Burn Wound Healing: When to Seek Further Treatment

Burn wound not healing?

Hello, doctor.
I would like to inquire about the recovery from a burn.
In mid-December last year, I burned the skin on the top of my foot where it connects to my calf.
I previously consulted a doctor who mentioned that the wound might be a deep second-degree or third-degree burn.
When I returned for a follow-up in late February, the doctor said I should wait for the skin to shed naturally and that I didn't need to apply any medication, so they prescribed me some ointment to apply myself.
However, it still hasn't healed, and the wound has turned black.
Should I return to the hospital for further treatment, or should I continue applying the burn ointment? I have tried not applying any medication and not covering it, but the wound still hurts slightly when it rubs against my pants.
I would like to know what the condition of the wound is like.

Yi, 20~29 year old female. Ask Date: 2016/05/04

Dr. Lu Daokuan reply Plastic Surgery

Healed skin is thinner and may be painful to the touch or develop small blisters with friction.
You can apply some lotion for care, or return for a follow-up appointment to consult your physician.

Reply Date: 2016/05/04

More Info

When it comes to burn wound healing, particularly for second-degree and third-degree burns, it is crucial to understand the healing process and when to seek further treatment. Based on your description, it sounds like you have been dealing with a significant burn injury that has not healed as expected.
First, let's clarify the types of burns. Second-degree burns affect both the outer layer of skin (epidermis) and part of the underlying layer (dermis), leading to symptoms like redness, swelling, and blistering. These burns can be quite painful. Third-degree burns, on the other hand, extend through the dermis and affect deeper tissues, potentially resulting in a white, leathery appearance and a lack of pain due to nerve damage.
In your case, since the wound has not healed and has turned black, it raises concerns about necrosis (tissue death) or infection. The presence of black tissue can indicate that the skin is not regenerating properly, which is a sign that you may need more intensive medical intervention. Here are some important considerations:
1. Seek Medical Attention: Given that your wound has not healed and has changed color, it is advisable to return to a healthcare provider for a thorough evaluation. A physician can assess the wound for signs of infection, necrosis, or other complications that may require surgical intervention, such as debridement (removal of dead tissue) or skin grafting.

2. Wound Care: Continuing to apply topical medications as prescribed is important, but if the wound is not improving, you may need a different treatment plan. Over-the-counter burn creams may not be sufficient for deeper burns, and specialized wound care products might be necessary.

3. Monitoring for Infection: Watch for signs of infection, which can include increased redness, swelling, warmth, pus or other drainage, and fever. If you notice any of these symptoms, seek medical care immediately.

4. Pain Management: If the wound is painful, especially with friction from clothing, it may be beneficial to use a non-stick dressing or a specialized burn dressing to minimize irritation. Pain management is an essential part of the healing process, and discussing this with your healthcare provider can help improve your comfort.

5. Avoiding Further Injury: Protecting the burn area from further trauma is crucial. If clothing is causing pain, consider using loose-fitting garments or protective coverings to shield the area while it heals.

6. Follow-Up Care: Regular follow-up appointments are essential for monitoring the healing process. If your doctor has advised you to let the skin fall off naturally, ensure that you are still keeping the area clean and protected. However, if there is no improvement, it is important to communicate this to your healthcare provider.

In summary, while some burns can heal with conservative treatment, the fact that your wound has not improved and has developed black tissue suggests that further medical evaluation is necessary. Do not hesitate to seek care, as timely intervention can significantly impact healing outcomes and prevent complications.

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