external image 220px-Burn_Degree_Diagram.svg.png


A burn is a type of injury to flesh cause by heat, electricity, friction, radiation, chemicals, or light. Burns usually do not penetrate the dermis but it is possible for a burn to go all the way to the bone.

Treatment can range from using basic first aid kit materials to requiring attention from a burn center where a skin graft may be used. A skin graft is the use of healthy skin from another part of the body to replace severely damaged or completely destroyed skin that is somewhere else on the body.


Nomenclature
Layer involved
Appearance
Texture
Sensation
Time to healing
Complications
Example
First degree
Epidermis
Redness (erythema)
Dry
Painful
1wk or less
None
A sunburn is a typical first degree burn.
A sunburn is a typical first degree burn.

Second degree (superficial partial thickness)
Extends into superficial (papillary) dermis
Red with clearblister. Blanches with pressure
Moist
Painful
2-3wks
Local infection/cellulitis
Second Degree Burn on Shoulder
Second Degree Burn on Shoulder

Second degree (deep partial thickness)
Extends into deep (reticular) dermis
Red-and-white with bloody blisters. Less blanching.
Moist
Painful
Weeks - may progress to third degree
Scarring, contractures (may require excision andskin grafting)
Second-degree burn caused by contact with boiling water
Second-degree burn caused by contact with boiling water

Third degree (full thickness)
Extends through entire dermis
Stiff and white/brown
Dry, leathery
Painless
Requires excision
Scarring, contractures, amputation
Eight day old third-degree burn caused by motorcycle muffler.
Eight day old third-degree burn caused by motorcycle muffler.

Fourth degree
Extends through skin,subcutaneous tissue and into underlying muscle and bone
Black; charred witheschar
Dry
Painless
Requires excision
Amputation, significant functional impairment


Partial thickness burns, such as second degree burns, only penetrate into the dermis and not necessarily throughout the entire layer of tissue. Full thickness burns, however, extend through the entire dermis, and in extreme cases, through subcutaneous tissue, muscle, and bone.

Complications:

Infections - Infection is a common major concern for burn victims. With the epidermis and possibly the entire dermis destroyed, the body has no protective barrier to keep out bacteria and other pathogens. Burns are typically sterile for the first 24 hours, after this time period, the risk for infection increases drastically.


Desiccation - Desiccation, or dehydration, is another common concern. In severe and widespread burns, fluid is lost through the skin, potentially resulting in dehydration and electrolyte imbalance (can lead to shock). The absence of skin and its layers again play a major role in this complication. the skin acts as an envelope that holds in a body's moisture, and with it no longer there, fluid can continue to be lost until eschar forms. Fluids must be administered through an IV to make up for the loss.


- A common way to estimate the amount of fluid lost, and the surface area of burned skin is through the "Rule of Nines."



Picture of the Rule of Nines used to evaluate burn victims
Picture of the Rule of Nines used to evaluate burn victims