According to the American Burn Association, there are approximately 500,000 burn injuries in the United States and Canada each year. While most are relatively mild, 60,000 require hospitalization and 5,000 a year result in death. In 2011, almost 19,000 people experienced a burn injury on the job (both thermal and chemical burns), according to the Bureau of Labor Statistics.
Burns occur when chemicals, flames, liquids, steam or electricity damage skin and tissue. Severe burns typically affect more than just the skin. Burns can shut down or weaken vital systems, putting the injured worker at greater risk for multiple complications. Depending on how extensive the area of burn is and how deeply the burns penetrate the skin’s layers (sometimes reaching into muscle tissue), virtually every system in the body may be affected.
A severe burn injury is highly complex and can often require difficult and lengthy treatment. The road to recovery can be especially arduous for those with third- or fourth-degree burns, burns over large areas of the body, or additional complicating factors like smoke inhalation. However, total burn surface area (TBSA) and depth are not the only factors that characterize a severe burn. Even second- and third-degree burns with relatively small TBSA can be highly complex injuries when they occur in particular locations, including the hands, head, major joints and the perineum. Equally, electrical burns can be challenging due to the management of entry and exit wounds, as well as secondary complications such as neuropathy or corneal damage. The related nerve injuries can be disabling and painful.
Patients with severe burn wounds need meticulous evaluation and correction of fluid and electrolyte, metabolic, cardiopulmonary, homeostatic and infectious derangements. Burn patients with pre-existing conditions such as diabetes, mellitus, obesity, hypertension and cardiovascular disease can experience enormous barriers to healing and may require additional attention.
Treatment and Complications
The vast majority of burn wounds close by epithelialization (the regeneration of skin across a wound surface), wound contraction, skin grafting or a combination of these methods. Acute burn wound management involves daily evaluation and management of all non-healed wounds by physicians and/or other members of a burn team. This care is often very complex and time-consuming.
In the ideal state, the surgical closure of a burn wound can be accomplished in one stage. Yet variables like blood loss, length of surgery, and donor site availability, may mean the body won’t tolerate closure in a single stage. The alternative is to perform the necessary steps in a planned sequence where part of the burn wound is excised initially and the remainder is removed in one or more subsequent operations. This is often done with cosmetically important areas such as the face, as well as with more extensive burns or burns in physiologically less stable patients.
Major burn complications include disfigurement, scarring, infection, psychological issues, chronic pain, inhalation injury, and corneal injury. Because of these potential problems and the numerous surgeries that accompany a severe burn wound, Paradigm provides an important overlay to the attending medical teams. Paradigm brings a wealth of information from the nation’s top burn specialists to coordinate care among the multiple physicians, and educate and support the injured person and his or her family.