If a burn is already infected when first seen, it is to be treated on the same principles as govern the treatment of other infected wounds.
All moist or greasy applications, such as Carron oil, carbolic oil and ointments, and all substances like collodion and dry powders, which retain discharges, entirely fail to meet the indications for the rational treatment of burns, and should be abandoned.
Skin-grafting is of great value in hastening healing after extensive burns, and in preventing cicatricial contraction. The deformities which are so liable to develop from contraction of the cicatrices are treated on general principles. In the region of the face, neck, and flexures of joints ([Fig. 63]), where they are most marked, the contracted bands may be divided and the parts stretched, the raw surface left being covered by Thiersch grafts or by flaps of skin raised from adjacent surfaces or from other parts of the body ([Fig. 1]).
Injuries produced by Electricity
Injuries produced by Exposure to X-Rays and Radium.—In the routine treatment of disease by radiations, injury is sometimes done to the tissues, even when the greatest care is exercised as to dosage and frequency of application. Robert Knox describes the following ill-effects.
Acute dermatitis varying in degree from a slight erythema to deep ulceration or even necrosis of skin. When ulcers form they are extremely painful and slow to heal. When hair-bearing areas are affected, epilation may occur without destroying the hair follicles and the hairs are reproduced, but if the reaction is excessive permanent alopecia may result.
Chronic dermatitis, which results from persistence of the acute form, is most intractable and may assume malignant characters. X-ray warts are a late manifestation of chronic dermatitis and may become malignant.
Among the late manifestations are neuritis, telangiectasis, and a painful and intractable form of ulceration, any of which may come on months or even years after the cessation of exposure. Sterility may be induced in X-ray workers who are imperfectly protected from the effects of the rays.
Electrical burns usually occur in those who are engaged in industrial undertakings where powerful electrical currents are employed.
The lesions—which vary from a slight superficial scorching to complete charring of parts—are most evident at the points of entrance and exit of the current, the intervening tissues apparently escaping injury.