Recognizing the Regional Burn Center During Burn Awareness Week, Feb. 2-8

Things were busy at Lehigh Valley Health Network (LVHN)’s Regional Burn Center this week. This is the season of space heater accidents and frostbite. And then there is ramen. “Parents might heat noodles for their child in the microwave, then set the bowl on the counter,” says physician assistant Katrina Schafer, PA-C, with the Regional Burn Center. “The next thing you know, the child is pulling the bowl off the counter and onto themselves.”

Scalding injuries are the second most common after fire-related burns in the 700 patients – from newborns to seniors – the Burn Center sees each year. The staff treats many types of burns, in addition to other conditions such as frostbite and Stevens-Johnson syndrome, a rare, serious disorder of the skin where the skin dies and sheds. Regardless of the type, burns all involve the skin.

Skin plays a major role in controlling body temperature, controlling water and salt content, managing our sensory perception, forming a barrier to microorganisms and synthesizing vitamins and hormones. That’s why – depending on the size and depth of a burn injury – the impact can be life threatening, and treatment is anything but simple. 

“The first 24 hours of a burn are critical, and we’re focused on fluid resuscitation and pain control,” Schafer says. “There are a lot of things we’re watching and constantly adjusting. Resuscitation using fluids is a priority, as shock sets in rapidly.”  

Schafer adds there can be other traumatic injuries along with the burn. Therefore, when a patient comes in, the trauma team assesses them, supporting their vital signs and monitoring for renal failure, blood pressure and cardiac problems. If the patient is intubated, they monitor for pulmonary issues.

As soon as possible, the depth of the burn is evaluated. This determines whether wound care will do, or whether surgery and skin grafting will be necessary. A skin graft is a surgical procedure that involves removing healthy skin from one area of the body to another. “We monitor the wounds for the first couple of days to find out whether there is enough blood supply and enough of the dermis left to heal without surgery,” Schafer says.   

Schafer points out that the primary objective is to close the wound. This is how the skin starts to form new vessels and heal. The ideal is to use the patient’s own skin for closure. But, in cases where the burns cover a large area or there isn’t a basis to support regeneration, science has stepped in with solutions that get the healing process started.

Options used at the Regional Burn Center include:

• NovoSorb® BTM (Biodegradable Temporizing Matrix), which consists of a sealing membrane and a matrix underneath that allows blood vessels and cells to weave into it and grow.  
• Kerecis Shield®, used as a graft, is intact fish skin that contains fat, protein, elastin, glycans and other natural elements shared by human skin.
• RECELL® uses a small piece of the patient’s skin to create Spray-On Skin™ Cells. The application of different cell types stimulates healing throughout the wound.

“With RECELL, we take a 1 square centimeter piece of skin from the patient – usually from the thigh but it can come from anywhere – and mix it with the RECELL solution,” Schafer says. “This can then be sprayed on a second-degree burn or a skin graft for skin restoration. The 1 square centimeter of skin will cover 80 square centimeters when sprayed.”

Schafer says the process is not always complete once a patient’s burn is healed. They often undergo scar management using methods such as compression garments, creams and lasers. The patient might also need psychological counseling, which is conducted through the outpatient survivor program, part of the Burn Recovery Center at LVHN.  

With experience as her teacher, Schafer, who has been working with burn patients for 20 years, feels it’s valuable to share what she has learned. Her most important bit of advice is to remember, “No matter how many times you’ve done something, if you’re working with an open flame, take nothing for granted. It takes just one time to have lifelong consequences.”

She advises not to use accelerants – ever – and be very cognizant around heaters. “Always keep children away when you are cooking, and stay diligent around hot water,” she says. “Absolutely, do not let pan handles hang over the edge of the stove where children can reach them.”

Finally, she adds, “Keep the ramen well away from tiny hands until it’s cool.”