Consultant, Plastic Surgery and Burns
Plastic Surgery and Burns Consultant, Chelsea and Westminster Hospital
From first aid to reducing scars, new knowledge and technology is helping medical staff to bring faster, easier, better treatment for burn patients.
“Tackling burns and optimising wound care starts with prevention,” says Declan Collins, Plastic Surgery and Burns Consultant at Chelsea and Westminster Hospital. “The rise in acid attacks has fuelled calls for better burn prevention, and a new campaign to prevent firework burns launches in 2018.”
At the same time, new knowledge and technology is improving treatment.
Knowing essential first aid for immediate treatment
Contrary to common misconceptions, we should run burns under lukewarm (rather than cold) water for 20 minutes. “Very cold or iced water, or applying ice, reduces the flow of blood to the wound potentially further damaging the tissue and slowing healing,” says Collins.
Accurate assessment of the extent of burns before treatment, to replace the fluid lost as a result of the burn (called resuscitation), is administered is paramount. “Apps, which assess the extent of burns and calculate the resuscitation required in seconds, are now being used by health care practitioners,” says Collins.
Glue made from patient’s blood used in skin grafts
Small burn wounds can be excised and closed, but larger burns require skin grafts.
Traditionally the graft was stitched or stapled over the burn wound, but now fibrin glue, made from one of the body’s clotting factors, can be used. Fibrin glue made using the patient’s own blood reduces the risk of and disease transmission and makes dressing changes more comfortable for the patient.
We can make a cell suspension from the patient’s own epidermal cells; made in theatre and sprayed over the meshed skin graft.
Where large skin grafts are required, a meshed piece of skin is used to cover the wound, “This does not always lead to attractive scars but now we can make a cell suspension from the patient’s own epidermal cells. Made in theatre and sprayed over the meshed skin graft, it promotes healing and potentially better appearance,” says Collins.
For very large areas, the patient’s cells can be grown into a cultured epithelial autograft in a laboratory, but this takes around three weeks. Meanwhile, to temporise the wound until definitive closure can be achieved skin taken from a donor cadaver is used – a long-proven technique.
Synthetic dermal substitutes have been used for many years, Collins says: “Currently, research groups are taking this further by using 3D printing techniques to create skin substitutes with characteristics added to improve immune response and promote healing.”
Technologies not yet in use but being investigated in the lab include injecting stem cells to change the environment of the wound and tissue engineering of stem cells.
Managing appearance of scars with laser drilling
In the past, scar treatment was limited to moisturising creams, massage, steroids and surgery.
Now, lasers are being used to create tiny holes in scar tissue so collagen can enter and remodel the scar. “Carefully-timed treatment can start as little as three months after the burn,” says Collins.
Meanwhile specialist burns rehabilitation units – some offering patient accommodation – offer treatment by a multidisciplinary team, to speed patients’ return to everyday life.