Expert: Jim B - 12/8/2008

Question
Hi - I have read some of your answers and find them very helpful. My boyfriend's face (lip, cheek and chin) and neck were burnt in a flaming drinking game on Saturday. He caught fire for several seconds. We applied cold water and ice to his lip and cheek but were not aware of the burns to the neck and chin, so they did not get cooled off (and the neck is now a deeper burn). The burns appear to be superficial on the face but the neck the doctors are afraid is deeper. They have dressed the neck with a bandage which will become a 'second skin' and they said to the face we are to apply vaseline. All the skins has been removed - either immediately and naturally - or the nurse took it the rest off yesterday (it looked very pink and sore). They say they may have to operate on the neck to do a skin graft. Aabout an inch of his lip is burnt off and the cheek and neck about 1 inch wide and quite long (5 inches) - although in patches - not one big wound. The neck is a much bigger patch - about 3 inches by 3 inches.  

I have a few specific questions although any information/ guidance would be appreciated:
1. What is the healing process what can we expect. What is the risk of scarring (my boyfriend is of Indian origin, not sure if that is relevant)?
2. If they say he needs a skin graft is this really necessary or are there any alternatives?
3. What should we look out for in terms of cleaning etc? At the moment we are just cleaning with water and applying vaseline apart from to the neck, which is covered.
4. Are there any danger signs to watch out for?

I really appreciate your help

Octavia


Answer
Hi Octavia,

Scars are more common with darker complected individuals than with lighter people. This is due to the fact that many darker complected people may have deeper burns than the melanin cells. But, the process is going to be the same regardless of skin type.

1, The process will be to see how much skin has been lost. The process is to debried the skin daily to give  as much as possible of as smooth a surface of the skin wound. This is then covered with silvadene and to keep it covered with a sterile coating of gauze.

2, Skin grafts are required any where the skin has been completely lost (third degree burns) as these areas will produce scar tissue.

3, The current process for you to do is to watch out for any thick white "eschar" to be forming under the wound, as these are areas with are most likely to form scars.

4, The best protection for these wounds at this point would be Silvadene cream. This would be the best protection from infection that would be available.

5, Lastly, make sure that the wounds are covered and protected.

Feel free to follow up.

Jim