B. Hartmann, Ch. Ottomann

another substance which should not be used for disinfecting wounds.

Wound dressings/Bandages

Currently, the market is flooded with an almost unlimited number of high-quality wound dressings. When providing outpatient burn treatment, products should be used that simultaneously fulfill several criteria. The products should have the proper structure and absorbency to allow patients to keep the dressings on the wound for a number of days. Ideally, they should be suited for use in combination with topical therapeutic agents (polyhexanide gel) within the scope of moist wound treatment. We prefer silicon-coated wound coverings, which prevent the dressing from sticking to the newly-grown epithelium in the wound bed. Ideally, such dressings can be left on the wound until the wound is completely healed. In this context, one must only change the absorbent outer bandages and apply new polyhexanide gel, if necessary.

When treating superficial burn wounds, paraffin gauze dressings should not be used, as they can dry out relatively quickly and stick to the wound bed. This can cause wound healing problems when removing the dressing [33].

When appropriate, biosynthetic membranes such as Suprathel or Biobrane can also be used on superficial burn wounds. However, the use of these products requires the treating physician to be especially good at evaluating wounds, and also calls for primary radical debridement of the wound surface. In addition, these products are fairly expensive. Due to these reasons, they are only used in outpatient wound treatment in individual cases and under the supervision of trained specialists.

As a matter of principle, dressings should be sufficiently thick, absorb moisture, and be padded. When burns cover joints, certain cases might call for a splint to be used to immobilize the area for a short period time.

Course of treatment

After providing initial treatment, primary debridement, and dressing and bandaging the wound, the further course of treatment calls for follow-up exam-

inations. Depending on the selected dressing regime, dressings must be examined and changed regularly. As mentioned above, treatment strategies should be pursued which offer the greatest possibility for the dressing to remain on the wound, as doing so prevents complications during wound healing. Clinical examinations deal with clear signs of infection such as reappearing pain, redness around the wound, fever, and the patient complaining of feeling sick. Laboratory tests of the inflammatory parameters may also be required in certain cases. Without wound healing complications, grade IIa° burns, which fall under the domain of outpatient treatment, completely heal without any scarring within a period of one to three weeks [34].

Complications

Both infections and/or the failure of the wound to heal represent complications which can occur during the aforementioned course of treatment. Both of these cases are serious and should lead to the patient being admitted to a specialize burn treatment facility.

Infections

Burn wounds are usually colonized by germs, and topical treatment should prevent the occurrence of relevant wound infections [28].

The occurrence of pain, fever, exudation, redness, smells, and illness should always lead to the patient’s admittance to a specialized facility. In addition to the danger of a systemic infection (sepsis), infections of the wound surface also cause delayed wound healing and as a result, ultimately lead to a worse healing result.

If an infection occurs, conducting a swab examination to determine the pathogen makes sense. In most cases, the treatment regime should be changed, regardless of the diagnosis. As previously explained, an infected burn wound represents an indication for admittance to a burn center for treatment. Whether the use of systemic antibiotics is required must be viewed as dependant on the patient’s general condition.

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