Water on cutting edge of burn treatment

null Brendan Green's grandmother looked away for just a few seconds; just enough time for the 14-month-old boy to get into trouble.

A hot cup of water scalded Brendan's skin when he pulled it off the countertop. He suffered burns over 13 percent of his body. The worst burns were on his neck, chest and left arm.

Plastic surgeon Brooke Burkey operated on Brendan one week after the accident. Instead of a traditional scalpel, Dr. Burkey used a new medical tool called a "liquid knife." It cuts through skin with a razor-thin stream of saline that moves faster than the speed of sound.

"The cutting area of water is smaller than a traditional knife, so we can get into very fine areas or very delicate areas with a lot more precision," said Dr. Burkey, who works with the St. Christopher's Hospital for Children in Philadelphia

Using the liquid knife, surgeons remove only dead cells while leaving healthy skin intact. Doctors say precision may be the key to reducing scars, especially for babies and toddlers.

"Young children's skin tends to be thinner than adult skin, so the more precise we can be, the better," said Dr. Burkey.

Brendan's mother, Meg Green, is thrilled that her little guy is back to being a curious toddler.

"Nobody said that he's not going to have scars, but if he does, it looks as if they'll probably be pretty minimal compared to what they could have been," said Meg.

So Brendan may have a chance to recover without missing a beat.

Doctors say the liquid knife cuts down the time a patient is in surgery. In addition, the tool prevents infections and can be used to remove ulcers.

According to the Centers for Disease Control, 300 children are treated every day at emergency rooms for burns caused by hot water.

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Background
Burns have long been viewed as some of the most painful and devastating injuries a person can sustain and survive. They can leave victims with life-long physical and psychological trauma. Long periods of rehabilitation, multiple skin grafts and painful physical therapy are often necessary. According to the Centers for Disease Control (CDC), almost 2 million people are treated annually for burns. Roughly 100,000 are hospitalized, but nearly 12,000 don't survive. According to the National Safety Council, the United States has the highest rate of burns in the industrialized world.

Burns and Children
Burns especially impact young children. They are the second leading cause of death of newborns to 5-year-olds. Since children have thinner skin, it burns quicker. Children may also not recognize danger and have less control of their surroundings, making it difficult to escape life-threatening burn situations. They may also be less tolerable of the physical stress of such injuries. 300 children are brought to the emergency room every day to be treated for hot water burns. Every year, 3,000 of those kids need to be hospitalized for their injuries. According to Safe Kids Worldwide, hot tap water is responsible for almost a quarter of all scald burns among children and is linked to a greater amount of deaths and hospitalizations than other hot liquid burns. Water heaters sold on the market are set between 140 and 150 degrees Fahrenheit. At 150 degrees, it takes just two seconds for a child to receive a third degree water burn. It takes five seconds for water heated to 140 degrees and 30 seconds for 130 degree water.

Half of hot water burns are attributed to parents putting their child in bathwater that is too hot. To avoid this, experts say turn your water heater down to 120 degrees and be sure to test it before putting your child in. Also, be sure to place your child on the side of the bath farthest from the faucet to prevent them from turning the water on. For minor burns, the CDC recommends holding the burned area under cool running water for 15 minutes and says not to apply ointments or butter. They also say the area should be covered with dry gauze and blisters should not be popped. If a burn affects the face, hands, genitalia, feet or any area on an infant, a doctor should be consulted. More severe burns require attention from medical personnel.

Treatment
Patients with second and third degree burns must undergo wound debridement, where dead tissue is removed to allow living tissue to heal. Traditionally, debridement is performed using a scalpel, which works well on larger areas of the body, like the leg. Smaller areas that are curved and delicate, such as on the face, are more difficult to treat. For those areas, there is now the Versajet Hydrosurgery system, a surgical instrument that uses a high-pressure stream of sterile saline to treat tissue damaged from traumatic wounds, chronic wounds and surgical incisions. The jet slices with razor sharp precision and allows surgeons to hold, cut and remove tissue at the same time, while also draining wounds. Power can be turned up to remove harder or tougher tissue. Brooke Burkey, M.D., a pediatric plastic surgeon at St. Christopher's Hospital for Children in Philadelphia, Penn., has used the "liquid knife" for about a year. Her hospital most often uses it on burn patients. Versajet results in less blood loss, faster recovery, less scarring and potentially fewer subsequent surgeries or skin grafts. It has been around for five years and is also used to treat ulcers.


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