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The initial management of patients with an acute burn injury is often undertaken by individuals with relatively little experience in this area. To optimize outcomes and minimize the risk of long-term sequelae, clinicians should understand the key steps in initial management and safe transfer of these patients to a specialist burns unit. These include safely extricating patients and providing prompt first aid at scene; rapidly and accurately assessing them at the nearest emergency department or trauma centre; appropriately managing their airway and oxygenation; obtaining intravenous access and initiating fluid resuscitation; assessing burn extent and depth and considering the potential need for escharotomies; providing analgesia and appropriate tetanus prophylaxis; and covering and warming the patient while temporarily dressing their burns. Once these measures are taken, any patient with a burn injury may be discussed with a specialist burns unit for advice. If deemed necessary and accepted, they should be promptly transferred to a burns unit with an appropriate escort. Prior to transfer, a systematic re-assessment should be undertaken, and any required treatments should be continued during the transfer. Copies of all referral information and the results of initial assessments and investigations should be sent with the patient to ensure a robust handover process.

Assessment of total body surface area of a burn injured patient is a crucial step in managing burn injury. The chapter describes a number of techniques from using the size of the patient’s palm as an estimate of 1% to the gold standard Lund and Browder Chart. Key caveats are explained, copies of the charts included as well as the use of the CE certified app Mersey Burns.

The burns multidisciplinary team includes surgeons, specialist nurses, anaesthetic and critical care specialists, operating theatre staff, physiotherapists, occupational therapist, play specialists, clinical psychologists and dieticians, with input from other specialties (eg. microbiology). Burns units receive referrals from primary and secondary care, usually by telephone. Referral proformas help to document these calls and any information provided about patients, their burns and associated injuries, the treatments provided and their planned transfer. The clinician accepting the patient for transfer must ensure that there is an available ward or ICU bed, as required, prior to arranging transfer. Care should be taken to minimize the risk of a patient deteriorating during transfer. Fluid resuscitation and patient warming should continue during a prompt transfer by an ambulance team with the appropriate equipment and expertise, along with a medical escort if required. Upon arrival, the patient should be formally and systematically assessed (including an ATLS primary and secondary survey and anaesthetic assessment if indicated) and any remaining investigations undertaken. The burn wounds should be cleaned, photographed, swabbed and dressed, and any resuscitation fluids recalculated and prescribed. Appropriate medications and adjuncts should be prescribed including tetanus, deep vein thrombosis and stress ulceration prophylaxis, analgesia, usual medications, and nutritional supplements along with enteral or parenteral feeds. An admission proforma helps junior medical staff to ensure that all required information is collected and all components of the standard management plan are instituted.

Exfoliating skin disorders or exfoliative and necrotizing disease of the skin form an important part for all those managing acute dermatological and plastic surgery emergencies; including the burns surgeon. It is imperative that such conditions are evaluated in a burns text as these patients should be managed on a burns unit with allied professional input. This chapter focuses on the classification, aetiology, and management of such disorders. Management includes initial assessment and suggested surgical approach. In addition scoring and prognostic indicators are referenced to allow the reader application of knowledge in clinical practice.

This chapter provides an overview of laser as applied to burns and scar management.

Frostbite is the damage sustained by tissues when exposed to temperatures below their freezing point (

This chapter explores the topic of non-accidental injury burns in children. It is important to consider the possibility of non-accidental injury and recognize injury patterns. The chapter gives a concise overview of the patient and parent characteristics, assessment of such patients and differential diagnoses to consider in the process of managing children in these situations. Patterns of injury in non-accidental burns are described.

C. Scott Hultman, ed. 50 Studies Every Plastic Surgeon Should Know . Boca Raton, FL: CRC Press, 2014. ISBN-10: 1482240823, ISBN-13: 978-1482240825, $75.00. ![Graphic][1] 50 Studies Every Plastic Surgeon Should Know , edited by C. Scott Hultman, is a concise book that aims to identify the most influential contributors of our discipline. It is divided into 10 sections, each containing 5 articles. For example, “Foundations,” starts off with a seminal article published in 1929 by Blair and Brown detailing the use and uses of large split skin grafts of intermediate thickness.1 The last section is entitled “Innovations” and, for example, includes a 2009 article by Siemionow et al on near-total Human Face transplantation in the United States.2 The editor, C. Scott Hultman, has compiled the studies to be included. Dr Hultman works as Chief of Plastic Surgery at the University of North Carolina and Associate Director for the North Carolina Jaycee Burn Center. Each study is reviewed by authorities in the relevant specialty presented and includes comments from the study authors themselves. Relevant studies for further reading are recommended within each section. … Corresponding Author: Professor Kayvan Shokrollahi, Mersey Regional Burns and Plastic Surgery Unit, Ward 4D, Whiston Hospital, Merseyside, L35 5 DR, United Kingdom. E-mail: kshokrollahi{at}hotmail.com [1]: /embed/inline-graphic-1.gif