[18] Cargile membrane makes an excellent covering for burns whose surfaces have been cleaned of sloughs and which are granulating. It adapts itself perfectly to all irregularity of contour, may be snugly applied and not changed until necessity requires it.
The disfigurement caused by a superficial burn will fade after a few months. In cases where the skin has sloughed there is a tendency to cicatricial contraction as soon as granulations begin to form, and the tendency then is to the formation of disfiguring scars. About the limbs the flexor muscles will always overcome the extensors, and bridle-like deformities will be formed at flexures of the joints. These are to be prevented so far as possible by two measures—proper splinting and early skin grafting. About the face splints cannot be used, but one of the grafting methods should be used.
Fig. 98
Epithelioma following ulcer due to burn. (Lexer.)
A tendency in the scars of old burns is to formation of keloid (see [below]) and epithelioma. The writer has seen epitheliomatous ulcers covering at least an area of a square foot, which had formed upon the sites of burns received years previously. In one case of this kind it was necessary to remove the entire upper extremity; even then the disease recurred and finally destroyed the patient ([Fig. 98]).
Burns produced by caustic acids or alkalies call for appropriate chemical antidotes at first and later essentially the same treatment as that already mentioned. In cases of severe burn there is danger of neglecting the ordinary rules of general treatment, which consist in maintaining elimination and nutrition.
FROSTBITE.
Effects similar to those produced by heat are caused also by cold, varying from a superficial dermatitis with its surface irritation, its possible vesication, and, later, desquamation, to complete freezing of an extremity or a part (e. g., the nose, or the ear), which may be followed by gangrene. Portions which are not frozen beyond the point of restoration of vitality undergo a marked reaction and become swollen and discolored, save in rare instances where they shrivel. Gangrene is not so immediate a process as in a severe burn, as it takes a number of hours, sometimes days, for the establishment of the so-called line of demarcation, by which the dead tissue is separated from the living. On one side of this line putrefaction goes on rapidly, as in moist gangrene from any cause; on the other side there is active circulatory disturbance, with phagocytosis, by which the line becomes more marked; no portion of tissue on the distal side of this dead line can be saved. The location of the lesion and the exigencies of the case will indicate where amputation should be made. (See chapter on [Gangrene].)