Burns of the auricle and face

Burn - tissue damage caused by local action of high temperature, electric current, corrosive substance and radioactive radiation. The most common are thermal burns; the pathomorphological and pathoanatomical changes that arise in them are very typical and, with the 1st degree of damage, are similar to chemical and radiation burns, the structural and clinical differences occur only with severe degrees of damage to these factors. Burns are divided into production, domestic and combat. In peacetime, 1.5-4.5% of the total number of surgical patients and about 5% of all trauma victims are burned in different regions of Russia.

[1], [2], [3], [4], [5], [6], [7]

Causes of burns of auricle and face

Thermal burns occur as a result of the action of a flame, radiant heat, contact with hot and molten metals, hot gases and liquids.

Classification of burns is based on signs of depth of lesion and pathologic and anatomical changes in burned tissues.

• First degree burns - erythema;
• II degree - the formation of bubbles;
• IIIA degree - necrosis of the skin with partial seizure of its germ layer;
• IIIB degree - complete necrosis of the skin throughout its thickness;
• IV degree - necrosis extends beyond the skin to different depths with charring of full or partial affected tissues.

From the clinical point of view, all burns can be conveniently divided into superficial (I and II degrees) and deep (III and IV degrees), as most often with superficial burns the first two degrees are combined, and for deep ones all four.

[8], [9], [10], [11]

Pathogenesis and pathological anatomy of burns of the auricle and face

With burns of the 1st degree, aseptic inflammation develops, manifested by the expansion of the capillaries of the skin and the moderate edema of the burned area due to the sweat of plasma into the skin thickness. These phenomena disappear within a few days. Burns of the 1st degree end with peeling of the epidermis and in some cases leave behind the pigmentation areas, which also disappear after a few months.

With second-degree burns, inflammatory conditions are more pronounced. There is an abundant effusion of plasma from the sharply expanded capillaries, which accumulates under the stratum corneum of the epidermis with the formation of blisters. Some of the blisters are formed immediately after the burn, some may appear after several hours. The bottom of the bladder is formed by the germinal layer of the epidermis. The contents of the bladder are initially clear, then cloudy due to the deposition of fibrin; with secondary infection becomes purulent. In uncomplicated course, the dead layers of the epidermis regenerate after 7-14 days without scarring. With secondary infection, a part of the epidermal layer of the epidermis perishes. In this case, the healing is delayed for 3-4 weeks, with the formation of granulation tissue and thin superficial scars.

Common phenomena characteristic of burn disease, with limited facial lesions or isolated lesions of the auricle with burns I and II are not observed.

With burns III and IV, the phenomena of necrosis, arising from the thermal coagulation of the protein of cells and tissues, come to the fore. Necrosis in more mild cases captures only partially papillary layer (IIIA degree), which creates the possibility of not only marginal, but also islet epithelization. With grade IIIB there is total necrosis of the skin, and at the fourth degree - and necrosis of deeper tissues (with face burns - subcutaneous tissue, mimic muscles, branches of facial and trigeminal nerves, with burns of the auricle - perichondrium and cartilage).

Burns of the 1st degree are caused by direct contact with a liquid or solid, heated to a temperature of 70-75 ° C, grade II - 75-100 ° C, and III and IV degrees - in contact with hot or molten metal or with a flame.

Differentiate according to clinical signs the depth and extent of necrosis in the first hours and even days after injury is not possible, since the pathological processes associated with thermal destruction of tissues continue for some time, up to the formation of demarcation boundaries between the tissues and tissues that have retained their physiological state , subjected to burns of different degrees. With burns of SB degree, the affected areas of the skin are dense to the touch (formation of the scab), acquire a dark or grayish-marble color, lose all kinds of sensitivity (necrosis of nerve endings). With burns of deep tissue, the scab turns black and from the outset all kinds of sensitivity of the affected area of the skin are lost. With deep burns of the face and the auricle, the suppuration is often developed, accompanied by melting and rejection of necrotic tissues and terminating in the type of healing by secondary tension with the formation of granulations and epithelization. After this, coarse, disfiguring UR and face scars with areas of sensitivity disturbance are often formed, and if the lesion touches the face, then the mimic function.

Diagnosis of thermal damage to the face and the auricle does not cause any difficulties and is based on an anamnesis and characteristic pathological anatomical signs of a burn. It is much more difficult in the first hours to establish the depth and limits of the lesion. Importance is attached to determining the area of the burn and its degree. According to the "rule of nine", the surface of the head and neck is 9% of the surface of the whole body. This rule is used to determine the extensive burns of the trunk and extremities, as for the face and outer ear, then for their burns they indicate specifically the anatomical formation that was affected, for example, "a superficial burn of the right side of the face and the right auricle (I-II degree)."

Symptoms of burns of the face and auricle are determined by the extent of the lesion, its size and possible concomitant lesions (eye burns, scalp). With local and limited thermal lesions, facial and auricle and burns of I and II degrees of general clinical symptoms are not observed. With more common burns of III and IV degree, there may be signs of burn disease, manifested by periods of shock, toxemia, septicotoxemia and convalescence. Each of these periods is characterized by its own clinical picture and the corresponding pathogenesis, which are considered in the course of general surgery. As for the local lesion of the face and the auricle, the clinical picture here consists of the dynamics of the burn process and the subjective and objective symptoms, which were mentioned above.

Treatment of burns of the auricle and face

Treatment of burned consists of general and local events.

General treatment

Victims with burns of the face and auricle are hospitalized either in a surgical hospital or in a specialized department of maxillofacial surgery or ENT. The first aid to the burned at the scene is to put out clothes (remove the burning headdress) and close the burned surface with a dry aseptic dressing. Nothing should be done to clean the burned area, just as you do not need to remove the rests of burned clothes adhering to the skin. When rendering assistance before evacuation, it is necessary for the injured person to inject 1-2 ml of a 1% solution of morphine hydrochloride or pantonone (promedol) under the skin. Evacuation should be carried out carefully, without unnecessary traumatization of damaged areas of the body, with a head burn (auricle or the corresponding half of the face), the head should be fixed with hands. Do not allow the patient to cool during transport. In the room, the air temperature should be in the range of 22-24 ° C.

If the victim is in a state of shock, he is placed in the intensive care unit and, before proceeding to examine the affected areas, carry out anti-shock measures. However, before they are carried out, you should make sure that the victim does not have carbon monoxide poisoning or toxic combustion products. Simultaneously, by analogy with the case of Novocaine blockade, conducted with burns of the extremities, a similar block of the periauricular region or uninjured areas of the face around the lesion is permissible. Novokainovaya blockade, being a pathogenetic means of treatment, acts favorably on the reflex-trophic functions of the nervous system, in particular, reduces the permeability of capillaries increased for burns. With extensive burns, the patient's head is behaving like a victim with significant burns of the trunk and extremities. Such patients should be hospitalized in burn centers.

For the prevention of secondary infection or the fight against it, antibiotics of a wide spectrum of action in combination with sulfonamides are used. To combat intoxication, anemia and hypoproteinemia, as well as to maintain the water-salt balance, one-group fresh blood citrate, plasma, protein hydrolysates, 5% glucose solution, saline solutions are transfused. According to the indications, analgesics, tranquilizers, cardioprotectors, vitamin mixtures are administered.

With deep burns of the face and mouth area and the impossibility of independent food intake, probe nutrition is established with parenteral administration of nutrient mixtures. Important in the treatment of burn patients is care for them and the protective regime. Victims with fresh burns should not be placed in the wards of the purulent department.

Local treatment of burns of the auricle and face

The burn surface for burns of II - III degree should be considered as a wound, which is primarily the entrance gate for infection, therefore, in all cases it is subject to primary surgical treatment. If there is no need for emergency anti-shock measures, this treatment should be carried out as early as possible. The amount of primary surgical treatment is determined by the extent and prevalence of the burn. Begin it with the introduction under the skin or in a vein of 1-2 ml of a 1% solution of morphine. The most sparing and pathogenetically grounded method of primary surgical treatment of burns was proposed by A.Vishnevsky (1952). With this method, after removal of the upper layers of the primary dressing, the lower layers of gauze adhered to the burnt surface are separated by irrigation with a warm weak potassium permanganate solution. After that, the burned surface is irrigated with a weak jet of a warm solution of furacilin to clean the affected area of the skin. Then the skin in the burn circle is wiped first with balls moistened in a 0.5% aqueous solution of ammonia, then in 70% ethyl alcohol. From the burned surface, scraps of epidermis are cut. Large bubbles are inscribed at the base and emptied, medium sized and small bubbles are retained. In conclusion, the burnt surface is irrigated with a warm isotonic sodium chloride solution and gently dried with sterile cotton balls or gauze balls.

The subsequent treatment is carried out openly, or, more often, in a closed manner by applying a bandage.

In the 50's and 60's of the XX century. The oil-balsamic emulsion of A.Vishnevsky and A.Vishnevsky with the following composition of liquid tar, 1.0, proved to work well with fresh burns; anesthesin and xerobe form 3.0; castor oil 100.0. This bandage is kept for 8-12 days, i.e., practically during the period of complete healing of burns of the 2nd degree.

Later, with second-degree burns, the method of DPNikolsky-Bettmann was used: the skin around the bubbles was wiped with an aqueous solution of ammonia; The burnt surface is greased with a freshly prepared 5% aqueous solution of tannin and then with 10% silver nitrate solution. The resulting crust is preserved until self-rejection.

SS Avadisov proposed a novocain-rivanol emulsion consisting of 100 ml of a 1% aqueous solution of novocaine in rivanol solution 1: 500 and 100 ml of fish oil. Change of this bandage is made only with suppuration of the burnt surface. In this case, resort to lubrication of affected areas with alcohol solutions of aniline dyes.

There are also ways to close burns with various anti-burn films, autografts or canned skin heterorrhanthenates, etc. Modern liniments, ointments and pastes containing antibiotics, corticosteroids, proteolytic enzymes, etc. Are also used, which accelerate the rejection of dead tissue, healing of the wound without gross scarring and prevention of secondary her infection.

With deep burns, accompanied by necrosis of the skin on the entire thickness of the skin, after the rejection of dead tissue, defects occur, and when they are healed by secondary tension, scars form which not only disfigure the face, but also often disrupt the mimic and articulatory function.

To prevent these complications, they often resort to early skin plasty with autografts.

Skin transplantation with burns speeds up the wound healing process and ensures the best functional and cosmetic results.

Forecast for burns of the face and auricle

The prognosis for burns of the face and auricle mainly concerns cosmetic and functional aspects. Often, when the ear is burned, the external auditory canal is affected, which is fraught with its stenosis or atresia. The auricle itself with deep burns is significantly deformed, which requires a plastic recovery of the form in the future. When burns of the face of I and II degree, as a rule, complete epidermisation of the skin without scarring occurs. With extensive burns of III and IV degree, the face is tightened by deep disfiguring scars, becoming masklike, immobile; eyelids are deformed by scar tissue, their function is limited. The pyramid of the nose is reduced, the nostrils look like formless holes. Lips lose shape, the mouth is inactive, and at times because of this there are difficulties in eating and articulating. Such victims require long-term functional and cosmetic treatment.

The danger to life is only a person's burns, complicated by a secondary infection, which can spread through emissaries and venous anastomoses (for example, through the angular vein) into the cranial cavity, causing intracranial purulent-inflammatory processes.

[12], [13]