Case Study: Management of a Partial-Thickness Firework Burn on a Mobile Joint

Case at a Glance

A 21-year-old female presented with a painful partial-thickness burn in the clavicular region sustained from a firework. She reported significant challenges in maintaining a wound dressing due to the high mobility of the area, leading to pain and exposure of the wound.

Patient's Story

The patient, a 21-year-old female with a history of anxiety/depression managed with an SNRI and using an IUD for contraception, presented for evaluation two days after sustaining a burn. She reported that she was struck by a pyrotechnic flare from a Roman candle firework. The resulting wound, located near her collarbone and shoulder, was approximately 1 by 3 inches. The patient described the pain as significant, especially when the wound was left exposed to air. Her primary difficulty was in wound care; standard gauze pads secured with medical tape would not adhere for more than an hour due to constant movement of the shoulder and clavicle. She was unable to find commercial adhesive bandages large enough to cover the area effectively. Concerned about proper care, signs of healing, and the threshold for professional medical intervention, she sought advice.

Initial Assessment

Physical examination revealed a linear, partial-thickness (second-degree) burn on the anterior aspect of the shoulder, superior to the clavicle. The wound measured approximately 3 inches in length and 1 inch in width. It was characterized by erythema, moistness, and evidence of ruptured bullae. The area was exquisitely tender to light touch. There were no signs of circumferential injury or neurovascular compromise in the distal extremity. The location over a highly mobile joint was identified as a key challenge for wound management.

The Diagnostic Journey

The diagnosis was made clinically based on the patient's direct history of a thermal injury from a firework and the physical appearance of the wound. The depth of the burn was classified as partial-thickness given the moist, erythematous base and significant pain, indicating nerve endings were still intact. The patient's initial online inquiry highlighted a common challenge for patients: a lack of knowledge regarding appropriate dressings for burns, especially in difficult-to-dress locations. The suggestion of a non-adherent, occlusive dressing like Xeroform was raised during this initial query, steering the patient toward standard medical practice.

Final Diagnosis

Partial-Thickness (Second-Degree) Thermal Burn.

Treatment Plan

The recommended treatment plan focused on promoting a moist wound healing environment and ensuring dressing adherence:

1. Wound Cleansing: Gentle cleaning of the area with mild soap and water or a sterile saline wash daily.
2. Dressing: Application of a non-adherent dressing, such as bismuth-impregnated petrolatum gauze (Xeroform) or a silicone foam dressing, to keep the wound bed moist and prevent sticking.
3. Securing the Dressing: To address the mobility issue, the primary dressing was to be covered with a larger, flexible, transparent film dressing or a conforming stretch gauze roll (e.g., Kerlix) to hold it securely in place during shoulder movement.
4. Pain Management: Over-the-counter analgesics such as ibuprofen or acetaminophen were recommended for pain control.
5. Patient Education: The patient was instructed on the signs and symptoms of infection, including increasing redness, purulent drainage, foul odor, worsening pain, or fever, and was advised to seek immediate medical attention if any of these occurred.

Outcome and Follow-up

The patient was advised to follow up with a primary care or urgent care provider if the wound did not show signs of epithelialization (new skin growth) within a week or if signs of infection developed. With proper adherence to the wound care regimen, the burn was expected to heal within 2 to 3 weeks. The patient was counseled that some residual post-inflammatory hyperpigmentation or hypopigmentation is common but typically fades over several months.