4 Burn Wound Care

Principles of burn wound care

Burn care depends on the wound’s depth, location, drainage, healing, and the patient’s ability to manage care. Follow the treating clinician’s instructions. Suspected deep, extensive, or high-risk burns need specialist assessment.

Recognizing burn depth

A superficial partial-thickness burn is commonly moist, red, blanches with pressure, may have blisters, and is very painful. These features best fit the described moist, red, blistered wound that blanches and is very painful.

Deep partial-thickness burns are often drier and paler, blanch less, and may be less painful. Full-thickness burns may look leathery and have reduced sensation. Burn depth can be mixed and may become clearer with reassessment.

Assessing and documenting the wound

Wound assessment should record the burn’s location and estimated area, its appearance and signs that suggest depth, drainage, and changes in the wound or surrounding skin. Record pain as well. Follow movement and sensation when relevant, especially for burns near the hands, feet, or joints.

Repeated assessment helps identify changes in depth, healing, and the care plan. Monitor how the wound changes over time rather than relying on a single observation.

Cleansing and managing loose tissue

For a burn being managed outside a burn center, gently cleanse with mild soap and water or a recommended wound cleanser, then rinse. Remove loose debris without unnecessary trauma; do not scrub firmly with a dry brush or apply ice directly to burn tissue.

Ruptured blisters and loose, devitalized tissue may need removal. Decisions about intact blisters depend on the wound and the clinician’s plan. Debridement should be performed by someone trained to assess what tissue is viable; patients should not cut away tissue themselves.

If transfer to a burn center is planned, ask the receiving team whether to cleanse or dress the wound before transfer.

Choosing and changing dressings

Protect the wound with a sterile, nonadherent wound-contact layer and enough absorbent outer material to manage expected drainage. Dry, adherent gauze placed directly on the wound and wrapped tightly is not the recommended approach described here.

Follow the dressing product’s change schedule. Dressing types differ, and some specialty dressings remain in place longer than simple gauze; do not assume every type should be changed at the same fixed interval.

Managing pain during wound care

Plan analgesia before wound care and match the approach to the patient and procedure. Adequate pain relief supports thorough cleansing and dressing changes. If procedural pain is severe, more than routine home measures may be needed. Reassess whether the pain-relief plan is working, particularly if pain is causing the patient to avoid care.

Monitoring healing and deterioration

Increasing redness that spreads beyond the wound, worsening pain, or new or increasing drainage can signal infection or deterioration and merits prompt clinical review. A wound becoming smaller with new skin forming is a sign of healing, while mild discomfort during a scheduled dressing change that improves afterward is distinct from worsening pain.

Continue to monitor wound appearance and follow the product-specific dressing instructions. A dry dressing remaining in place for the interval specified for that product is not, by itself, the worsening change described above.

When specialist assessment is needed

Seek burn-specialist consultation for potentially deep burns of any size. A potentially deep burn over a major joint warrants specialist consultation because depth, healing, and function may require specialized care. For deep burns involving major joints, immediate consultation with consideration for transfer is recommended.

Do not wait for infection before seeking advice about a potentially deep or high-risk burn. The exact care plan depends on the burn and should follow the treating clinician’s instructions.

• Nonadherent dressing