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Monday, 27 December, 1999, 13:35 GMT
Saving your skin
Burns can leave deep scarring
A severe burn can still be sentence of death, despite great strides made by doctors over the last couple of decades.

Accident and Emergency
Doctors still use a rough calculation to work out the chances of survival - if the percentage of the body burned added to the age of patient exceeds 100, then things are looking bad.

This rough formula does not take into account the depth of the burn - if it is a deep burn, then the chances drop still further.

However, burns unit doctors have an impressive arsenal of treatments available to both save the victim, and reduce the amount of scarring.

And how the first medics on the scene deal with the patient can make a big difference.

One of the things commonly used is a water-filled antiseptic gel wrapped around the burn which not only cools down the injury fast but helps prevent the infections which are the biggest killer of burns patients.

If the gel is not available, first aiders are advised to cool down the wound by pouring on water.

The burns specialists awaiting the arrival of the patient in the ambulance knows what type of injury is on the way.

Mr John Gowar, a consultant plastic surgeon at the West Midlands Regional Burns Unit, says: "If you have been trapped in a burning building, then you are likely to have deep burns, whereas if you are caught in a gas explosion, they are likely to be shallow burns."

Shallow burns hurt much more than deep ones - the nerves under the skin have not been burned away.

Mr Gowar prefers to strip away as much of the dead tissue as soon as possible and set about replacing the skin.

Shallow burns can heal by themselves, but deeper burns, in which both the layers of the skin have been damaged, will require grafting.

Some burns victims require years of grafts
Plastic surgeons prefer to use the patient's remaining skin to patch the burn, but if a large surface area is affected, there may not be enough spare to go around.

"We have a number of tricks we employ to make a little go a long way," says Mr Gowar.

"We chop it into lots and lots of little bits."

The skin graft can also be sliced and stretched out over a wider area - the mesh graft.

And a small sample of skin cells can be grown in the laboratory.

The hide of an ox

Another development is an artificial skin layer made from a combination of cow skin and a material taken from sharks.

This is laid down while the fresh top layer, the epidermis, is grown to lay on top later.

Despite all these breakthroughs, the biggest threat is bacteria, which find the burned areas a perfect breeding ground.

Teams have to identify which particular bug is responsible and pick an antibiotic which can kill it before it grows too much, and overwhelms the patient.

Mr Gowar's own figures show that the number of people surviving different severities of burn has not improved over the years.

Some experts think that this is because more people are suffering smoke inhalation during fires.

The super-hot gases burn the delicate tissues of the lungs, which - if as severely burned as the skin, may not heal properly.

See also:

21 Dec 99 | Health
Paddington: Contrasting stories
10 May 99 | Health
Treating London's bomb victims
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