Burn Surgery

B

• Burn Center Referral — Criteria and Transfer

  Burn-center referral is based on depth, size, anatomic site, mechanism, inhalation injury, comorbidity, associated trauma, pediatric needs, pain control, rehabilitation requirements, and local capability. Stabilize airway and circulation, cover wounds, prevent hypothermia, provide analgesia, begin indicated fluids, and communicate directly with the receiving burn center before transfer.
• Burn Center Referral Criteria

  Burn-center consultation or transfer should be considered for major partial-thickness burns, any full-thickness burn, critical anatomic areas, electrical/chemical/inhalation injury, pediatric or medically complex patients, associated trauma, poorly controlled pain, or needs that exceed local burn-care capability.
• Burn Escharotomy — Indications and Technique

  Escharotomy relieves vascular or ventilatory compromise caused by a rigid circumferential full-thickness burn. Diagnosis is clinical and serial: worsening pain, paresthesia, coolness, delayed capillary refill, weak Doppler signals, rising compartment pressure, or restricted chest excursion despite appropriate resuscitation should trigger urgent burn-surgical assessment and timely release.
• Burn Wound Care — Initial Cleansing and Dressings

  Initial burn wound care aims to stop ongoing thermal injury, gently cleanse and assess the wound, control pain, preserve viable tissue, prevent desiccation and contamination, and select a dressing that matches burn depth, exudate, location, and follow-up reliability. Deep, extensive, high-risk, or functionally important burns require early burn-specialist input.

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

  Chemical burns require immediate removal of the offending material and prolonged decontamination, usually with copious water irrigation after brushing off dry powders. Neutralization is generally avoided because it can generate heat or unpredictable reactions. Management also requires agent identification, eye irrigation when exposed, systemic-toxicity assessment, and early burn or toxicology consultation for significant injuries.

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

  Deep partial-thickness and full-thickness burns often benefit from timely excision of nonviable tissue and durable wound closure. Operative timing is individualized to burn depth, size, physiologic stability, donor-site availability, infection risk, and reconstructive priorities. Early burn-surgical planning can reduce prolonged open-wound time and support faster rehabilitation.
• 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

  Hydrofluoric acid causes both corrosive tissue injury and fluoride-mediated systemic toxicity through calcium and magnesium binding. Immediate decontamination, topical or local calcium therapy, serial ECG and electrolyte monitoring, aggressive correction of hypocalcemia and hypomagnesemia, and early toxicology and burn consultation are central to management.
• 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

  Smoke inhalation can cause rapidly progressive upper-airway edema, lower-airway chemical injury, and systemic carbon monoxide or cyanide toxicity. Priorities are immediate high-concentration oxygen, early airway assessment with a low threshold for definitive airway control when edema is evolving, targeted toxicology evaluation, bronchoscopy when needed, and burn-center consultation.
• 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

  Pediatric burn care requires age-adjusted airway planning, accurate weight and burn-size estimation, careful fluid titration to urine output and perfusion, maintenance dextrose in young children when needed, active hypothermia prevention, weight-based analgesia, and explicit assessment for non-accidental trauma. Early pediatric burn-center consultation is appropriate for significant injuries.

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

  Hot tar and asphalt produce a combined thermal and adherence injury. Cool the material rapidly to stop ongoing heat transfer, do not peel hardened tar from viable skin, soften it gradually with a lipophilic agent such as mineral oil or petrolatum, then reassess burn depth and manage the underlying wound using standard burn principles and referral criteria.
• 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

  Thermal-burn care begins with stopping the burning process, airway and trauma assessment, pain control, burn-depth and total-body-surface-area estimation, and prevention of hypothermia. Major burns require early burn-center consultation and structured fluid resuscitation guided by physiologic response rather than a fixed formula alone. Assess for inhalation injury, carbon monoxide and cyanide exposure, circumferential eschar, electrical or chemical mechanisms, and associated trauma. Partial-thickness and fu

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.