Thermal burns and scalds, or simply burns, refer to thermal injuries or damages of the skin tissue caused by exposure to hot materials, chemicals or radiation. In general, burns refer to dry heat damage while scalds refer to damages caused by moist heat.
When exposed to an extreme temperature (either hot or cold), human body may sustain damages to the skin, tissues, muscles, bones and major organs.
Burns are caused primarily by flames, hot fluids or hot surfaces, chemical agents, radiation or electricity. The extreme temperatures will result in tissue damage and cell death. Thermal burns not only cause skin damages but also weaken the skin’s antimicrobial function, which leaves the wound susceptible to infections.
There are two types of trauma:
1. Blunt trauma: The skin surface is intact but internal tissues are damaged. This is also referred to as internal injury, which may result in internal bleeding, subcutaneous hemorrhaging or bruising, or may not show any signs on the surface.
2. Open trauma: Both the skin and underlying tissues are damaged. This is also referred to as external injury and can be categorized into the following types:
(1) Abrasions: Abrasions are caused by rubbing of the skin against rough objects. These will cause minimum bleeding and tend to leave dirt and sand on the wound, making the wound susceptible to infections.
(2) Puncture wounds: Puncture wounds are caused by insertion of sharp objects. These normally cause minimum bleeding but may injure internal organs and cause internal bleeding. If the puncture is deep, the chance of infection and the chance of tetanus may increase.
(3) Cuts: Cuts are caused by sharp objects, such as: knives, metal sheets and glass. These may sever blood vessels and tend to cause massive bleeding, which must be stopped immediately. Patients with deep cuts should seek medical attention.
(4) Lacerations: Lacerations are caused by collision with enormous force. The wounds are of irregular shape and susceptible to infections. Those sustain severe laceration should seek medical attention.
(5) Avulsion wounds: A body part, such as a limb or an ear, is forcibly detached from the torso. These tend to be accompanied by lacerations and cuts. The bleeding must be stopped immediately by elevating the injured part. The patient should be sent to the hospital along with the ruptured part immediately.
After suture, there might be oozing from microscopic bleeding spots. A drainage tube or pressure bandage might be required to stop bleeding and reduce edema. Wound care becomes very simple after suture as the wound has been cleaned, especially for post-surgical wounds; however, for wounds with oozing blood or possible infection, frequent dressing change will be required.
Wounds from surgeries conducted via endoscope and various imaging technique to allow surgeons to perform the surgery without a huge incision.
During cesarean sections, incisions will be made either in a transverse or vertical fashion. The former leaves a nicer looking scar while the latter achieves faster result and is more suitable for emergency conditions.
Transverse wounds: The wound is located at approximately 3 to 4 cm above the symphysis pubis and is about 10 – 15 cm long. The transverse incision goes from the skin, subcutaneous tissue to the fascia and turns vertical at the rectus abdominis muscle before entering the abdominal cavity from the midline.
Vertical wounds: The wound is located at the midline between the navel and symphysis pubis and is about 15 cm long.
In general, there are two ways to close the incision of cesarean section. One requires the removing of stitches after the surgery while the other uses catgut which can be absorbed by human body.
The flaps are from the surrounding flaps near the injured site. Make one or several supplementary incisions from the edge of the wound to the closing site. A slide detachment is performed on the skin and subcutaneous fat to form one or several pedicle flaps, which are slid over to cover the wound. The flaps closing the wound are sliding flaps; flaps rotated into the wound are called rotation flaps. As these flaps are obtained from the site immediately adjacent to the injured site, the thickness, color and toughness of the flaps all fit the requirement of the injured site. Usually it only takes one surgery to repair the wound with this type of flap (two at most, i.e. one delay). It does not require special fixation; however, the defect at the donor site must be taken care of immediately. For the site with a small donor flap, the defect can be sutured directly. For those with a large flap where the defect cannot be sutured directly, a free skin grafting must be performed to repair the wound. Regardless of direct suture or skin graft, a new scar will form on the surface, affecting the appearance of the skin.