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How To Debride and Dress a Burn

By

Matthew J. Streitz

, MD, San Antonio Uniformed Services Health Education Consortium

Last full review/revision Sep 2020| Content last modified Sep 2020
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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

  • Minor burn wounds

Contraindications

Absolute contraindications

  • None

Relative contraindications

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

Complications

  • Allergic reactions to topical antibiotics

Equipment

  • 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

  • Burns involving the hands, feet, face, genitals, perineum, or major joints or burns that are extensive often require transfer to a burn center.

Depth of skin injury:

  • First-degree: Involving the epidermis only

  • Second-degree (partial-thickness): Extending into the dermis

  • Third-degree (full-thickness): Destroying the entire skin

Positioning

  • Patient comfort with excellent exposure of burned areas

Step-by-Step Description of Procedure

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

  • Clean 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

  • 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

  • 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 burns on the face and neck: Clean 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.

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

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