Conservative or local treatment of burns is one of the few treatments that came to us from ancient times, but it is still widely used along with much more modern and progressive methods. The use of a conservative method of treating burns is determined by the extent of the affected surfaces and the stage of the wound process.
It should be noted that of all hospital burn patients, approximately 80% are subjected to conservative treatment, and if we take into account that in case of deep burns, as a primary therapeutic measure for preparation for surgery (to ensure the survival of skin implants), local treatment is used, then coverage reaches 100%.
The basis for conservative treatment of burns is an aseptic dressing applied in order to avoid infection on the affected surface and primary treatment of the burn, which is carried out either immediately or on the following day with the first change of the dressing (if the burn is small) or on the second or third day in case The wound is severe and there are all signs of a shock condition.
Primary burn treatment
Primary treatment of the burn includes 4 stages:
- Washing with antiseptic solutions of the skin surface adjacent to the wound. As antiseptics apply 0.25% solution of ammonia, furatsilin, 3% solution of boric acid, or just warm water with soap.
- removal of wounded foreign bodies, remnants of the epidermis, fibrinous overlays, using tweezers, a tampon and a sponge.
- re-rinsing with an antiseptic and drying the wound with sterile wipes.
- application of a dressing impregnated with an antimicrobial agent.
In certain cases (deep lesion), primary treatment is performed under anesthesia, using both conventional analgesics and, if the situation requires, narcotic drugs.
Closed method of treatment of burns
All of the above applies to the closed method of treating burns. If the patient is outside the hospital, this is the only possible method. In addition to protecting against infection, the bandage also protects from the adverse effects of the environment (temperature and humidity fluctuations, foreign bodies, air currents), is indispensable for transportation of the patient, to some extent dulls pain, concentrates the medicinal product in the near-wound region, absorbs the wound detachable .
Open method of treatment of burns
There is another, open method of treating burns. It lacks some of the shortcomings inherent in closed (pain in bandaging, a significant expenditure of dressings and medicines), but it is quite demanding: the necessary condition is to create a sterile environment around the wound, which can be achieved only with the help of special equipment (UV irradiators) in a hospital. This method is very convenient for burns on the face and in the genital area, that is, where the presence of a dressing is undesirable.
Half-open or semi-closed method
Just as half the glass is empty or full, there is still a so-called half-open or semi-closed method, as you wish. Its essence is this: after the initial treatment, a thin bandage impregnated with an antibacterial agent is superimposed and fixed with bandages on the wound. Then the dressing is exposed to warm air (hair dryer) or infrared radiation, so that it sucked to the wound. After 2-3 days, bandages are removed, the dressing is treated with a solution of betadine or iodonate. And all: the bandage remains until the final healing. And if there is suppuration, only the patch of bandage over suppuration is removed, the wound is re-treated with an antiseptic and re-closed with a bandage. After 2 weeks, the dressing is removed.
Preparations for the treatment of burns
As antimicrobial agents for the conservative treatment of burns, in addition to those already mentioned, solutions of all hydrophilic antibiotics, dioxidine, chlorhexidine bigluconate, antiseptic in the form of aerosols (olazol, polcortolone TS), ointments and creams on a water-soluble basis (levosin, dioxidine) are used. The choice of a specific antibiotic is determined by the species composition of the microflora of the wound. It should be remembered that the resistance of bacteria to antibiotics is formed faster than to antiseptics (1-2 weeks).
Separately, I want to focus on preparations based on sulfadiazine silver in the form of ointments and creams. Currently, these drugs without exaggeration are the best choice for conservative treatment of burns. In our country the following trade names containing this pharmacologically active substance are registered: Estonian sulfargin, Slovenian dermazin, Bosnian argdin. The advantage of silver sulfadiazine-based drugs is a wide range of effects, efficacy against both gram-negative microorganisms and Gram-positive, as well as dermatophyte fungi. The ointment is applied to the wound with a layer of 2-3 mm, covered with a bandage and bandaged with bandages. The dressing is changed every other day.