coagulate. Identify agents and decontaminate safely; specific antidotes are rare.
• Chemical Burns — Irrigation Principles

  Immediate copious irrigation is the cornerstone; remove contaminated clothing, avoid neutralization, and know special agents that need targeted therapy.

E

• Early Excision & Grafting — Strategies

  Early excision (post‑resuscitation day 2–7) reduces sepsis and LOS. Choose autograft type (split vs full thickness), meshing ratio, and consider dermal substitutes in large TBSA deficits.
• Early Excision and Grafting — Timing and Strategy

  Early tangential excision and grafting of deep partial and full thickness burns reduces infection and length of stay; coordinate hemodynamic stability, nutrition, and glycemic control.
• Electrical Injury — High‑Voltage Evaluation & Care

  High‑voltage electrical injuries cause deep muscle damage, arrhythmias, and compartment syndromes despite minimal skin findings. Continuous cardiac monitoring and rhabdomyolysis management are essential.
• Escharotomy & Fasciotomy — Indications and Technique

  Circumferential full‑thickness burns threaten perfusion and ventilation. Perform escharotomy along anatomic lines; escalate to fasciotomy for compartment syndrome or high‑voltage injuries.

F

• Fluid Resuscitation — Parkland & Modern Endpoints

  Use weight‑ and TBSA‑based formulas for initial estimates (e.g., 2–4 mL/kg/%TBSA LR first 24 h), then titrate to endpoints (urine output, hemodynamics) to avoid under‑ or over‑resuscitation.
• Frostbite — Diagnosis & Treatment

  Frostbite is a thermal injury—rapid rewarming, analgesia, thrombolysis in select, and delayed surgery after demarcation preserve tissue.

H

• Hydrofluoric Acid Burns — Calcium Rescue

  HF causes liquefaction necrosis and systemic hypocalcemia/hyperkalemia. Immediate irrigation and calcium therapy (topical/intradermal/IV) are lifesaving.
• Hydrofluoric Acid Burns — Calcium Therapy

  HF causes deep tissue injury and systemic hypocalcemia and hypomagnesemia; irrigate, give calcium topically and infiltrated, monitor electrolytes, and treat severe cases aggressively.
• Hypertrophic Scars & Contracture Prevention

  Prevent hypertrophic scars and contractures with early splinting/positioning, pressure therapy, silicone, and timely therapy; consider laser and steroid injections for refractory scars.

I

• Infection Control & Antimicrobial Stewardship

  Prevent infection with aseptic wound care, early excision/coverage, catheter stewardship, and culture‑guided therapy; avoid blanket prophylactic antibiotics.
• Inhalation Injury — Airway & Ventilation Management

  Suspect inhalation injury with enclosed‑space fire, facial burns, soot, hoarseness. Early airway control, bronchoscopy, lung‑protective ventilation, and adjunct nebulized therapies improve outcomes.
• Inhalation Injury — Airway and Toxic Gases

  Recognize airway edema risk and toxic exposures from smoke; secure airway early when indicated, give high flow oxygen, and treat potential carbon monoxide and cyanide toxicity.
• Initial Burn Assessment — Primary/Secondary Survey

  Structured burn assessment begins with ATLS primary survey, early airway decisioning, exposure with temperature control, and calculation of TBSA using Lund–Browder for adults/children.

N

• Nutrition & Metabolic Support in Major Burns

  Severe burns cause hypermetabolism; early enteral nutrition, high protein intake, and micronutrient supplementation reduce infections and improve healing.

P

• Pain, Sedation, and Pruritus Management

  Use multimodal analgesia and sedation strategies tailored to dressing changes and procedures; address chronic pain, pruritus, and sleep to improve rehabilitation.
• Partial‑Thickness Wounds — Assessment & Dressings

  Superficial and mid‑dermal partial‑thickness burns often heal with advanced dressings; deep partial may require early excision/grafting. Choose dressings that maintain moisture, limit infection, and reduce pain.
• Pediatric Burns — Fluids & Special Considerations

  Children have different fluid needs and higher risk of hypoglycemia/hypothermia. Always assess for non‑accidental trauma in concerning patterns.
• Pediatric Burns — Resuscitation and Special Issues

  Adjust fluid strategies, include maintenance with dextrose for small children, protect airway, and consider non accidental injury.

R

• Rehabilitation & Psychosocial Support

  Rehab starts day 1: edema control, ROM, splinting, mobility, ADL training, and psychosocial support reduce disability and improve return‑to‑work.

S

• SJS/TEN — Burn Unit Management

  Manage SJS/TEN in a burn unit: stop culprit drugs, aggressive supportive care (fluids, temperature, nutrition), wound care like partial‑thickness burns, and consider immunomodulators per protocol.

T

• Tar and Asphalt Burns — Removal and Care

  Cool quickly to stop thermal injury, soften tar with mineral oil or polyethylene glycol, avoid harsh solvents, and treat as partial thickness burns with modern dressings.
• Thermal Burns — Adult Initial Resuscitation

  Primary survey, accurate TBSA estimate, early fluids with titration to urine output, analgesia, and timely transfer when criteria are met.
• Thermal Burns — Initial ED Management

  Stop the burning process, assess airway and inhalation injury, estimate TBSA, begin fluid resuscitation using Parkland formula for large burns, provide analgesia, and update tetanus.

V

• VTE Prophylaxis in Burn Patients

  Burn patients are hypercoagulable; provide pharmacologic and mechanical prophylaxis unless contraindicated. Adjust LMWH dosing by weight/anti‑Xa levels in large TBSA or obesity.