Surgical Interventions to Release Burn Swelling

Posted on September 29, 2009 by Kristine Meredith

Victims with full thickness burns, as discussed here, on their arms and legs experience tremendous swelling from the fluids necessary to heal. The swelling puts pressure on the nerves and tissues of the healthy sections of the burned limbs.  The pressure may cause a complete loss of blood flow and tissue damage to the distal limb.  To relieve the pressure and promote blood flow, the burn surgeon may perform the following procedures:

  • Escharotomy -- slitting of the burned skin (eschar);
  • Fasciotomy -- slitting of the burned  skin and splitting of the fascia (the thick white covering of the muscle) to inspect how the muscle is doing.

Although gruesome, the surgeons often take photos before and after the procedure to document the health of the tissue and progression toward recovery.  Such photos may be helpful to educate the jury about the victim's pain and suffering.

 

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The Burn Pain Myth: "full thickness burns are not painful because the nerves are destroyed".

Posted on June 12, 2009 by Kristine Meredith

Full thickness (third and fourth degree) burn victims suffer pain: 

  • Nerves may partially function.  
  • Burns on arms and legs cause swelling and pressure on the nerves and tissues of the healthy sections of the burned limbs.
  • Repeated painful interventions to prevent infection and promote healing.

Burn pain worsens over time:

Unlike other types of trauma, in which pain over time plateaus or diminishes, the interventions necessary to prevent infection and promote healing actually worsen the pain of burn injury. 

Pain continues after scars heal:

  • Joint and skin stiffness 
  • Relentless itching
  • Emotional pain of scars and physical deformity

Because of the long, complicated, painful path to recovery, we advise family members of burn victims to photograph the various medical interventions necessary to promote recovery. Photographs of the stages of recovery may help the victims see their improvement and communicate the painful recovery process to a jury.

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Partial Thickness and Full Thickness Burns

Posted on June 11, 2009 by Kristine Meredith

Overview of burn depths

 Partial thickness burns:

 First degree burns (superficial):

  •  May blister and peel in a few days (ie. sunburn). 
  • Heals in 3-6 days
  • Generally no scarring
  • Topical creams provide relief
  • Antibiotics not needed
  • Drink water

Second degree burns (deeper partial thickness):

  • Blisters are typical.
  • Heals in 14-21 days.
  • Blisters provide biologic dressing and comfort. (Don’t be in a hurry to break the blisters.)
  • Once blisters break, red raw surface will be very painful.
  • Usually do not require surgery.

Full thickness burns:

Third degree burns (full thickness): 

  • Waxy, white, tan or charred and possibly blistered.  
  • Swelling and hair loss are always present. 
  • May have areas of no sensation because the nerve endings are damaged. 
  • The area surrounding the full thickness burn is usually painful.
  • Natural healing of small burns is possible but with risk of infection and scarring. 
  • Surgery is usually required. 

Fourth degree (deep full thickness):

  • Charred and hard to the touch.  
  • The burn extends past the dermis into the tissue, muscle and bone. 
  • Even after the skin is no longer in contact with the heat source, damage may continue in the remaining cells. 

 

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