10. What are the specific features of wound healing in patients with burn injuries?

It is estimated that 400,000 people receive a burn injury in France each year (of which more than a third are children). Thus it is important that practitioners are able to accurately assess the wound. This assessment allows the patient to be referred to a specialised unit, if necessary, and be offered a suitable treatment to achieve optimal healing.

The depth of the burns corresponds to the anatomical level affected, and a distinction is made between:

• superficial burns (1^st degree and 2^nd degree burns): medical treatment and healing without after-effects;

• deep burns (2^nd degree and 3^rd degree): management generally requires the intervention of a plastic surgeon, and healing will involve after-effects (Figure7 and Table3).

Figure 7. Classification of burns in degrees.

Table 3. Differences in the clinicalvappearance of the burn depending on the degree.

In any burn injury, the wound should first be cooled down under running water for a prolonged time (about ten minutes). Pain management, which is often the primary concern, is essential. In common with all wounds, it is important to check the tetanus vaccination status of the patient.

Superficial burns should be treated by:

• washing with soap and water;

• excision of blisters (except on palmsof the hand and soles of the feet);

• daily tulle-gras dressing.

Healing normally occurs in under two weeks. If this is not the case, the patient should be referred to a specialist centre. Determining the depth of a burn is not always easy and the initial assessment may be incorrect and explain the delay in healing. For this reason, in second-degree burns, a reassessment after 24-48 hours is always required.

Deep burns should always be treated in a specialised burns centre for rapid flattening and grafting.

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