Course of Therapy

Admission

After accidental burns, we distinguish between small and large burns.

Small burns

Smaller burns are treated in the emergency department of the Zurich University Hospital by specialists.

Large burns

Larger burns and severe burn victims will be admitted to the burn center by paramedic service or REGA.

In this case admission takes place via central telephone service (phone +41 44 255 11 11), to the physician on call for the Plastic Surgery and Hand Surgery Clinic.

Treatment

Initial treatment and dressings

We first cleanse the burn wounds. At the same time, we determine a therapeutic approach based on degree and extent of the burn injury. After wound cleansing, we apply antimicrobial salves and dressings. In the first days after a burn injury daily dressing changes are required. If there is joint involvement, physical therapists are there to assist with passive and active motion exercise during the dressing change, in order to preserve or restore joint mobility as much as possible. Physicians assess the wounds at every dressing change and decide further treatment course.

Surgical treatment of burns

For healing of deep burns, the affected tissue areas must be removed until healthy, well-perfused tissue is present.

Skin grafting

We use various skin graft techniques to optimize healing, to diminish scarring, and to facilitate free movement. We use both autologous as well as artificial skin.

Split-thickness skin grafting

In this method of skin transplantation, we harvest a thin layer of skin, so-called split-thickness skin, from a healthy site and transplant it to the prepared wound bed. Meshed enlarged split-thickness skin grafts are often used to cover extensive wounds. The harvest site heals spontaneously as would a superficial abrasion. The grafted skin heals into the wound within a few days, as long as the healing process is not impaired through infection, major metabolic disturbance, or inadequate immobilization.

Transplant of cultured skin cells

If you have extensive burn wounds comprising more than 50% of the body surface, we transplant cultured skin cells (keratinocytes). To this end, we harvest a healthy piece of skin the size of a postage stamp. We use this to isolate skin cells in the lab and multiply them in cell culture. This method allows for production of large grafts of your own skin cells within three weeks, which are then placed on the prepared wound bed. Treatment following a keratinocyte transplant is similar to that following split-thickness skin transplant, however, it is important to handle the new, initially thin, friable skin, which is easily injured and prone to infection.

Skin substitute for temporary wound coverage

If the patient's overall condition is poor or if it is not possible to find sufficient donor sites, the wound can unfortunately not be covered with autologous skin. To protect the wound surfaces from infections, limit fluid, elektrolytes and albumin loss, and reduce pain, we are dependent on a temporary coverage with skin substitutes (artificial or donor skin). However, as soon as a definitive coverage with split-thickness skin or keratinocyte sheets is possible, this artificial skin is replaced.

Physiotherapy and Ergotherapy

Physiotherapists and occupational therapists will support you during your entire hospital stay and beyond. The physical therapist is responsible for the physical strengthening program, i.e. the maintenance, and if possible, the improvement of the function of the motor system, but also for stimulation of all organ systems. The occupational therapist is concerned with preserving function.

Compression treatment

Spontaneous healing of severe burns and skin grafts can result in extensive, thickened (hypertrophic) scars that contract and eventually lead to restricted joint mobility. However, the amount of scarring is very individual and cannot be estimated. Constant, even pressure through customized compression garments decreases the formation of thickened scars and helps improve the cosmetic result. It is important that you start compression therapy immediately after the burn wounds heal. Pressure should be exerted 24 hours a day, thus also at night.

Silicone inserts can helps distribute pressure evenly in areas of the body that are difficult to compress. It is also important to take good care of your skin by daily application of a fatty salve. It can take up to 12–24 months until the initially reddish discolored and itchy scars have matured enough so that exuberant scarring is no longer a risk; this is how long you must wear at all times the compression garments. It will require patience and discipline – we can show you how to accomplish this.

Intensive Care Ward

Our highly specialized intensive care unit provides six treatment units. All patient rooms are specially air-conditioned and isolated from the rest of the division, to prevent transmission of germs. In the Intensive care unit, a competent care team will nurse and monitor you around the clock.

A key feature of the burn center is its own surgical division, which is integrated into the intensive care ward. It consists of two interconnected units: a room with bath and hydraulic patient lift for the cleansing of wounds as well as a fully equipped operating room for removal of burnt skin and for wound dressing.

Patient Bedrooms

The rooms, renovated in 2008, all include separate bath rooms with shower and W.C. Rooms are outfitted with one, two, three, or four beds.

An expert nursing team cares for patients around the clock. We emphasize the best possible interdisciplinary collaboration with the medical and therapeutic fields as well as social and psychological services.

A spacious room is available to apply complex dressings. For cleansing of wounds and after-care for burns a special bathtub is available.

Follow up Care

Clinic

In our burn clinic we treat acute burns as well as their long-term sequelae (scars, functional limitations) and all related functional and esthetic disorders. In our specialized nursing consultation, we can also perform extensive dressing changes with administration of appropriate analgesics during ambulatory therapy. We treat functional impairment early on with a physical therapy team specialized for burn treatment.

Treatment of scars

In our interdisciplinary clinic we can advise you regarding individual corrective measures, and whether conservative treatment with silicone plasters and superficial application of scar products is adequate.

In the reconstruction phase, i.e. after wound healing, we often use full skin grafts and flap plasties to treat functionally restrictive scarring. In full skin transplants, full thickness skin is harvested from a healthy donor site, preferably the groin, and grafted onto the prepared wound bed. The resulting wound is either sutured directly or covered with split skin. In specific sites, where there are for instance exposed nerves, vessels, bone, or cartilage, a so-called targeted or free microsurgical flap-plasty is performed.