How do burn pads work in treating burns, particularly for patients with minor to moderate burns?

How Burn Pads Work

Burn pads function through multiple mechanisms: they provide immediate cooling to limit tissue damage, create a protective barrier against contamination, maintain a moist wound environment that promotes healing, and reduce pain through temperature modulation and physical protection of exposed nerve endings. 1

Primary Mechanisms of Action

Cooling Effect

• Burn pads work initially by actively cooling the thermal injury, which limits the progression of burn depth by stopping the ongoing thermal damage to deeper tissue layers 1
• Cooling for 20-39 minutes significantly reduces the need for skin grafting (P < 0.001), as demonstrated in a study of 2,320 patients 1
• The cooling mechanism reduces pain by affecting the inflammatory cascade and decreasing nerve ending stimulation 2
• Critical caveat: External cooling devices (e.g., Water-Jel dressings) should not be used for prolonged periods to limit the risk of hypothermia 1

Barrier Protection

• Burn pads create a physical barrier that protects the wound from external contamination and reduces infection risk 1
• The dressing prevents heat loss from the wound surface, which is particularly important in larger burns where hypothermia risk increases 1
• Non-adherent dressings prevent trauma during removal, minimizing pain and preserving healing tissue 2, 3, 4

Moisture Management

• Modern burn pads maintain an optimal moist wound environment that accelerates epithelialization and healing 5, 6
• Hydrogel-based burn dressings provide continuous moisture while absorbing excess exudate 5
• The moist environment prevents wound desiccation, which would otherwise delay healing and increase pain 7

Types of Burn Pads and Their Specific Mechanisms

Petrolatum-Based Dressings

• Work by creating an occlusive barrier with petrolatum (Vaseline) or petrolatum-based antibiotic ointments that prevent moisture loss 2, 3
• Xeroform (3% bismuth tribromophenate/vaseline impregnated gauze) adheres to the burn and peels off as new epithelialized skin forms, requiring minimal dressing changes 8
• These dressings reduce pain by preventing air exposure to nerve endings 1

Silver-Containing Dressings

• Release antimicrobial silver ions that reduce bacterial colonization and infection risk 6
• Important limitation: Silver sulfadiazine is associated with prolonged healing when used long-term on superficial burns and should be avoided in this context 1, 6
• Newer silver-containing dressings (not silver sulfadiazine) demonstrate better healing outcomes than traditional treatments 6

Biosynthetic and Occlusive Dressings

• Create a synthetic "second skin" that mimics normal skin barrier function 6
• These dressings consistently show superior healing outcomes compared to silver sulfadiazine 6
• They work by maintaining optimal temperature and moisture while allowing gas exchange 9

Clinical Application Algorithm

For Burns <20% TBSA in Adults or <10% TBSA in Children (Without Shock)

1. Immediate cooling with tap water (15-25°C) for up to 40 minutes 1
2. Remove jewelry before swelling occurs 2, 3, 4
3. After cooling, apply petrolatum or petrolatum-based antibiotic ointment (without sulfonamides) 2, 3
4. Cover loosely with clean, non-adherent dressing 2, 3, 4
5. Leave blisters intact 2, 4

For Larger or More Severe Burns

• Burn wound care should be performed only after resuscitation is complete 1
• Clean wounds with tap water, isotonic saline, or antiseptic solution before applying dressing 1
• The type of dressing depends on total body surface area, wound appearance, and patient condition 1
• Antiseptic dressings are appropriate for large or contaminated burns 1

Critical Pitfalls to Avoid

• Never apply ice directly to burns—this causes tissue ischemia and worsens outcomes 1, 2, 4
• Do not use external cooling devices during transport to hospital—hypothermia risk outweighs benefits 1
• Avoid prolonged cold exposure to large burns or brief exposure with ice, as this causes further tissue injury 1, 3
• Do not use topical antibiotics as first-line treatment—reserve for infected wounds only 1
• Avoid silver sulfadiazine for superficial burns due to prolonged healing times 1, 6
• When applying dressings to limbs, prevent tourniquet effect and monitor distal perfusion 1

Pain Control Mechanism

• Burn pads reduce pain through multiple pathways: cooling decreases inflammatory mediator release, physical coverage prevents air exposure to nerve endings, and moisture maintenance reduces desiccation-related pain 1, 2
• The pain reduction is significant enough that covering burns with fatty substances and dressings is recommended as a non-pharmacological pain control technique 1