Burns have been a major problem for humans eversince the discovery of fire and its applications. Problems associated with burn injuries are wide-ranging, and the social and economic impacts of burns affect the whole society. So, the search for solutions to prevent and treat this severe and often fatal injury is never- ending. As a modern approach, burn victims recieve care from a variety of specially trained health care professionals who work together in multidisciplinary teams at burn centers. In addition to patient care, scientific research and preventive measures are supposed to be held at these specialized centers.
BAŞKENT have been among the innovators of modern burn care in Turkey, since founded: ‘Başkent University Burn and Fire Disaster Institute’ was established by Dr Mehmet Haberal in 2000 within the structure of BAŞKENT. Currently, there are 3 burn centers affiliated with the institute. These burn centers are located in 2 different regions of Turkey: Adana in the south (burn unit established in 1997), and Konya (unit established in 2003), and Ankara in the more central zone (unit established in 2003). Specially trained staffs including general surgeons, pediatric surgeons, plastic and reconstructive surgeons, anesthetists, nutritionists, physiotherapists, psychiatrists and social workers, nurses and health care workers are employed in these modernly designed centers: professional knowledge of the staff is updated every year and the physical conditions are renovated if needed. The burn centers are in close communication with each other for a qualified patient care, telemedicine is one of the communication methods in use. In addition to the burn patient treatment, ‘Baskent University Burn and Fire Disasters Insitude’ carries out clinical and experimental research projects, organizes scientific meetings that reach to a large number of burn care professionals in Turkey as well as the Middle-east and Mediterranean Coast including North Africa. The Institute provides cooperation with other burn care institutions in the country and is in communication with the ‘Ministry of Health’. For widespread ‘first aid knowledge’ among the public, the university has founded a ‘First Aid Training Institute’ that conducts public education programs in first aid, including first aid for burns.
These facilities at BAŞKENT are based on a multidisciplinary approach. This kind of approach is the core of excellent burn care. Experienced staff who are dedicated to total rehabilitation of the burn patient is mandatory. As burn prevention, first aid, burn care at the burn centers and rehabilitation of burn patient after discharge are the main components of a qualified burn care, synchronized work for these components is the main target of BAŞKENT for burn care.
Burn injuries are common among children and adults and most are preventable. Although most burns are not life threatening, they can cause significant pain and disability. Prompt identification of the type of burn and quick implementation of appropriate treatment can help minimize scarring and pain, and can also minimize the psychological impact of the injury. On the other hand, severe burn injury is a leading cause of morbidity and mortality. These life threatening injuries are treated by specialized burn teams and burn victims must receive first aid and burn care that are specific to their needs.
Types of burn injury:
- Thermal burns
- Chemical burns
- Radiation burns
Causes of Burns
Some of the most common causes of burns include:
- Scalds from a hot liquid
- Contact with flame
- Contact with a hot object, such as a cigarette, stove, iron, etc.
- Electrical burns, (high and low voltage, lightening)
- Steam burns, such as those that occur in industrial accidents (steam burns often cause injury to the airways of the lungs)
- Gas burns from inhalation of hot gas
- Flash burns from rapid ignition of a flammable gas or liquid
- Tar burns
- Chemical burns from alkaline or acid substances
1st degree burns (epidermal burns) – First-degree burns are superficial, involving only the uppermost layer of skin called the epidermis. Signs of a first degree burn include:
- tissue damage is minimal and limited to epidermis
- skin is red and turns white or pales when pressure is applied
- swelling may be present but skin generally will not form blisters
- the wound is red, dry and painful, and heals in about three to six days without scarring
2nd degree burns (burns including dermis as well as epidermis) – second degree burns may also be called partial-thickness burns because they permeate deeper into the skin, involving both the upper layer – the epidermis – and the second layer – the dermis. Signs of burn differ in regards of the depth of affected dermis. Sings of a second degree burn include:
- blisters forming very quickly or within 24 hours
- skin does not pale when pressure is applied
- the wound is red, wet and painful,
- Pain color change and moisture decreases when the injury is deeper into dermis
- Deeper burns more likely result in scarring when healed
3rd degree burns (include the whole epidermal and dermal layer) – third degree burns may also be called full thickness burns because they extend completely through the skin to the subcutaneous tissue.
4th degree burns (include tissues under the skin)-These burns may also involve underlying structures like tendons, nerves, muscle or bone.
Signs of a third and forth degree burns include:
- charring of the skin or skin that is a translucent white color with coagulated vessels visible below
- the skin has no feeling, but the patient complains of pain (most likely a result of second degree burns to surrounding tissue)
- healing is very slow and there may be extensive scarring
- wounds vary from waxy white to charred and black with a leathery texture; the skin is usually dry and painless to the touch.
Evaluation of burn extent:
- The extent of injury is best described using the percentage of the total body surface area (TBSA) that affected by a burn.
- There are several methods that provide a reproducible estimation of the area of surface area burns. The Lund Browder charts are more accurate than either the Rule of Nines or palm size in identifying TBSA., the Lund-Browder chart is commonly used to assess the burned body surface area for children and infants. Different percentages are used in pediatrics because the surface area of the head and neck relative to the surface area of the limbs is typically larger in children than adults.
Burn treatment and services at BAŞKENT
- Burn, acute care and critical care
- Outpatient burn center
- Burn reconstruction
- Burn physical and psychological rehabilitation
Burn, acute care and critical care: Expert care is provided for both pediatric and adult patients who have suffered burn injuries and other skin disorders. When patients who have experienced significant burns are brought to BAŞKENT, they are evaluated by the Burns Center team. Following initial evaluation, these patients are either discharged for outpatient follow-up or admitted to the hospital for further evaluation and treatment. If the size of the burn warrants, some patients are admitted to the Burn Intensive Care Unit (ICU) for minute-to-minute care. Those patients with less severe burns may be admitted to the inpatient floors for general care.
Critical Care: Patients are closely monitored from the moment they arrive in the Burn ICU. Within the first 24 to 48 hours of admission, our burn team will determine the optimal treatment course for the injury. Treatment may be continued in Burn ICU or the inpatient floor.
Acute Care: Patients requiring less monitoring than critically ill patients are admitted to the Burn Inpatient Unit, where they benefit from our staff's specialized expertise in caring for their burns. In order to return patients to their normal lives as quickly as possible, within 24 hours of admission, the patients are evaluated by our team of specialists, including physical and occupational therapists, to begin a rehabilitation program. Within 24 hours after admission, our team also begins planning for the patient's discharge. When the meticulous treatment modalities are ended, the patients are discharged. After discharge, we continue to monitor the patient's rehabilitation efforts through our outpatient service
Outpatient Burn Center Our outpatient Burn Center provides comprehensive outpatient care to patients suffering from burn injuries. We offer treatments for follow-up on acute burn injuries (less than 10% of TBSA, superficial burns), outpaient treatments which must be applied under sedoanelgesia, monitoring of the severely burned patients after discharge. Our burn team offers the full spectrum of surgical services available at BAŞKENT, performed by surgeons specializing in burn and reconstructive surgeries, advanced wound care technology, comprehensive reconstructive evaluations, full psychiatric evaluation and support for pain, sleep disturbances, post-traumatic stress disorder (PTSD), adjustment disorder and depression, referral to and care coordination with physical therapists, occupational therapists, and other health care providers, scar management, including burn garment measurement, steroid injections, etc. Our staff will monitor the patient’s progress to optimize the functional and scar outcomes in the outpatient service.
Burn Reconstruction: Early and appropriate treatment of a burn is crucial in preventing complications and deformities. The Burns Center is committed to addressing reconstruction options early in the course of treatment.
Our burn team offers a full spectrum of state-of-the-art surgical reconstruction procedures. Our burn team includes board-certified plastic and reconstructive surgeons and acute burns surgeons (pediatric surgeon and general surgeon) who are dedicated to the care of burn patients. Early intervention to prevent and treat the scarring or deformities associated with a burn injury is provided. Our surgeons tailor a personalized treatment program for the patient to optimize results to address the patient’s needs and goals. In addition for burn survivors seeking burn reconstruction, we can typically arrange appointments withina short period of time.
Burn Rehabilitaion: Experienced staff who are dedicated to total rehabilitation of the burn patient are in charge afterdischarge. Physical therapy needs are determined and a personalized program is organized for the patients’s needs and goals in physical therapy unit.