Besonderheiten in der Erstversorgung von Brandverletzten

Abstract

Burn Surgery Today. Burn Trauma requires immediate fluid resuscitation. The initial fluid replacement therapy is based upon a rough estimation of burn size by the 1 % = palm of one hand rule. As soon as the extent of injury has been assessed, the decision to transfer the patient to a specialized burn center should be made. The criteria for transfer are burn size over 15% TBSA in adults and over 10% TBSA in children, burns to the face, hands, genital region or any significant size third degree burn. In small burns (< 15% TBSA in adults and <10% TBSA in children) cold water irrigation may be used for pain control, while in larger burns cold water is contra-indicated because of the danger of hypothermia. Only in chemical burns is warm water irrigation recommended to neutralize the substance. After transfer to a burn center and initial stabilization the surgical removal of burn eschar should be completed by 72 hours post burn. At least a temporary, if not a final, closure of the wound should be achieved. Various synthetic materials have been developed for this purpose and allograft and xenograft are employed to substitute for limited autograft donor sites. While the necrectomy has not been completed, topical ointments are being used to prevent bacterial colonization (Flammazine®, Sulfamylon®-Mafenidacetat, Betaisodona®, Hibicet®-Chlorhexidin etc.). After grafting the grafts have to be protected from shear forces by immobilizing dressings for approximately 3-5 days. Burn patients are per se immunocompromised and have to be isolated until wound closure is achieved, to prevent infection. Prophylactic use of systemic antibiotics is not recommended. The presence of inhalation injury adds a special challenge. Probability of survival decreases significantly with the presence of inhalation injury and pre-existing conditions. After wound closure and acute rehabilitation the phase of secondary reconstruction begins. The necessity for reconstruction is partially influenced by the choice of donor sites and thickness of graft during the initial grafting procedures. Any procedure has to be planned carefully and only the interdisciplinary approach promotes early reintegration.