Treatment of Fireworks-Related Burns with Hyperemic Skin and Bulbar Urethral Injury
For fireworks-related burns causing hyperemic skin and bulbar urethral injury, immediate cooling of the burn site followed by appropriate wound dressing should be performed, while urethral injury requires urinary diversion via suprapubic cystostomy as first-line management. 1, 2
Management of Thermal Burns
Immediate Care for Hyperemic Skin Burns
- For burns with total body surface area <10%, immediate cooling with tap water for 20-40 minutes significantly reduces burn depth and need for skin grafting 1
- Cooling should be performed in the absence of shock and helps reduce pain by affecting the inflammatory cascade 1, 3
- After cooling, burns should be cleaned with tap water, isotonic saline, or antiseptic solution before applying appropriate dressings 1
- Wound dressings should be applied in a clean environment, which may require deep analgesia or general anesthesia 1
Wound Care Considerations
- Burn wound dressings reduce pain, protect from external contamination, and limit heat loss 1
- Silver sulfadiazine should be avoided for prolonged use on superficial burns as it may prolong healing 1
- Antiseptic dressings are appropriate for large or contaminated burns, while topical antibiotics should be reserved only for infected wounds 1
- When applying dressings on limbs, prevent bandages from creating a tourniquet effect and monitor distal perfusion with circular dressings 1
Pain Management
- Multimodal analgesia is recommended for burn pain management, with titration based on validated pain assessment scales 3
- Short-acting opioids and ketamine are effective for managing burn-induced pain 3
- Non-pharmacological treatments such as cooling limited burned surfaces and covering burns with appropriate dressings can improve pain control 3
Management of Bulbar Urethral Injury
Initial Assessment and Management
- Diagnosis of urethral injury should be confirmed and classified by retrograde urethrogram 2, 4
- The World Journal of Emergency Surgery recommends obtaining urinary drainage as soon as possible via suprapubic catheter for traumatic urethral injuries 2
Primary Treatment Options
- Suprapubic cystostomy is the preferred initial management for bulbar urethral injuries, especially before any attempt at urethral catheterization 2, 4, 5
- Avoid urethral catheterization attempts as they may worsen the injury and increase stricture formation risk 6, 5
- For partial disruptions, endoscopic realignment is associated with a lower stricture rate (41.5% requiring no further surgery) compared to suprapubic cystostomy alone (14.6%) 5
- For complete disruptions, emergency anastomosis has shown better outcomes with a 90.4% success rate compared to cystostomy alone 5
Follow-up and Monitoring
- Perform urethrography every two weeks to monitor healing progress 2
- Monitor for stricture formation, which occurs in 86% of complete ruptures and 32% of partial ruptures 6
Management of Complications
- Urethral strictures may develop as a complication and require surgical intervention 4, 6
- Visual internal urethrotomy (VIU) has a low success rate of only 15% for strictures following trauma 6
- Urethroplasty (stricture excision and re-anastomosis) has a significantly higher success rate of 96% for strictures that develop after bulbar urethral injury 6, 7
- Anastomotic urethroplasty shows success rates of 68.7-98.8% for strictures from 1-3.5cm in length 7
Important Considerations and Pitfalls
- Avoid placing excessive tension on the urethra during repair as this increases complication risks 2
- Do not routinely administer antibiotic prophylaxis for burns unless there is evidence of infection 1
- Avoid using external cooling devices (e.g., Water-Jel dressings) for prolonged periods to prevent hypothermia 1
- Return to normal activities should be allowed only after microscopic hematuria has resolved 2
- For extensive burns with urethral involvement, consider the need for specialized reconstructive techniques such as flap coverage for tissue defects 8