“Ask Dr. HKSH” - Burns and Scalds

Dr. MAK Ming Shan, Vincent

Specialist in Plastic Surgery

1. What are the common causes of burns and scalds?

There are several common causes of burns and scalds. Thermal injuries are the most common, including those caused by flames, hot water, hot liquids, and high-temperature gases such as steam or exhaust fumes from engines. Less common are chemical burns, which can be caused by acid, alkali, or industrial corrosive liquids. Even rarer are those caused by electrical energy or electric shock, which can also lead to burns.

2. How should burns and scalds be treated? When should one seek medical attention?

While there are numerous folk remedies for burns and scalds, such as applying toothpaste or soy sauce to the wound, the best treatment is to rinse the affected area thoroughly with room temperature water. It helps dissipate the heat, or wash away and dilute the corrosive liquid. One may wonder if ice packs can help, as ice feels colder than water and thus seems to be more effective. But ice is too cold and may stick to the skin, causing additional harm when removed. Therefore, it is recommended to rinse the wound with a large amount of room-temperature water.

Medical attention should be sought depending on wound depth and size. As assessment involves medical expertise, a doctor should be consulted promptly to determine if the wound needs immediate treatment and further management. Surgical intervention may be necessary in severe cases.

3. What are the classifications of burns and scalds?

Burns and scalds are primarily classified by depth and extent. Wound depth is categorised as first, second and third degree. A first-degree burn only affects the epidermis; a second-degree burn reaches the dermis but does not penetrate it fully; a third-degree burn penetrates the entire dermis and affects the fat, muscles, or even deeper tissues. In addition to depth, the extent of the injury is also crucial. The burn area is often measured as a percentage of total body surface area affected. It helps determine the need for surgical intervention and urgency of treatment.

4. What are the consequences if the wound is not managed properly?

This depends on the size of the wound. In general, a relatively small wound, which covers less than 20% of the body surface area, may get infected by bacteria and delay in healing if not managed properly. It may affect scar formation in the long run. Surgical intervention such as skin grafting may even be required in some cases. These are the potential complications of improper wound care.

If the wound area exceeds 20% of the body surface, improper management can cause not only scarring but also life-threatening outcomes such as bacterial infections and septic shocks.

5. What is skin grafting?

Skin grafting is often performed to treat burns and scalds, particularly when the wounds are deemed unlikely to heal within a short period and in need of skin grafting to accelerate healing, reduce wound infection risk and minimise scar-associated complications in future.

In skin grafting, a thin layer of skin is harvested from a “healthy” area of the patient’s body, namely the donor site, and transplanted to the injured area. Since the skin is taken only from the superficial layer in the donor site, that wound will heal on its own. The burn area is covered with the skin graft, which expedites healing with reduced risks of scarring and infection.

6. I am self-conscious about the burn and scald scars. What can be done to fade them?

If you are concerned about scarring, the first step is to assess the stage of the scar. For example, a newly healed scar tends to be red and active, and can be made less so with different methods. Some non‑surgical approaches, such as pressure garments or scar tapes, can also help improve the scar. In certain situations, doctors may inject a proper amount of corticosteroids into the scar to reduce its activity. Some scars may remain uneven or affect function even when mature, for instance, scars on joints may cause tension and make it difficult to fully straighten the arm or bend fingers. Depending on severity, scar revision surgery may be required to restore motion.