53 Y Female was exposed to boiled water which fall on her abdomen. She left the burn untreated and scab formation occurred. TBSA expected 1-4% , probably superficial partial thickness burn. How would you manage this burn? Peel the scab and create a moist wound environment? Or what procedures would you follow now after the scab has formed?
We don't know the period between the injury and visit to the doctor...But, I would like to see the wound under the scab anyway. if the wound seemed uninfected, for an unpainful peeling of the scab, I would like to moist it with a 24 hour wound dressing with silver sulfodiazine, next day, peel the scab and give the decision according to the wound's depth. In a clinically infected wound, I would prefer a prompt debridement of the scab, obtain wound tissue culture, apropriate wound care for a few days and then give the decision.
So Dr.Ayse, you will peel the scab in both cases whether infected or not? Is this better than leaving the scab? If so, what will be my next step after peeling the scab in case I found uninfected wound and 2nd degree burn (superficial partial thickness)? Will I continue with silver sulfadiazine covered by dressing daily and that is it?
It has been 4 days since the injury and today is the first day in which the scab formed
If the wound is clean and superficial 2nd degree, the wound must be kept clean, and moist enough, so it can heal itself. For a good healing environment suitable open or closed wound dressings are used. In this period, for a comfortable and qualified period of healing,(according to resource settings) first choice will be a product such as aquacel, ag, biobrane, suprtahel, mepilex etc. . All of them have have their own instructions which must be known before using.
If not possible silver sulfodiazine is of course one of the choices. The wound is to heal uneventfully in a short period of time in standart conditions.
If silver sulfodiazine is used, it is important to use SF or sterile water when opening the wound dressing (reduces the pain), and to take away the pseudoeschar which is created by the SSD and wound secretions on the wound surface. If clean, wound dressings may be changed on alternate days.
You would need to determine the depth of the burn and predict healing potential: whether it will heal spontaneously or would need excision and grafting. If grossly infected the wound needs to be debrided early. If not the wound could be dressed with silver sulfadiazine for a few more days to see if the "scab" separates off which would allow you to reassess better.
If you still would have a layer of ?eschar after a week the burn wound is most likely deep and would need excision and grafting.
Posting a picture would help a lot.
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