children , and many may be man- |
burn wound . This most commonly |
will respond to oral antihistamines , |
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aged by the patient ’ s GP with appro- |
will involve formal surgical debride- |
but severe cases may require the use |
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priate support , if required , from their |
ment in the operating theatre fol- |
of TENS or , under the supervision of |
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regional burns unit . Just as inappro- |
lowed by autologous split-thickness |
the burns unit pain team , psycho- |
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priate referral of a minor burn con- |
skin grafting . Other techniques may |
tropic medication . |
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sumes valuable resources and causes |
be used , including primary closure , |
In children , the normal burn scar |
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considerable inconvenience and dis- |
autologous full-thickness grafts , |
maturation typically occurs over a |
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ruption to the child ’ s family , it is also |
meshed split-thickness skin graft- |
1-3-year period , with repigmentation |
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important to avoid delayed referral |
ing with or without cultured kerati- |
usually the last process . During this |
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of deep or more severe burns that do require hospital resources and involvement of a burns unit for opti- |
nocytes and novel forms of biological skin substitutes . 11 Dedicated MDT support requires input from nursing |
phase , the burn wound remains more photosensitive , so the use of sunblock or a rash vest to cover the affected |
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mal care . Most burns units will pro- |
and allied health colleagues , who will |
area is recommended . |
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vide an electronic referral service |
be especially important in helping |
Further surgical care will likely |
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through which clinical images and a |
prepare and manage patients before |
be restricted to patients who require |
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brief patient history can be submitted |
and after any surgery . 1 |
scar releases or who develop severe |
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for evaluation . Patients thought to be suitable for community care can then be jointly managed and reviewed , minimising healthcare costs and dis- |
FOLLOW-UP AND SCAR MANAGEMENT
BURN wound closure , either from
|
scarring that does not respond to standard therapy . Contractures and poor scar outcomes are more likely in those patients with limited com- |
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ruption to the child and their family . |
natural healing processes or opera- |
pliance with pressure therapy and |
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Similarly , those patients with more |
tive surgical intervention , represents |
splinting , or it may occur much later |
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severe burns can be promptly identi- |
an important step in the management |
in patients with growth spurts , such |
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fied and appropriately referred on a |
of a burn wound . However , in many |
as during puberty . |
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semi-urgent basis . |
cases , it marks the end of the begin- |
Patients and their families will |
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In children , always refer burns |
ning of treatment rather than the |
require careful assessment by a multi- |
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that present late , those with an unu- |
beginning of the end . |
disciplinary team before any poten- |
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sual history or burns not consistent |
Burns that heal within 1-2 weeks |
tially difficult and costly course of |
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with the reported mechanism to a |
are much less likely to scar ; those |
treatment is started . In those children |
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burns unit in case of non-acciden- |
that take longer than 14 days to heal |
with darker skin and hypopigmenta- |
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tal injury . Referral is not solely about |
have a much greater risk of develop- |
tion following burn injury , repigmen- |
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management of the burn but involves |
ing hypertrophic scarring ( see fig- |
tation has been achieved with the use |
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a multidisciplinary team that may |
ure 7 ). These patients will require |
of a commercial autologous spray-on |
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include a child life therapist ( formerly |
an extended period of scar manage- |
skin culture system . |
||||||
referred to as a play therapist ), dieti- |
ment , involving topical moisturisers , |
While scar excision , regrafting , |
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tian , hospital schoolteacher , physio- |
pressure therapy — either the use of |
dermabrasion , steroid injection , laser |
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therapist , Aboriginal liaison officer , social worker and occupational ther- |
topical silicone , pressure dressings or pressure garments ( see figure 8 ) — |
therapy , microneedling and other modalities all have advocates — with |
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apist , as well as medical and nursing |
together with splinting , massage and |
different side effects and risk pro- |
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|
staff .
HOSPITAL MANAGEMENT
MOST children initially seen in the
ED of a burns unit will have a simple wound debridement under sedation with application of a nanocrystalline silver-based dressing and will be discharged for follow-up in 3-7 days . A small number of patients require resuscitation and formal admis-
|
Figure 7 . Hypertrophic burn scar , 10 months post-injury . Note the raised , thickened scar tissue . Residual erythema indicates that the scars are still active . Note the more superficial burn area superiorly with significant hypopigmentation . Poor initial first aid , delayed grafting and darker skin remain risk factors for subsequent scarring .
Inpatients may require a more extensive debridement under general
or a negative-pressure dressing . Following reassessment of the burn and
|
exercises to help ensure a satisfactory cosmetic and functional outcome .
This treatment involves extensive input from allied health colleagues . Some care can be offered using remote communication technology and / or may involve care facilitated through local services but arranged in conjunction with the burns unit to help guide and support optimal care . Itchiness can be a significant problem in some children ; it may be
|
files — none will always be effective or have clear evidence of objective efficacy from randomised controlled trials . 12
Further , at least in children , each procedure will require a general anaesthetic during a course of therapy that may extend over 12 months .
CASE STUDIES
Case study one
MOHAMMED , a 13-month-old boy ,
|
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sion to the burns unit or paediatric |
anaesthesia and the application of |
potentially the use of laser doppler |
so severe that is causes the child to |
presents to his GP with a burn injury |
ICU if they are intubated or require |
either a nanocrystalline silver , bio- |
imaging , about one-third of patients |
remove a healed skin graft and reo- |
he sustained the previous day . His |
close observation and monitoring . |
logical dressing with porcine collagen |
will require surgical closure of the |
pen the burn wound . Most children |
mother reports that he was playing |
International Encyclopedia of Rehabilitation 2013 : bit . ly / 3BxHnvu |
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Figure 8 . Custom-made pressure garments are measured and fitted when the child ’ s skin can withstand pressure and oedema has resolved . |