LNSLNS We wholeheartedly agree with Professor Menke’s recommendation to follow up such patients in a specialized burn care clinic. This allows reacting promptly to complications and initiating appropriate measures in a highly targeted manner. The article aimed to raise awareness of this option among doctors involved in treating patients with burn injuries and thus improve the care for such patients.

Epithetic treatment, as mentioned by Professor Federspil, is an important component of esthetic late treatment of patients with burn injuries. However, at the time such treatment is being considered, scars should be fully formed or fully treated by using all available options, so as to design the prosthesis optimally.

We thank Dr Trupkovich for his correspondence, in which he focuses on cold water treatment. Even if animal models can be translated into clinical practice to a limited degree only, they provide helpful and correct pointers. Early administration of heat in persons with severe burns injuries makes sense—as mentioned in the article—to avoid hypothermia, but can often only be given after analgesia and/or sedation or intubation since patients may experience heat as extremely painful. The preparation of (several) venous accesses, if required during transport, is absolutely essential in our opinion and should be done by default. The cited article regarding nutrition provides helpful—albeit rather general—guidelines for patients in intensive care units. Our article mentions the lack of detailed, burns specific data for nutritional therapy in several places.

We dealt mainly with burns in adult patients and intentionally avoided focusing on the complex subgroup of children with burn injuries. However, in our opinion, all severely burnt children should be treated in specialist pediatric burns hospitals or burn care units. To admit a child with a burn injury to a normal pediatric ward or pediatric surgical ward will result in a suboptimal scenario for both patient and doctor.

The guidelines for admission to a hospital for burn injuries are clearly defined by the societies. Smaller burn injuries, however, may still be treated by colleagues of numerous specialties. Years of experience in treating patients with severe burns have made us aware of often the degree and extent of burn injuries are misinterpreted. In general, the following rule applies: assessing a burn is best done by colleagues who have frequent exposure to this task and therefore have accumulated experience in the area. In Germany, this includes primarily the large burn care centers, which are run by plastic surgeons (www.verbrennungsmedizin.de).

On behalf of my co-authors, I thank our readers for their constructive comments, and I hope that this article may serve to improve our understanding of this highly specialized pathology (“burn disease”)..
DOI: 10.3238/arztebl.2010.0101b

Dr. med. Timo A. Spanholtz
Klinik für Plastische und
Rekonstruktive Chirurgie, Handchirurgie,
Zentrum für Schwerverbrannte
Universität Witten/Herdecke
Campus Köln-Merheim
Ostmerheimer Str. 200
51109 Köln, Germany

Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Spanholtz TA, Theodorou P, Amini P, Spilker G: Severe burn injuries–acute and long-term treatment [Versorgung von Schwerstverbrannten: Akuttherapie und Nachsorge]. Dtsch Arztebl Int 2009: 106: 607–13. VOLLTEXT
1. Spanholtz TA, Theodorou P, Amini P, Spilker G: Severe burn injuries–acute and long-term treatment [Versorgung von Schwerstverbrannten: Akuttherapie und Nachsorge]. Dtsch Arztebl Int 2009: 106: 607–13. VOLLTEXT