Pus releasing Burn

[Banan]

Hello. My brother had a bad motorbike accident oversees and burned an area on his leg above his ankle. He was treated at a hospital with saline solutions, pain killers, and antibiotic shots (including ampicillin). He has been changing the covering of the burn with sterile gauze and treating it with saline solution. Someone accidentally tripped on his leg and the new skin formed peeled off and he went to be treated again with painkillers and antibiotics. He continues to use gauze and a metal net type of thing. His burn is taking some time to heal now and because it continues to form pus right at the center he is currently using pyiodine topically. The medical situation in the country he is in is not superb so I was just wondering if it would be wise to treat his burn with mafenide for the infection?  should he ask that they take a bacterial culture and prescribe antibiotics? He is not experiencing any symptoms except for moderate-severe pain when he walks and no pain at all when sitting or laying. Circulation looks good, same color and temp in both feet, and no fever, chills, or dizziness. The burn wound is about 7 cm long and 3.5 wide. He describes the pain as coming out of the inner 5 cm. There is no bleeding and only bleeds if he unintentionally wacks it on the wall as he sleeps.

[frankenfoot]

A related discussion, ankle burn wound sentanced to debridement was started.

[Jeffrey S Guy, M.D., M. Sc.]

If the dressing is sticking, it will tear off the healing tissue when you go to change the dressing.  Therefore, get the dressing saturaated with water or vaseline prior to removal.  

[Jeffrey S Guy, M.D., M. Sc.]

When a burn is healing, the new skin is very fragile and susceptible to simple trauma like you have described.  Mafenide is a great topical antibiotics to apply to an open burn.   He should not use mafenide if he has problems with his kidneys.  Typically mafenide will cause some discomfort when applied, and he only need to apply a small amount.  One does not need antibiotics unless the burn becomes infected—something impossible to determine on the internet.  Often, the burn will release chemicals that bind with the topical antibiotics and create something that looks like pus (what we call a pseudoeschar).  He should wean an ACE or elastic bandage over the wound even when the wound heals.  Wearing an elastic bandage or compression garment will protect the skin and prevent repetitive injury to the healing area.  I would tell your brother to wean an elastic bandage for perhaps several months until the healed skin becomes more robust to tolerate his “wacks.”

[dk_wangmo]

A related discussion, wound management was started.

[Banan]

Thank you for your detailed reply. He is currently wearing a tulle. The only problem is when the nurse changes it, dried up blood as well as newly formed skin peels off. The pseudoeschar info was really helpful. Hopefully he can find some sort of elastic gauze or bandage to cover it with. Thanks again.