Development of an Illustrated Guide to Techniques of Dressing Application in the Patient With Burns

Susana Rodrigues de Melo Pieroni, RN, MS; Leila Blanes, RN, PhD; Christiane Steponavicius Sobral, MD, PhD; Lydia Masako Ferreira, MD, PhD


Wounds. 2019;31(12):301-307. 

In This Article

Abstract and Introduction


Introduction: Burns are complex, difficult-to-treat wounds associated with high rates of morbidity and mortality.

Objective: The aim of this study is to develop and validate an illustrated guide to techniques of dressing application for use in the initial management of the patient with burn wounds.

Methods: The construction of the illustrated guide was based on a literature review conducted of publications between 2001 to 2017 in MEDLINE/PubMed, Scientific Electronic Library Online, Cochrane Library, and Google Scholar. No similar work was found in the literature. Standardized photographs were taken using a manikin to illustrate the step-by-step procedures. The content validity of the illustrated guide was assessed by a panel of 7 burn specialists through a questionnaire in the search for a consensus opinion according to the Delphi technique. The questionnaire assessed 3 main components: Objective, Structure and Presentation, and Relevance of the guide.

Results: The final version of the illustrated guide showed an excellent overall content validity index (CVI) of 0.99. The CVI was 1.0 for the component Objective, 0.98 for Structure and Presentation, and 1.0 for Relevance. The guide has 79 pages, 86 illustrations, and 10 chapters on techniques of dressing application for patients with burn wounds. Topics including material preparation, gowning and gloving procedures, and techniques of dressing application for different parts of the body were addressed.

Conclusions: An illustrated guide for dressing application in burn wounds was developed and validated for content by an expert panel.


Burn injury is a serious source of trauma, with social, economic, and public health repercussions that require the attention of government agencies.[1] Burns are complex, difficult-to-treat wounds associated with high rates of morbidity and mortality.[2] People with changes in the skin as a result of burn wounds, especially exposed scars, may have difficulty establishing or maintaining close interpersonal relationships, even among friends and relatives.[3]

Burns can be classified based on the wound depth as first-degree (epidermal), involving only the epidermis; second-degree (superficial and deep partial-thickness), involving the epidermis and superficial dermis; third-degree (full-thickness), involving the epidermis, dermis, and subcutaneous tissue; and fourth-degree, which are also full-thickness burns, but involve underlying structures such as muscles or bones.[4–6] The treatment of patients with burn wounds has been a great challenge worldwide because of their medical, surgical, and psychological complexity, requiring intensive multidisciplinary care.[7,8]

About 300 000 burn victims die annually across the world.[1] In Brazil, it is estimated that 1 million burn cases occur per year, with only 100 000 victims seeking medical care, resulting in 30 000 hospitalizations per year and about 2500 deaths as a direct or indirect consequence of the burn injury, showing the importance of the topic in public health planning.[9] Burns have various causes, such as chemical, radiation, thermal, electrical, and inhalation of smoke and chemical products.[1,2,8–10] The costs of care and modern specialized treatments are high.[11] Adequate human and technological resources for the treatment of patients with burns tend to decrease the length of hospital stay and mortality rate.[12] The quality of care provided to the burn patient is monitored constantly from admission to discharge in specialized burn facilities, representing a challenge for health care professionals and increasing their interest in patient recovery.[2–13]

Dressing applications in patients with burn injuries usually are performed by physicians and nursing professionals based on protocols from a specialized burn facility. Occlusive dressings are an alternative for burn treatment and may be applied to a clean surface of a burn injury within 24 hours after the accident.[4–14] Difficulties may occur at the time of application and removal of occlusive dressings, especially at the end of the procedure, when the correct positioning of the patient may be difficult to maintain due to the extent of the injury or prolonged duration of the procedure. Burns may result in functional disability due to sequelae such as hypertrophic scars, skin retraction, sensory changes, physical impairment, and anxiety, making it difficult for the patient to return to previous activities. A burn treatment should increase skin flexibility, because scars formed as a consequence of burn injuries are commonly inelastic and permanently restrict mobility of underlying tissue and joints.[15] The use of occlusive dressings may facilitate physical therapy interventions, which aim to improve skin and muscle flexibility, joint mobility, and range of motion.

Guides and manuals with recommendations for health promotion and education provide important pedagogical support for the continuing education of health professionals. In addition to training, the educational material contributes to the standardization of protocols and empowers professionals to take action in patient care.[16] Thus, the aim of this study was to develop and validate an illustrated guide of dressing application techniques for use in the initial management of the patient with burn wounds. This educational material may be used to standardize medical and hospital supplies and dressing procedures for burn injuries and serve as instructional tools for health care professionals.