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CHAPTER 28

Burns and Burn Deformities

Serious burns are common in villages where people cook, warm themselves, or sleep by open fires.

First aid for burns is discussed in health care manuals, including Where There Is No Doctor. Here we discuss only the precautions that can be taken to help prevent deformities and disabilities from burns.

The most common deformities resulting from severe burns are contractures, and the scarring, or sticking together, of skin around joints. For example:

Lupito slept too close to the fire and his blanket caught fire.	He was badly burned under the arm and behind the knee.
As he was healing, Lupito lay with his arm and leg bent. This kept the air away from the burns, and they hurt less.	But as a result, the skin scarred to itself. After the burns healed, Lupito could not lift or straighten his arm or straighten his leg.

TO PREVENT SCARRING TOGETHER OF THE SKIN AT JOINTS:

Keep the joints extended (straight) while the burns heal. You may have to support or tie the limbs so that the child does not bend them in his sleep.

For burns between fingers or toes, keep them separated with sterile cloth pads with Vaseline.

To keep the chin from scarring to the chest, it is very important to keep the head tilted up as the burns heal.

TO HELP BURNS HEAL: When possible, leave the burns open to the air.

Protect against flies and dust with mosquito netting or by covering the burns with light gauze.

To keep the blanket or mosquito netting off a burned part of the body, cut a cardboard box or make a frame to hold it up.

If burns need to be covered, you can put petroleum jelly (Vaseline) on sterile gauze or sterilized cloth and gently cover the burn.

To help healing, and to prevent or control infection of deep or open burns, you can put bees' honey or sugar directly on the burn. Or make a paste of bees' honey mixed with sugar. It is important to wash the burn with water that has been boiled and cooled, and to put on fresh honey 2 or 3 times each day. (if the honey gets too diluted with oozing from the burn, it will breed germs rather than kill them.)

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Ways to help burns heal faster and better

Skin grafts

Large deep burns heal very slowly and form ugly stiff scars. Healing can be faster and scarring reduced by using 'skin grafts'. A very thin layer of skin from another part of the body is stretched over the burn. Usually this is only done by a surgeon (although some village health workers have been taught how to do it).

Also, to speed healthy healing, you can use the fresh 'bag of waters' or transparent membrane that comes out with the placenta after child-birth.

This sac must be kept clean. Wash it in boiled and cooled, slightly salted water, and put it on the burn as soon as you take it out of the water.

RANGE-OF-MOTION EXERCISES

As soon as burns are covered with new skin or by a scar, gently begin range-of-motion exercises. Slowly straighten and bend the affected joint-a little more each day.

For exercise details, see Chapter 42. If scarring is severe, you may need to continue range-of-motion exercises for years after burns are healed. Scar tissue does not grow and stretch like normal skin. Skin contractures often form and may slowly get worse - sometimes even with exercises.

Before beginning exercises, it helps to rub body oil or cooking oil into the healed burn (but never into a fresh burn). Reports from several parts of the world claim that fish oil on healed burns helps prevent thick scarring and skin contractures.

SURGERY

When joints are scarred down or severe contractures form after burns, 'plastic surgery' may be needed. Sometimes skin is taken from another part of the body and used to add more skin over the joint area (a skin transplant).

In case of severe burns that have destroyed fingers or thumb, special 'reconstructive' surgery may help to return use of the hand. (This surgery is very costly and usually can only be done by special surgeons in larger hospitals.)

For example, if the thumb has been destroyed, sometimes a finger (or toe) can be attached to the end of the stump so that the child can grasp things better.

PREVENTION of burns is important: