Burn Center

Treatment of severe burn injuries

Burns are among the most serious injuries a person can suffer.

The extensive destruction of the skin disrupts the entire biological balance of the organism and extensive scarring leads to visible disfigurement.

For this reason, burn patients of all ages should be referred to a burn center for optimal treatment. With the specialist medical and nursing expertise available there, state-of-the-art equipment, technology, intensive care and all options for skin replacement, it is possible to alleviate the consequences of severe burns and achieve the best possible functional and cosmetic results.

Indications for transfer to a burn centeraccording to the internationally agreed criteria(in accordance with the DGV guidelines)

• All patients with burns to the face/neck, hands, feet, anogenital region, armpits, areas over large joints or other complicated localization
• Patients with >15% second-degree burns on the body surface
• Patients with >10% third-degree burns to the body surface
• Patients with concomitant mechanical injuries
• All patients with inhalation injury
• Patients with pre-existing conditions or age 8 years or >60 years
• All patients with electrical injuries

Burn center

The correct assessment of the extent of the burn injury is a prerequisite for successful treatment right from the start. Burn centers have an air-conditioned shock room in which aseptic (germ-free) initial treatment is carried out.
The correct assessment of the depth of the burn determines further treatment, in particular whether surgery is required to remove the burnt skin and replace it with skin grafts. In the acute early phase, intensive therapy is required to maintain vital functions, but above all to replace the enormous loss of fluids.
After stabilization, phase-appropriate operations are then performed to replace skin in order to achieve the best possible result.

Qualified rehabilitation treatment is essential for the recovery of physical function, but above all for the restoration of mental balance. To this end, we work closely with specialized rehabilitation facilities. Further measures, such as necessary plastic surgery corrective operations, can then be decided there.
Our burns center is characterized by the highest treatment standards and early implementation of improved research results.

For example, we were the first in the world to introduce medical microneedle therapy to improve burn scars and are constantly working on improved skin replacement to alleviate the after-effects of burn injuries.

The European Burns Association has certified the MHH Burn Center as one of the first in Europe due to its recognized high treatment standards and research achievements.

Skin grafts

Superficial burns with blistering heal spontaneously with professional treatment and usually leave no visible scars. One of the aims of treatment is to prevent so-called post-burn deepening with a lack of self-healing. To this end, intensive aseptic wound treatment is carried out using special gels, foreign skin or membranes.

If the burns are deeper or have deepened (deep 2nd or 3rd degree), i.e. if spontaneous self-healing through regeneration of the epidermis is no longer possible, a skin graft must be performed. This is usually carried out from the patient's own body, e.g. from the thigh. Thin layers are removed from the donor area and transplanted onto the cleaned burn areas. The donor sites heal within 10 days.

Nursing and moisturizing ointment treatment of grafts and donor sites is important.

Skin substitute

If there is not enough of the patient's own donor skin available for extensive burns, skin substitutes must be used.

A distinction is made between temporary and permanent skin substitutes. Temporary materials consist of biological or synthetic material and are only used on a temporary basis. Only biological skin substitutes that are permanently integrated into the body are able to replace the special properties of human skin (sensitivity, elasticity, texture, etc.). We are working intensively on these scientific issues ourselves.

Aftercare

Unfortunately, a deep burn wound never heals without scarring. This can lead to functional or aesthetic problems. The scars can be conspicuously colored, raised (hypertrophic) or appear as scar strands. Nursing the skin with ointments and wearing compression garments and silicone-containing pads are conservative treatment measures to reduce or improve scars.

All patients (adults and children) who have suffered a burn are treated in the burn aftercare consultation. In this special consultation, options for the conservative and surgical treatment of their scars are discussed in detail with the patient and, if necessary, determined. As a rule, multiple consultations are necessary.

Many burn scars can be improved using special plastic surgery techniques. Surgical treatment methods include excision, i.e. cutting out the scar (which may need to be done several times as a so-called serial excision), skin expander treatment, Z-plasty, tissue transfer and medical needling.

Correction of burn injuries

Burn patients are affected by extensive burns due to the extensive expansion, aesthetic disfigurement of visible parts of the body and functional limitations.

Corrections can be made using conservative procedures alone, surgery or a combination of both.
While conservative therapies should generally be applied as early as possible, surgical procedures should only be carried out once the scars have matured. Exceptions are particularly severe functional impairments, which also justify early surgical interventions.
Severe scarring, especially in children and adolescents, can lead to growth and development disorders, so that early consultation with a plastic surgeon is recommended with the question of corrective surgery.

Scar treatment

Wound healing and thus scarring is individual and depends on the conditions in which the development of wound healing to scar healing occurs. For example, diseases such as diabetes, smoking (impaired blood flow to the wound edges) or cortisone therapy are unfavorable for rapid scar formation without complications. Furthermore, wounds that are sutured under tension can lead to widened scars during scar healing. Recent studies have shown, among other things, a genetic defect in scar formation, whereby "soft" collagen (connective tissue) cannot be converted into the definitive "hard" collagen.

We recommend scar correction at the earliest about one year after injury or suturing. However, in each case it is decided individually with the patient whether and when the right time for scar correction has been reached. Surgery should be avoided if scar formation is not yet complete, which can be recognized by a red scar, for example. In the case of proliferating scars, conservative therapy using special dressings or injections (Volon A) into the scar area is initially advisable.

Depending on the location and extent of the scar, surgery can be performed under local or general anesthesia. In either case, the scar should be completely excised. As a rule, direct wound closure can then be achieved without tension. In individual cases, local skin plasty or preliminary operations (expanders) are necessary to close the defect.

The technique of medical needling has become very important, with which impressive improvements in scar appearance can often be achieved using a gentle and minimally traumatizing technique. You can find out more about this method, which we were the first to introduce into the treatment of complicated scars on the basis of thorough research, here: "Therapy of hypertrophic scars and keloids"

We will be happy to advise you in detail and work with you to develop a concept for the appropriate treatment of your scars.

Tissue ablation (laser resurfacing, dermabrasion) or chemical peelings are the methods of choice for the treatment of sun-aged, wrinkled skin or for the treatment of annoying scars (e.g. pregnancy marks or burn scars). However, ablative surgical procedures or peelings are ablative or "abrasive" procedures that injure the epidermis and can damage the skin's basement membrane. The wound healing cascade is induced by the resulting superficial wound. An exudation (inflammation) phase, granulation (proliferation) and epithelialization phase are passed through in succession, but also overlapping. The inflammation induced by tissue ablation stimulates certain skin cells (fibroblasts) to produce scar collagen instead of normal skin (collagen-elastin matrix). The resulting scar in the dermis leads to skin tightening or scar smoothing. Histologically, however, the regenerated epidermis is thinner and the connecting layer between the epidermis and dermis is flattened. The skin becomes more susceptible to UV rays and there is a higher risk of pigment shifts, especially in darker skin types. However, the biggest disadvantage is the risk of new scarring.
The ideal therapy for any type of wrinkles or scars should therefore increase the skin's self-renewal through regenerating messenger substances without significantly damaging the skin. Recently, the Laboratory for Experimental Plastic Surgery at Hannover Medical School demonstrated that percutaneous collagen induction therapy, or microneedling, brings us closer to this ideal.

Indications:

• Wrinkles
• Sun-damaged skin
• Stretch marks
• scars
• Burn scars

Technique
The natural inflammatory reaction in the skin is induced by a roller with 3 mm long needles. During the operation, the plastic surgeon moves the instrument under controlled pressure vertically, horizontally and diagonally over the skin of the area to be treated. The pinpricks create thousands of micro-wounds in the dermis and stimulate skin cells (fibroblasts) to produce collagen. Medical needling can be used on all areas of the body and on all skin types. The procedure can be performed either under local anesthesia or under short anesthesia.

Procedure after the operation
Immediately after percutaneous collagen induction, the treated area is swollen and discolored like a bruise. The bleeding stops spontaneously after a few minutes. The skin secretes wound fluid via the puncture channels within the first few hours. Moist compresses should be applied to the skin during this time to prevent crust formation. Approximately one hour after the operation, the skin is cleaned with an antiseptic washing lotion. Tea tree oil wash gel has proven effective here. To maximize collagen production and initiate the release of growth factors, we recommend local vitamin A and vitamin C therapy. The procedure is extremely painless for the patient. After about a week, the swelling is barely visible.

Advantages/disadvantages
One advantage of medical needling is that after only the epidermis and the basement membrane are punctured, the patient's wound is closed again after just a few hours. This minimizes the risk of infection and significantly shortens the healing phase. As a result, the procedure can often be performed on an outpatient basis. This is particularly advantageous for patients who associate traumatic experiences of their burns with hospitalization. Last but not least, the socio-economic aspects such as low treatment costs are also achieved. Compared to the other procedures mentioned above, the so-called convalescence of the patient is extremely low. Laboratory tests have shown that a tissue substance (TGF β 3) is released immediately after the operation, which leads to scar-free healing of the skin. Since the cells anchored on the basement membrane, which are responsible for the pigmentation of the skin (melanocytes), are not damaged, there is no risk of a postoperative pigment shift. Minimizing the risk of scar re-triggering is therefore one of the most important clinical benefits achieved. After medical needling, certain endogenous growth factors are released in the first few months after the operation, which lead to regeneration of the epidermis and dermis. The disadvantages are that the operations can only be carried out under anesthesia and that there is considerable swelling in the first four to seven days after the procedure.
After appropriate assessment by the statutory health insurance companies, the costs of medical needling for the treatment of burn scars can be covered.