Systemic reactions and late exhaustion
Severe thermal injuries inevitably lead to systemic disorders. Major dysfunctions occur in excretory and detoxification organs: destructive processes are triggered in the liver, while the kidneys exhibit polyuria with proteinuria, hematuria, and leukocyturia.
Two to three months after the incident, the patient may develop burn cachexia, which is characterized by complete organism areactivity. During this period, healing halts: wounds become covered with pale granulations, and epithelialization ceases entirely. Pathogenic flora, including Proteus, putrefactive anaerobes, and Pseudomonas aeruginosa, begins to actively proliferate within the lesions. The musculoskeletal system also suffers, manifesting as muscular atrophy and joint stiffness. Sepsis serves as the primary cause of mortality at this stage.
The convalescence (recovery) period lasts from three to five months. It is considered complete only after full wound closure, normalization of body weight and temperature, and the correction of hypoproteinemia and anemia. However, even years later, patients may experience long-term sequelae involving internal organs, which necessitates prolonged follow-up dispensary monitoring.
Specifics of facial and neck injuries
Head and neck injuries are exceptionally severe even when isolated. This is due to the dense innervation and blood supply of the region, as well as the patient's severe psychological distress caused by facial disfigurement. Because of the complex topography and uneven skin thickness, the thermal agent produces "mosaic" wounds: superficial and deep lesions may lie adjacent to one another. Furthermore, the depth of penetration on the face is always greater than in other body areas under equivalent exposure.
The most vulnerable areas are protruding parts: the nose, lips, superciliary arches, cheekbones, and auricles.
- Auricles and nose: The skin here is thin, and subcutaneous adipose tissue over the nasal bridge is practically absent. Cartilage damage frequently leads to suppurative chondritis with subsequent tissue necrosis, fluctuation, and permanent deformities.
- Lips and cheeks: The vermilion border of the lips lacks sweat glands and hair follicles. During trauma, it frequently undergoes necrosis and everts outward (“fish mouth” sign), leading to microstomia and feeding difficulties. On the cheeks, necrosis may reach the parotid fascia, exposing the glandula parotidea.
- Eyes and forehead: The eyelids suffer less frequently due to the reflex blinking response, but their edema is always significant (submerging only by days 5–6). Cicatrization causes eyelid eversion and keratitis resulting from corneal trauma by eyelashes. In deep lesions of the forehead, bone necrosis, development of frontal sinusitis, and even the spread of inflammation to the dura mater are possible.
- Neck: The danger lies in the superficial location of the platysma muscle. Its cicatrization leads to the fusion of the chin with the chest, inability to close the mouth, and continuous drooling.
Respiratory tract injury
Exposure to hot gases and combustion products causes hyperemia and edema of the mucous membranes of the mouth, trachea, and bronchi. Clinically, this manifests as singed nasal hairs, dysphonia (voice disturbance), cough with soot, and signs of respiratory failure. Deep mucosal injuries are rare—typically occurring during fires in enclosed spaces or when the victim is unconscious.
Important: In case of tracheal and bronchial burns caused by combustion products, tracheostomy is contraindicated as it worsens the condition. Treatment includes bronchodilators, corticosteroids, oxygen inhalation, and local antiseptic irrigation.
First aid and transportation
The key objective at the scene is to stop the thermal effect and cool the tissues. If clothing is burning, the victim must not be left standing (flames will rise toward the face) and must not be allowed to run. They should be laid on their side and the fire smothered.
Cooling with water or ice within the first 15–20 minutes is critically important: tissue temperature can reach 75 °C and persist for up to 10 minutes, destroying cells. Cold restores temperature to normal within 20 seconds.
Pre-hospital care includes the administration of analgesics, tetanus prophylaxis, and oral rehydration (electrolyte solutions). Administering pure water in volumes exceeding 0.5 L is strictly prohibited due to the risk of water intoxication. An aseptic dressing is applied to the wound. The application of ointments and dyes is strictly prohibited, as they hinder the surgeon's ability to assess the depth of the lesion.
Hospital stage and local treatment
Primary wound toilet involves gentle cleansing. Formed blisters are irrigated with an antiseptic and incised for fluid drainage, but not completely excised. The detached epidermis serves as a biological dressing. The blister roof should be removed only in the event of suppuration.
An open method of wound management is preferred on the face. For superficial injuries, cooling creams, boric petrolatum, or ointments (nitrofurazone, synthomycin, Levomekol) are used. For deep lesions (grades IIIA–IV), the goal is to form a dry scab and prepare granulations for autodermoplasty, which is why a closed method using wet-to-dry dressings is more effective here.
Briefly: answers to topical questions
What are the pathogenetic differences between the degrees of frostbite in the maxillofacial region according to the classification?
The pathogenetic differences between the degrees of frostbite lie in the depth of tissue damage, with necrosis always being secondary and developing in the reactive phase. The pathological process spreads deep into the tissues due to initial spasm followed by thrombosis of blood vessels.
| Grade | Pathogenetic characteristics |
|---|---|
| Grade I | Circulatory disorder with the development of reactive inflammation |
| Grade II | Damage to the epithelium down to the germinative layer |
| Grade III | Necrosis of the full thickness of the skin and partially the subcutaneous tissue |
| Grade IV | Necrosis of the skin and deeper tissues (loss of soft tissue with bone exposure) |
What specific symptoms are characteristic of the reactive stage of facial frostbite?
The reactive stage of frostbite is characterized by the appearance of tingling, burning, itching, pain, and tissue warming as blood circulation recovers. Specific symptoms depend on the depth of the lesion:
- Superficial frostbite — the skin turns red, and pain sensations intensify.
- Deep frostbite — the skin acquires a cyanotic (bluish) or mottled tint, pronounced edema appears, and pain does not intensify.
In grade IV, edema extends beyond the dead tissues, a scab forms, and signs of intoxication appear. On the face, the nose, auricles, cheeks, and zygomatic region are often affected. When the facial cartilage tissue is damaged, there is a high risk of developing protracted perichondritis (perichondritis), leading to deformity.
Class and exam questions
Why should a victim with burning clothing not be left standing?
In a vertical position, flames and superheated air rush upward, leading to severe burns of the face, neck, and upper respiratory tract.
Is it permissible to cut open burn blisters at the first aid stage?
No, blisters must not be excised. The detached epidermis acts as a natural biological dressing and promotes healing; only nicking to evacuate fluid is permitted.
Which treatment method for facial burns is preferred?
For superficial wounds on the face, the method of choice is the open method (application of emulsions and ointments), whereas for deep lesions, the closed method is more commonly used to prepare for plasty.
Why shouldn't the victim be given large amounts of plain water to drink?
Ingesting more than 0.5 liters of plain water without electrolytes can trigger life-threatening water intoxication.
What else to study on this topic
- Pathogenesis of burn cachexia development
- Autodermoplasty techniques for deep thermal facial injuries
- Features of surgical removal of necrotic cranial bones
- Prevention of cicatricial ectropion and keratitis development
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