Recommended course of action for the treatment of thermal injuries:
Burns 2a:
- Conservative occlusive dressings (dressing in which the wound surface to be treated is covered with an impermeable or semipermeable plastic film).
- Temporary synthetic/biological skin substitute.
Usually heals well.
Grade 2b burns:
- Surgical debridement (surgically performed cleansing of a wound to remove dead tissue and coatings)/tangential necrosectomy (removal of dead tissue).
- Temporary synthetic/biologic skin substitute
- Autologous skin grafting (split skin, mesh graft).
Grade 3 burns:
- Epifacial necrectomy (surgical debridement).
- Escharotomy (zigzag relief incisions of the skin) for prophylaxis of compartment syndromes (condition in which increased tissue pressure in closed skin and soft tissue sheath leads to decreased tissue perfusion) or respiratory obstruction of the thorax (chest)
- Autologous skin grafting (split skin, mesh graft)/dermis replacement.
- If necessary, temporary coverage (VAC = vacuumassisted closure/ “negative pressure wound therapy“, NPWT; synthetic/biological skin substitute).
Grade 4 burns:
- Necrosectomy,
- Elaborate plastic surgical defect coverage (flapoplasty) (often necessary).
- Amputation if necessary
