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How To Debride and Dress a Burn

By

Matthew J. Streitz

, MD, San Antonio Uniformed Services Health Education Consortium

Reviewed/Revised Apr 2023
View PATIENT EDUCATION

Burn wounds typically need debridement and/or dressing.

Debridement (removal of nonviable tissue) and wound dressings are used to decrease the risk of infection and provide comfort in minor burns.

Indications for Debriding and Dressing a Burn

  • Minor burn wounds

Contraindications to Debriding and Dressing a Burn

Absolute contraindications

  • None

Relative contraindications

In these cases, decide together with the receiving burn center what burn care to provide before transfer.

Complications of Debriding and Dressing a Burn

  • Allergic reactions to topical antibiotics

Equipment for Debriding and Dressing a Burn

  • Nonsterile gloves

  • Cleansing solution, such as 2% chlorhexidine

  • 25- and 21-gauge needles

  • 10-mL syringe

  • Local injectable anesthetic, such as 1% lidocaine

  • Sterile scissors, forceps

  • Nonadherent dressing

  • Specialized burn wound dressings, if available and warranted (eg, petrolatum gauze impregnated with 3% bismuth tribromophenate)

  • Absorptive bulk dressing (such as 4 × 4 gauze dressings and tape, flexible rolled gauze wrap for extremity burns)

Relevant Anatomy for Debriding and Dressing a Burn

Depth of skin injury:

  • Superficial (formerly 1st-degree burns): Involving the epidermis only

  • Partial-thickness (formerly 2nd-degree burns): Extending into the dermis

  • Full-thickness (formerly 3rd-degree burns): Destroying the entire skin

Estimate the size of burn, expressed as percentage of total body surface area of partial-thickness and full-thickness burns (see figure [A] Rule of nines [for adults] and [B] Lund-Browder chart [for children] (A) Rule of nines (for adults) and (B) Lund-Browder chart (for children) for estimating extent of burns (A) Rule of nines (for adults) and (B) Lund-Browder chart (for children) for estimating extent of burns ).

Positioning for Debriding and Dressing a Burn

  • Patient comfort with excellent exposure of burned areas

Step-by-Step Description of Debriding and Dressing a Burn

Initial care of all burn wounds

Transfer stable patients with major burns to a burn center. For other patients, complete burn wound care.

Definitive burn wound care

  • Cleanse the burned area gently with a clean cloth or gauze and soap and water or a mild antibacterial wound cleanser such as chlorhexidine.

  • Irrigate the wound with saline or water.

  • Some physicians recommend leaving unruptured blisters intact, and others recommend opening them with scissors and forceps. Regardless, loose skin and broken blisters are devitalized tissue that should be debrided by peeling from the wound and snipping with scissors close to the border with viable, attached epidermis.

  • Apply a sterile burn dressing, with or without a topical agent.

There are several options for burn dressings. Some are impregnated with antimicrobials (eg, silver). Most are a form of gauze, but there are biosynthetic dressings with some of the characteristics of skin that adhere to the wound and can be left in place for extended periods of time. Some are typically used over a layer of antimicrobial cream or ointment, whereas those containing an antimicrobial are not. In all cases, dressings should be sterile and have an absorptive layer sufficient for the amount of exudate expected.

Aftercare for Debriding and Dressing a Burn

  • Provide analgesics to take at home.

  • Instruct the patient to elevate an affected limb to prevent swelling, which may cause delayed healing or infection.

  • Follow up in about 24 hours. At the first follow-up visit, remove the dressing and reassess the burn for depth of injury and need for further debridement, then redress.

The timing and location (eg, clinic, home) of subsequent dressing changes depend on

  • The type of dressing used: Some dressings are intended to be left on for a period of time and others are changed frequently.

  • Patient and family capability: Large burns, areas requiring awkward or complicated dressings, and patients with limited self-care skills, may need more frequent professional care and/or less frequent changes.

  • The amount of exudate produced by the wound: Drier burns need less frequent dressing changes.

For self-care, patients should gently remove the old dressing, rinse the wound with lukewarm tap water, and apply similar material as first used.

In any case, the wound should be examined 5 to 7 days after injury.

Warnings and Common Errors When Debriding and Dressing a Burn

  • Do not underestimate the need for procedural analgesia and sometimes sedation, particularly for complicated debridement or dressing changes. Inadequate analgesia deters thorough wound care.

Tips and Tricks for Debriding and Dressing a Burn

  • For burns on the face and neck: Cleanse the wound with chlorhexidine and debride blisters and any loose skin, then apply a bland topical antibiotic such as bacitracin but leave the wound uncovered. The wound can be washed 2 or 3 times per day, followed by reapplication of the topical agent. Encourage patients to sleep with their head elevated to help minimize or decrease swelling.

  • Alternatives to IV opioids include regional or nerve block anesthesia; inhaled nitrous oxide; or IV ketamine.

  • For debridement of small burns, local anesthetic injection may be adequate analgesia.

  • Home burn care and dressing changes may be quite painful. An adequate supply of an oral opioid analgesic should be provided, and responsible analgesic use should be encouraged.

Reference

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

Drugs Mentioned In This Article

Drug Name Select Trade
Betasept, Chlorostat, DYNA-HEX, Hibiclens, Oro Clense , Peridex, Periogard, PerioRx , Perisol
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, AsperFlex, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidocan III, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Dologesic, Ela-Max, GEN7T, Glydo, Gold Bond, LidaFlex, LidaMantle, Lido King Maximum Strength, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , LidoLite, Lidomar , Lidomark, LidoPure, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lubricaine For Her, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
ABSTRAL, Actiq, Duragesic, Fentora, IONSYS, Lazanda, Onsolis, Sublimaze, SUBSYS
ARYMO ER, Astramorph PF, Avinza, DepoDur, Duramorph PF, Infumorph, Kadian, MITIGO, MORPHABOND, MS Contin, MSIR, Opium Tincture, Oramorph SR, RMS, Roxanol, Roxanol-T
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Aphen, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
AK-Tracin, Baciguent, BaciiM, Baci-Rx, Ocu-Tracin
Bactroban, Centany, Centany AT
Silvadene, SSD, SSD AF, Thermazene
Ketalar
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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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