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How to Manage Hot Water Burns

Most superficial and superficial partial thickness burn wounds will heal on their own. These are typically hot water or hot liquid contact burns, steam burns and such like, where contact times with the heat source is minimal and the heat of the substance dissipates quickly.

Once the epithelial layer of the skin has been injured its response is to form a blister. Taking care of blisters can be tricky. If they haven't burst then leaving them alone is an option and simply applying a topical ointment antiseptic/antimicrobial ointment (bactroban/fucidin) will suffice. However, if the blister is large it might catch onto clothing and tear; or the blister may spontaneously open. Once the blister has opened the fibrinous liquid jelly content of the blister (the bodies healing fluid) now forms a concentrate which is potentially exposed to bacteria. Therefore it is advised to remove all the skin of the blister and gently wash off the fluid from the wound.

The open wound can then be dressed with a non-adherent contact layer such as vaseline gauze (jelonet) or silicone based gauze (adaptic) with an antiseptic ointment, then covered with cotton gauze and a bandage. However this will require daily or every second day dressing changes. These can be time consuming and sometimes painful particularly in children.

Alternatives to these are epidermal substitutes membranes (eg. biobrane). This membrane can be stitched over the burn wound area under anaesthesia. The advantage being that this will be a once off dressing; peeling away by itself after 3 weeks leaving the regenerated skin behind. No dressing changes, reduced pain. Earlier ability to mobilise the hand.

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