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Consequences and complications after burns
Last reviewed: 18.10.2021
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Systemic complications after burns
The larger the burn area, the higher the risk of systemic complications. The risk factors for both complications and death are burns> 40% of the body surface area, age> 60 years or <2 years, concomitant severe trauma and inhalation damage.
The most characteristic systemic complications are hypovolemia and infection. Gy-povolemia, resulting in insufficient blood supply to the burned tissues and sometimes to shock, may be the result of loss of fluid from the surface of deep and extensive burns. Hypoperfusion of burned tissues can also be the result of direct damage to blood vessels or vascular spasm, secondary hypovolemia. Infection, even with small burns, often causes sepsis and death, as well as local complications. Violation of the body's protective reactions and tissue devitalization increases the invasion of bacteria and their growth. In the first few days streptococci and staphylococci are most common, in the next 5-7 days - gram-negative bacteria; but in almost all cases a mixed flora is identified.
Metabolic disorders may include hypoalbuminemia, arising, in part, due to hemodilution (due to fluid refund), in part due to the transition of the protein into the extravascular space through damaged capillaries. Hypoalbuminemia and hemodilution contribute to hypocalcemia, but the concentration of ionized calcium usually remains within normal limits. Possible deficiency of other electrolytes, namely dilution hypomagnesemia, hypophosphatemia and, especially in patients taking potassium-withdrawing diuretics, hypokalemia. Extensive tissue destruction can lead to hyperkalemia. Metabolic acidosis can be a consequence of shock. Rhabdomyolysis and hemolysis develop as a result of deep thermal and electrical burns of muscles or ischemia of muscle tissue due to contraction of the scab. Rhabdomyolysis causes myoglobinuria, and hemolysis - hemoglobinuria, which eventually leads to acute tubular necrosis.
Hypothermia can develop after intravenous injection of a large amount of chilled liquid, and under the influence of cool air and objects in the emergency room on uncovered parts of the body, especially with extensive burns. Against the background of electrolyte disorders, shock, metabolic acidosis, sometimes hypothermia, as well as in patients with inhalation lesions, ventricular arrhythmias may occur again. After extensive burns, the development of intestinal obstruction is characteristic.
Local complications after burns
Circular burns of extremity of the third degree lead to the formation of constricting scabs, which can promote the development of local ischemia, and in the chest area - to respiratory disorders.
Spontaneous healing of deep burns leads to excessive formation of granulation tissue, causing later scarring and contractures; if the burn is located near the joint or on the hand, foot or perineum, this can lead to serious functional impairment. Infections can stimulate the scarring process. Keloid scars are formed only in some groups of patients, especially in representatives of the black race.