Diagnosis Principles of Burn Medical Therapy

Many textbooks describe the method of diagnosis of burn depth. It is based on naked eye observation and the doctor’s own experience, therefore, it is often difficult to differentiate between full-thickness burns and deep partial-thickness injury. Understandably, therefore, wounds should not be excised since the result is the removal of all skin tissues and superficial fascia. After surgical excision, we see that the prognosis is worse and the mortality and disablement rates are elevated.

In order to standardize the diagnosis of burn depth, the following principles should be followed.

1) Principle of Clinical Diagnosis
First of all, it is necessary to determine whether the burn wound requires surgical excision or not. If the wound demonstrates surviving skin tissue in the deep layer with appearance of exudate within 6 h after injury; then the subcutaneous tissues are viable with functional microcirculation and surgical excision is not required. After treatment with this BRT, white exudates will appear on the wound surface. One notices that the more the exudate, the more superficial of the wound. If the wound has no exudates after 3 days postburn, surgical operation should be considered. If the wound reveals no hemorrhage of subcutaneous tissue after the fasciotomy, it can be excised. However, this does not apply to the wound where the exudates disappeared after treated with dry therapy. If such cases occur, there are mistakes in the treatment.

2) Pathological Diagnosis
Pathological diagnosis is used to diagnose the depth of burns wounds without exudate and to determine whether the wounds need to be excised. Wounds with exudate do not need pathological diagnosis. Pathological diagnosis is easy and painless. If there is misdiagnosis of one biopsy sample of a small piece of skin including subcutaneous tissue from the wound, histological examination of the section is performed. If most of the subcutaneous tissue is necrotic, the wound can be excised and treated with skin grafting. If the subcutaneous tissue is still structural vitality, then the wound should not be excised and BRT (MEBT/MEBO) should be applied. Accurate pathological diagnosis based upon scientific investigation is feasible and, when performed correctly, can afford the patient correct diagnosis and optimum prognosis. It is no longer acceptable for the physician to rely upon the naked eye as too many treatment errors could result.