The importance of treating burns both surgically and psychologically

In the past, most second and third-degree burns occurred at the workplace. Today, however, most burns happen at home, transforming it into much more of a domestic hazard. Nevertheless, following the proper steps in treating a burn is crucial not only to ensure the affected person’s safety but also their mental well-being.

To shed some light on this process, Dr Fabrizio Malan, specialist in reconstructive and aesthetic plastic surgery, shares his experience as Head of Plastic Surgery at Turin’s Orthopaedic Trauma Centre Severe Burn Unit. 

Time is key in treating burns

According to Dr Malan: «Most accidents that happen nowadays involving burns occur in the domestic setting, or in a sort of semi-domestic setting. In other words, many people get burned in their gardens or in the fields around their homes while burning stubble, doing small chores, or in household accidents, whether it is while cleaning or due to cases of negligence, such as people who smoke and fall asleep in bed».

Despite occurring in a safer environment, treating burns immediately is paramount. Unlike pinpoint lesions, burns do more damage as minutes pass. «Therefore – Dr Malan explains – the first thing to do is to try to lower the temperature of the area affected by the burn, so cold water, for example, is already a good first measure».

Following recovery, it’s important to create a treatment plan. Often, before considering any sort of plastic reconstructive surgery, the patient has needs of a resuscitative type. Dr Malan emphasises how «maintaining hydration, and preventing multi-organ syndromes, is crucial. Plastic surgery plays a role at this stage, by removing necrotic tissue, since necrotic tissue is always a potential source of infection».

Therefore, removing necrotic tissue is an important step. This must be done under sterile conditions, and it is also essential to provide initial coverage of these areas, because the exposed regions, where tissue is no longer present,  cause very severe dehydration, which can be fatal. 

«And this is the reason why, by using tissues from the tissue bank that we have had for several years here in Turin, it serves as a temporary coverage that allows us to drastically reduce the exposed surface area after a burn».

The psychological aspect of treating burns

Suffering from a burn can be extremely difficult for people. Unlike many diseases and conditions, burns can completely change one’s life in an instant. This is why offering patients psychological support is key. As Dr Malan explains: «reconstructive and aesthetic plastic surgery comes into play later, when we need to provide definitive coverage of the burned areas, and at the same time, we also need to try to make the scars as tolerable as possible». 

Furthermore, Dr Malan stresses the importance of having a trained team to provide psychological support to patients. «The psychological aspect is fundamental because, as I mentioned earlier, burn injuries are, essentially, irreversible injuries in many cases and in many areas of the body».

This more human approach has only begun in recent years. Dr Malan explains: «From a mental and psychological approach of those who carry out these treatments, the key difference is treating the patient not just clinically, but as a whole person». No longer is the focus on merely curing the condition or disease, but it’s about healing the person. 

This more ethical approach goes hand in hand with scientific progress in the field. «There are scientific approaches mainly aimed at finding ways to perform escharotomies, that is, the removal of necrotic tissue, in a less traumatic way and, if possible, through non-surgical methods». In addition, Dr Malan mentioned the use of some new natural products based on proteolytic enzymes, enriched with bromelain extracted from pineapple stems. «However, it must be applied after adequate training». These are products that improve the healing process and help reduce treatment times.

Nevertheless, an important element that must not be overlooked is the availability of tissue from the skin bank. «Thanks to the skin from donors – Dr Malan concludes – which is processed, completely sterilised, and in some cases even decellularised, it is possible to have these temporary coverings, which are truly life-saving».