Thermal Burns
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Adam Singer, SUNY Stonybrook:

Blister fluid has good and bad stuff in it. Aloe inhibits thromboxane A2
(vasoconstrictor).
Gimbel Arch Surg 1957: burned students and then unroofed half. Healed faster
with blisters intact.
Forage Lancet 1962:690, case control of two legs same person: leg with
blisters left intact healed better at 6 months.
Singer Acade Emerg Med 200:7:114. Healed faster if left intact, fewer scars.

At our Burn Center (one of the largest in the United States) it is standard
practice to excise all blisters greater than 1 inch in diameter and provide
aggressive wound care.  It is felt that early excision provides superior wound
healing and allows us to keep the infection rate minimized.  These blisters
will eventually rupture and by excising early we can begin good wound care and
speed the healing process.  We have very good results with this practice.

Steve Weinman
Emergency Department Instructor
Interim Burn Instructor
Burn Center
The New York Hospital-Cornell Medical Center
New York, NY

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I aspirate if the blister has become infected.

Otherwise, I leave them alone - patients seem to be more comfortable with
the blister intact. Studies have examined the effect of substances found in
blister fluid on burn healing (1-5). Some have found a theoretical
impairment of healing, but I don't know of any clinical trials which have
compared the rates of healing for intact versus aspirated burns.

It's a topic which generates plenty of dogma and confident assertions; like
Greg Winterflood said, it probably doesn't make much difference.

David Gollogly
MB ChB

1   Reagan BJ, et al; The effects of burn blister fluid on cultured
keratinocytes. (J Trauma, 1996 Mar, Abstract available) [MEDLINE]
2   Garner WL, et al; The effects of burn blister fluid on keratinocyte
replication and differentiation. (J Burn Care Rehabil, 1993 Mar-Apr,
Abstract available) [MEDLINE]
3   Sugiyama S, et al; Prostaglandins released into human burn blister
fluid. (Biomedicine, 1978 Apr, Abstract available) [MEDLINE]
4   Wilson AM, et al; The effect of burn blister fluid on fibroblast
contraction. (Burns, 1997 Jun, Abstract available) [MEDLINE]
5   Rockwell WB, et al; Fibrinolysis inhibition in human burn blister fluid.
(J Burn Care Rehabil, 1990 Jan-Feb, Abstract available) [MEDLINE]