Management of 2nd-degree Burns 二度烧烫伤的治疗

There are four factors that determine the depth of a burn: temperature of the contacting agent, duration of contact, thickness of skin and local blood supply. The threshold for a burn injury is around 43.5 degree C (110 degree F). Water at 66 degree C (150 degree F) will cause a full-thickness burn in only 2 seconds.

Any burn that does not penetrate the epidermis is considered to be a first-degree burn. Since the barrier is intact, the burn is dry and red. Minimal treatment (analgesia and moisturizer) or no treatment is required, and healing is very rapid.

A second-degree, or partial-thickness, burn penetrates into but not through the dermis. Because the epidermal barrier is lost, the wound forms a blister or, if uncovered, weeps interstitial fluid. Since the dermal plexus of vessels and nerves is intact, the wound will blanch with pressure and the pain will be severe.

A third-degree, or full-thickness, burn completely destroys the dermis and enters the fat.

Fourth-degree burns extend into muscle, bone, or tendon and need to be treated in burn centers, since they may require flaps or amputations.

A second-degree burn heals through reepithelialization. At the wound edge, the basal cells start migrating across the viable wound bed. Any wound that requires more than 2 to 3 weeks to reepithelialize has a high chance of becoming a hypertrophic scar. The goal of treating 2nd-degree burns is to encourage reepithelialization with topical Tangs Herbal ointment which heals the burn lesion with 2 weeks.

Burn 2degree 5

有四个因素决定烧伤的深度:接触剂的温度,接触的持续时间,皮肤的厚度和局部血液供应。烧伤的阈值约为43.5摄氏度(110华氏度)。 66摄氏度(150华氏度)的水会在2秒内造成全皮厚度烧伤。

任何不穿透表皮的烧伤都是一度烧伤。由于表皮屏障是完整,皮损处是干燥和红色的。只需要镇痛和保湿或者不需治疗,伤口愈合非常迅速。

二度烧伤渗入但不穿透真皮。由于表皮屏障丢失,伤口形成水疱,间质液流出。由于血管和神经的真皮丛是完整的,伤口会因压力而变白,疼痛会很严重。

三度烧伤完全破坏真皮并进入脂肪层。由于所有的血管系统和真皮神经被破坏,烧伤比二级烧伤疼痛少得多。伤口可以是任何颜色的,比浅表烧伤更干燥。

四度烧伤延伸到肌肉,骨骼或肌腱,需要在烧伤中心进行治疗,因为它们可能需要植皮或截肢。

二度烧伤通过上皮细胞再生治愈。 在伤口边缘,基底细胞开始在活的伤口床上迁移。 任何需要超过2至3周才能使上皮再生,那么伤口很有可能成为增生性瘢痕。 外用唐氏中药软膏治疗二度烧伤的目的是鼓励上皮细胞再生,在两周的窗口期治疗烧伤不留疤痕。

Wound_healing_phases

Reference:

  1. Greenhalgh DG, Lawless MB, Chew BB, Crone WA, Fein ME, Palmieri TL. Temperature threshold for burn injury: An oximeter safety study. J Burn Care Rehabil 2004;25:411-5.
  2. Moritz AR, Henriques FC Jr. Studies of thermal injury. II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol 1947;23:695-720.
  3. David G. Greenhalgh. Management of Burns. N Engl J Med 2019;380:2349-59. DOI: 10.1056/NEJMra1807442.
  4. Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J. Hypertrophic burn scars: analysis of variables. J Trauma 1983; 23:895-8.