Skin Burns Of The Head And Neck

Describe the causes of burn and management of face and neck burn.

Answer. Burn: A burn is a wound in which there is coagulation necrosis of tissue.

Causes Of Burn

First Aid of Face and neck Burn

Definitive Treatment of Face and Neck Burn

Fluid resuscitation of Face and neck Burn

Fluid replacement is done by calculating with various formulas such as Parkland regime, Muir and Buckley regime, etc.
The fluids used are normal saline, Ringer lactate,
Hartmann’s flid. Ringer lactate is the choice of fluid.
Blood is transfused in a later period after 48 hours.

For the first 24 hours, only crystalloids should be given.
After 24 hours up to 30–48 hours, colloids should be given to compensate for plasma loss. Plasma, haemaccel (gelatin), dextrans, and hetastarch are used. Usually at a rate of 0.35–0.5 mL/kg% burns is used in 24 hours.
Urinary catheterization to monitor output; 30–50 mL/hour should be the urine output.
Tetanus toxoid.
Monitoring the patient: Hourly pulse, BP, PO₂, PCO₂ electrolyte analysis, blood urea, nasal oxygen, often intubation is required. Endotracheal intubation is secured in such a way as to minimize pressure necrosis of the lip.
IV ranitidine 50 mg 8th hourly is given.
Ryle’s tube insertion was initially for aspiration purposes later for feeding.
Antibiotics: Penicillins, aminoglycosides, cephalosporins, and metronidazole should be given.
Culture of the discharge; total white cell count and platelet count at regular intervals are essential to identify the sepsis along with fever, tachycardia, and tachypnea.
In burns of the oral cavity, a tracheostomy may be required to maintain the airway.
Total parenteral nutrition (TPN) is required for faster recovery, using carbohydrates, lipids, and vitamins.
A tracheostomy/intubation tube may be required in impending respiratory failure or upper airway block.
Intensive nursing care.

Dressing at regular intervals under general anesthesia using paraffin gauze, hydrocolloids, plastic films, vaseline-impregnated gauze or fenestrated silicone sheet, or biological dressings like amniotic membrane or synthetic biobrane.
Open method with application of silver sulfadiazine without any dressings, used commonly in burns of the face and neck.
The closed method is with dressings done to soothe and protect the wound, to reduce the pain, and as an absorbent.
Tangential excision of burn wounds with skin grafting can be done within 48 hours in patients with less than 25% burns.
It is usually done in deep dermal burn wherein dead dermis is removed layer by layer until fresh bleeding occurs. Later skin grafting is done.
In burns of the head and neck region, exposure treatment is advised.
Slough excision is done regularly.
After cleaning with povidone iodine solution silver sulfadiazine ointment is used. It is an antiseptic and soothing agent.

Better outcomes can be achieved if the non-healing areas are excised (likely to take 3 weeks or more) and then skin grafted.
The donor skin needs to be taken from the area above the nipple for the best color match.
Many surgeons favor the scalp skin but, alopecia and hair growth from trans-planted skin are of concern whereas the upper part of the back has thick skin.
Facial excision is carried out using Goulian knives or Versajet water dissector. Exposed cartilage needs excision with closure of the skin.
Sheets of autografts are used as the meshed grafts are cosmetically unacceptable.
Epinephrine lysis is essential to limit hemorrhage.
A face mask should be placed to help immobilize of skin graft.
Grafts should be placed in such a fashion as to mimic the esthetic units. Fibrin glue can be used to enhance graft adherence.
Postoperative facial elastic mask compression helps in avoiding hypertrophic scars.