Why does the skin peel when burned?

Treatment of burns

Burn injury: Tissue damage when exposed to heat at a skin temperature of more than 50 ° C. In Germany, 15,000-18,000 burns are treated annually, including around 1,600 third-degree burns.

Burns aren't just caused by fire and hot liquids. Similar defects on the body surface are caused by electricity, lightning strikes, chemical burns or radiation damage, and frostbite also provokes a similar clinical picture. Depending on the duration of the exposure, there may be temporary or permanent damage that must be repaired plastic-surgically. The spectrum of therapies ranges from outpatient treatment by the family doctor to intensive medical measures in special burn centers.

For the prognosis of a burn injury, the determination of the volume of destroyed tissue is decisive, which is composed of the depth of the burn wounds and the extent of the burned body surface (depth and surface determination).

The engagement

With the mesh graft technique, a flap of skin is finely incised in many places and pulled apart like a wire mesh in order to cover larger skin defects with relatively unhealthy skin. The example shows a large skin defect as a result of a serious work accident, above before, in the middle ten days and below three months after it was covered with a split-thickness skin graft.
Georg Thieme Verlag, Stuttgart

Serious burns must be treated surgically, as there is no possibility of spontaneous healing. First, the skin is removed down to the undamaged depths.

  • In the case of extensive damage to the skin, one Split skin graft required. In this process, a 0.2–0.5 mm thick layer of skin, called split skin by the doctor, is planed off on a healthy part of the body (usually on the buttocks, thighs, stomach or upper arm) and transplanted. If the split skin is not sufficient to cover the affected area, it is incised and pulled apart like a net (meshgraft technique, Meek technique). So it is stretched up to three times; The resulting holes close as soon as the transplanted skin grows "normally" on the burned area. Depending on the size of the burned area, several operations are usually necessary.
  • Smaller, deeper skin defects are caused by Full skin grafts covered. These grafts encompass all three layers of skin, if necessary even underlying muscles, and are correspondingly thick. If healthy skin is available in the immediate vicinity of the wound, a skin flap is cut out on three sides and "swiveled" into the wound area (sliding flap). The intact blood supply to the fourth side of the skin flap that remains in place facilitates healing. A similar technique can also be used to transfer skin from more distant parts of the body. Either as a free full-thickness skin graft, in which the donor skin is completely cut out, or as a pedicle flap, in which the blood supply initially remains in one place. The prerequisite for this is that the wound and the donor area are closely adjacent.
  • A new method of skin extraction is that Keratinocyte transplant. Removed skin cells (keratinocytes) are stimulated to divide in artificial nutrient media. The cultured cells are then placed on a carrier membrane and then transplanted onto the skin defect. After about ten days, the carrier membrane dissolves, leaving only the new, cultured skin behind. Since the keratinocytes need about 2-3 weeks to grow, the wound is temporarily covered. For this purpose, artificially produced, synthetic skin (Epigard®, Geliperm®) or foreign skin (mostly obtained from corpses) is used.

The main problem after burns is the formation of scars. These disfiguring skin changes are particularly a psychological burden for the person concerned if they occur in the face, neck, hairy scalp or in the area of ​​the female breasts. When it comes to correcting larger ones Burn scars, it is more the functional than the aesthetic aspects that are considered by the medical professional, e.g. B. In the vicinity of the joint, shrinking scar strands that drastically limit the range of motion (scar contractures).

After the skin grafts heal, compression bandages will help minimize raised scarring. If scar contractures nevertheless develop, a Z-plastic Create a remedy that extends the scar in a kind of accordion effect. With a Z-plasty, triangular skin flaps are placed at an angle of 45 ° to the course of the scar. Shifting the tips of the flaps creates a Z-shaped scar line that is closed with fine sutures. The course of the scar is planned in such a way that some of the incisions lie in the natural skin tension lines.

Authors

Dr. Nicole Schaenzler, Dr. Hans-Hermann Wörl, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:04