Silver sulphadiazine ointment is as good as anything, cheap and easily available, so it is widely used. Stick a good thick smear of it all over the wound, or on the gauze and slap it on, bandage it on firmly but not tightly and leave it alone until it is either messy or for 5 days. Then soak it off with diluted hydrogen peroxide.

My favourite dressing is honey. It is antiseptic but does not delay healing, it does not stick so the dressings float off easily, it also prevents yeast and fungi growing and is cheap and available. A lot of good research has been published on honey on all wounds, including burns. Some have even shown that certain species of flower or tree are better for certain infections! The best is the local runny honey with dead bees floating in it. We get through bottles and bottles of it. Pour it all over the wound, slap on the gauze and leave it for 2 to 5 days. We find most dressings get a bit messy after 3 days, so 5 days may work for some people but not for your average active 2 year old.

Quick note: this “leave it for 5 days” business is for recent burns seen in a few hours, not the stinking, festering, infected horrors from neglected wounds inappropriately treated for a week that we see all the time. Those we dress twice a day until they are clean. If you look after a burn properly from the outset, it will never go like that and either nothing or a dressing change every 3 to 5 days is fine.

Infection
Superficial burns left alone to dry and blisters left alone or dressed with a thick layer of gauze do not get infected. Giving antibiotics is inappropriate. Antibiotics do not prevent infection and do more harm than good. They simply encourage yeast, fungi and resistant bacteria. Even deep wounds with an eschar treated in hospitals do not require systemic antibiotics. When they get infected, good antibiotic treatment is necessary. The first sign may be a bit of redness around the edge, perhaps a slightly manky wound, then antibiotic dressings are probably the best. When there is fever or red, swollen tissue and spreading infection in the surrounding tissue, then systemic antibiotics are needed.

Outcome
Superficial burns should heal in 2 weeks without a scar, deep skin burns in 3 or 4 weeks with maybe some discolouration but no real scar and all other wounds probably require surgery. If it looks as if it isn’t healing in that sort of time table, then it must be reassessed. See a doctor.  It may require excision and grafting and these days, earlier is better than later.

Summary:
-    Keep cool
-    Buckets of water or anything else cold
-    Assess TBSA and depth
-    Deep burns are best treated with early                  surgery
-    Superficial burns: keep it simple. Most                  ointments, creams, antiseptics and drama
     are inappropriate.
-    Honey rocks!

For more information please contact:
stockley@thesurgeryuganda.org