doi: 10.1111/1346-8138.13288 Journal of Dermatology 2016; : 1–22 GUIDELINE The wound/burn guidelines – 6: Guidelines for the management of burns Yuichiro YOSHINO,1 Mikio OHTSUKA,2 Masakazu KAWAGUCHI,3 Keisuke SAKAI,4 Akira HASHIMOTO,5 Masahiro HAYASHI,3 Naoki MADOKORO,6 Yoshihide ASANO,7 Masatoshi ABE,8 Takayuki ISHII,9 Taiki ISEI,10 Takaaki ITO,11 Yuji INOUE,12 Shinichi IMAFUKU,13 Ryokichi IRISAWA,14 Masaki OHTSUKA,15 Fumihide OGAWA,16 Takafumi KADONO,7 Tamihiro KAWAKAMI,17 Ryuichi KUKINO,18 Takeshi KONO,19 Masanari KODERA,20 Masakazu TAKAHARA,21 Miki TANIOKA,22 Takeshi NAKANISHI,23 Yasuhiro NAKAMURA,24 Minoru HASEGAWA,9 Manabu FUJIMOTO,9 Hiroshi FUJIWARA,25 Takeo MAEKAWA,26 Koma MATSUO,27 Osamu YAMASAKI,15 Andres LE PAVOUX,28 Takao TACHIBANA,29 Hironobu IHN,12 The Wound/Burn Guidelines Committee 1Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, 2Department of Dermatology, Fukushima Medical University, Fukushima, 3Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, 4Intensive Care Unit, Kumamoto University Hospital, Kumamoto, 5Department of Dermatology, Tohoku University Graduate School of Medicine, Miyagi, 6Department of Dermatology, Mazda Hospital, Hiroshima, 7Department of Dermatology, Faculty of Medicine,University of Tokyo, Tokyo, 8Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, 9Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, 10Department of Dermatology, Kansai Medical University, Osaka, 11Department of Dermatology, Hyogo College of Medicine, Hyogo, 12Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, 13Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, 14Department of Dermatology, Tokyo Medical University, Tokyo, 15Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, 16Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 17Department of Dermatology, St. Marianna University School of Medicine, Kanagawa, 18Department of Dermatology, NTT Medical Center Tokyo, 19Department of Dermatology, Nippon Medical School, Tokyo, 20Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Aichi, 21Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 22Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, 23Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, 24Department of Dermatology, University of Tsukuba, Ibaraki, 25Department of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 26Department of Dermatology, Jichi Medical University, Tochigi, 27Department of Dermatology, The Jikei University School of Medicine, Tokyo, 28Ichige Dermatology Clinic, Ibaraki, 29Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan ABSTRACT Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic manage- ment, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of ini- tial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we pre- pared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures. Key words: burn index, deep burn, deep dermal burn, epidermal burn, superficial dermal burn. Correspondence: Hironobu Ihn, M.D., Ph.D., Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. Email: [email protected] This is the secondary English version of the original Japanese manuscript for The wound/burn guidelines – 6: Guidelines for the management of burns published in the Japanese Journal of Dermatology 2011; 121(14): 3279–3306. Received 3 December 2015; accepted 4 December 2015. © 2016 Japanese Dermatological Association 1 guide.medlive.cn Y. Yoshino et al. BACKGROUND OF THE DRAFTING OF THE COLLECTION OF EVIDENCE GUIDELINES FOR THE MANAGEMENT OF BURNS Databases used: Medline, PubMed, Japana Centra Revuo Medicina Web and Cochrane Database of Systematic Reviews of ALL EBM Reviews. References obtained by manual search Burns are a common type of skin injury encountered at all of each member were also added. levels of medical facilities from private clinics to core hospitals. Search period: The published work that could be searched Minor burns heal by topical treatment alone, but moderate to between January 1980 and December 2008 was reviewed. severe burns require systemic management, and skin grafting Recent published work of importance was added when consid- is often necessary also for topical treatment. Inappropriate ini- ered appropriate. tial treatment or delay of initial treatment may exert adverse Adoption criteria: Priority was placed on systematic reviews effects on the subsequent treatment and course. Therefore, of randomized controlled trials (RCT) and papers on individual accurate evaluation of the severity and initiation of appropriate RCT. If they were not available, papers on cohort studies and treatment are necessary. case–control studies were adopted. Although some papers on To the present, the Guidelines for the Management of Burn case series studies were also used as references, the pub- Injuries were issued in March 2009 from the Japanese Society lished work on basic experiments was excluded. for Burn Injuries as guidelines concerning burns, but they were focused on the treatment of extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to CRITERIA FOR THE DETERMINATION OF THE support the appropriate diagnosis and initial treatment of EVIDENCE AND RECOMMENDATION LEVELS patients with burns that are commonly encountered including The criteria adopted in the Guidelines for the Diagnosis and minor as well as moderate and severe cases. Because of this Treatment of Malignant Tumors edited by the Japanese intention of the present guidelines, there is no recommendation Dermatological Association mentioned below were used as of individual surgical procedures. references. Evidence levels: POSITION OF THE GUIDELINES FOR THE MANAGEMENT OF BURNS I Systematic reviews/meta-analyses. II One or more RCT. The Wound/Burn Guidelines Committee consists of members III Non-RCT (including before/after comparative studies commissioned by the Board of Directors of the Japanese Der- with statistical analysis). matological Association. It held several meetings and evalua- IVa Analytical epidemiological studies (cohort studies). tions in writing since October 2008 and drafted the Guidelines IVb Analytical epidemiological studies (case–control stud- for the Management of Burns by taking opinions of the Scien- ies/cross-sectional studies). tific Committee and Board of Directors of the Japanese Der- V Descriptive studies (case reports and case series stud- matological Association into consideration. The present ies). guidelines show the current standards of the treatment for VI Opinions of special committees and individual experts. burns in Japan. However, as individual patients vary in the background including underlying diseases, severity of symp- Recommendation levels: toms and complications, the physicians who conduct the diag- A Strongly recommended (there is at least one piece of nosis and treatment should determine the therapeutic level I or good level II evidence indicating the effec- approaches together with the patients, so the contents of their tiveness). decisions are not required to be in complete agreement with B Recommended (there is at least one piece of inferior the present guidelines. Also, the guidelines are not relevant for level II, good level III or very good level IV evidence). citation in lawsuits. C1 Recommended as an option despite the lack of good evidence (there is inferior level III–IV evidence, several SPONSORS AND CONFLICTS OF INTEREST pieces of good level V evidence or level VI evidence endorsed by the committee). All cost needed for drafting the present guidelines has been C2 (Presently) not recommendable due to the lack of borne by the Japanese Dermatological Association, and no sufficient evidence (there is no evidence indicating fund has been received from particular organizations, enter- effectiveness or there is evidence indicating ineffec- prises, pharmaceutical companies and so forth. If any mem- tiveness). bers of the committee have been involved in the development D Disrecommended (there is good evidence indicating of particular related drugs and so forth, they were excluded ineffectiveness or harmfulness). from the evaluation of the recommendation