Surgical treatment and management of burns in Jordan

Burn care and burn surgery form a single pathway that begins with assessing the depth, surface area, site and mechanism of the burn, then covers wound cleansing and dressing, infection surveillance, pain control and fluid replacement, and may extend to surgery such as removal of dead tissue and skin grafting for deep burns. The order of priorities never changes: protect life and limb first, close the wound as early as possible, then limit scarring and the contractures that tighten skin and restrict joint movement. What happens in the first minutes shapes everything that follows. Remove the heat source, then run **cool (not iced) running water over the area for ten to twenty minutes**. Do not use ice or iced water: over-cooling constricts blood vessels and can deepen the injury. Do not apply toothpaste, oil, ghee, coffee, salt, egg or any traditional paste. These are widespread myths that contaminate the wound, trap heat inside it and hide the true depth from the treating doctor, delaying the right decision and raising the risk of infection. Take off rings, watches and any clothing that is not stuck to the skin, leave adherent material alone, cover the area with a clean non-adherent dressing or clean cloth, and seek assessment. Go to the emergency department immediately if the burn involves the face, neck, hands, feet, joints or genital area, if it encircles a limb or the chest, if the skin looks white, dry brown or charred, or has lost pain sensation, or if it is wider than the injured person's own palm. The same applies to electrical and chemical burns, to smoke inhalation with hoarseness, sooty sputum or breathing difficulty, and to burns in children, pregnant women, older adults and people with diabetes or reduced immunity, as well as when tetanus vaccination is not up to date. Chemical burns need prolonged irrigation with running water and removal of contaminated clothing; never try to neutralise them with another substance. The limits of treatment matter as much as its benefits. Surgery closes the wound; it does not restore the skin to its original state, so differences in colour and texture usually remain and scars may need months of pressure therapy, silicone sheeting and sun protection. A skin graft requires a healthy donor site that also heals with a mark of its own, and topical antibiotic cream alone neither prevents infection nor replaces regular cleansing and dressing changes. Burn depth can evolve over the first forty-eight hours, so it is reassessed rather than judged once. Suitability for any surgical step is decided by clinical examination of depth and extent, not by reading about it.