Burns

  • Definition
  • Wound Care
  • Patient Advice and Prevention
  • Products

A burn is an injury to the skin, and sometimes to underlying tissues, caused by contact with heat, electricity, chemicals, light, radiation or friction. Severe loss of skin can lead to infection and loss of the skin’s functions such as thermoregulation and immunity.

The majority of burns (95%) are of thermal origin (heat burns). Severely burnt patients will need to be treated in a special burns unit.

Severity

The prognosis in terms of life or death depends on the extent of the burn. The prognosis in terms of function depends on the depth, extent and the location of the burn.

The extent of burns to the total skin surface can be estimated fairly accurately in adults using the Wallace’s Rule of Nines.

Wallace rule of nines

 

Each body part is considered to account for 9% of the skin’s surface area:

  • Head and neck total for front and back: 9%
  • Each upper limb total for front and back: 9%
  • Thorax and abdomen front: 18%
  • Thorax and abdomen back: 18%
  • Perineum: 1%
  • Each lower limb total for front and back: 18%
In children body, proportions are different from those of adults, so the rule of nines has to be adapted depending on the age of the child.

 

Types of burns

By causal agent

Heat burns / Thermal burns

heat_burnSkin may be burnt from contact with heat e.g. from liquids such as hot drinks, steam from a kettle or saucepan or from touching a flame or hot surface such as a radiator or oven. Heat causes visible burns with redness, blistering and pain. The source of heat must be removed as quickly as possible and the skin cooled with tepid water. The degree and extent of the burn dictates the subsequent treatment.

Electrical burns

Electrical burns e.g. from an electrical cable, often cause serious injury to organs inside the body, but the injury may not be visible on the skin. The patient should go directly to hospital.

Chemical burns

chemical_burnA chemical burn occurs when tissue is exposed to a corrosive substance such as a strong acid or base. Normally the result of an accident, the wound will be dependent on the type of agent.

Typically chemical burns:

  • Occur immediately on contact
  • May be extremely painful
  • May not be immediately evident or noticeable
  • Diffuse into tissue and damage structures under skin without immediately apparent damage to skin surface
  • May cause extensive tissue damage

By degree

First-degree burns:

First-degree burns (superficial burns)

A first-degree burn refers to a burn that affects only the superficial layers of the epidermis, causing erythema (redness) which may be painful but without blistering (phlyctena). Spontaneous healing occurs within 2 to 3 days with no residual effects.

Second-degree burns:

Superficial partial thickness

second_degree_burn

This is a lesion affecting almost all of the epidermis. Morphologically, it is recognised by the continuous presence of blisters, the base of which are red following excision, well vascularised and very sensitive. Spontaneous healing normally occurs within 1 to 2 weeks with no residual effects, but there is still some risk of an indelible scar, particularly in children, darker pigmented skin and more generally when healing is delayed by a complication (usually local infection).

Deep dermal

second_degree_burn_deepA deep dermal second-degree burn involves complete destruction of the epidermis and the superficial dermis. All that remains intact is the deep dermis and skin appendages (hair, sweat and sebaceous glands). These burns, like superficial second-degree burns, have blisters, but following excision, the base of the blisters look whitish-pink, are poorly vascularised and have reduced sensitivity. Spontaneous healing is possible from the skin appendages but slow (2 to 4 weeks). The general condition of the patient or a local secondary infection can frequently deepen the lesions by destroying the few surviving epidermal cells preventing normal spontaneous healing.

Third-degree burns (full thickness)

With full thickness third-degree burns there is complete destruction of the skin with a minimum inclusion of the entire epidermis and the dermis. The wound looks like an adherent cutaneous necrosis, without phlyctena, is more or less dark colour (from white to brown to black) and there is a total loss of sensitivity. The complete disappearance of cutaneous cells does not allow spontaneous healing and definitive cutaneous healing can only be obtained by skin graft, i.e. by importing autologous epidermal tissues, taken from an area of intact skin. Skin-grafting is only possible following excision of the cutaneous necrosis.

Healing

  • First-degree burns usually heal within 2 to 3days.
  • Second-degree burns usually heal in 2 to 4 weeks.
  • Third-degree burns usually take a very long time to heal

Burns must be protected from physical damage and infection by micro-organisms, the ideal dressing must:

  • Be comfortable, compliant and durable
  • Be non-toxic, non-adherent and non-irritant
  • Allow gaseous exchange
  • Allow humidity at the wound
  • Be compatible with topical therapeutic agents
  • Allow the wound to heal without retarding or inhibiting any stage of the process

TLC (Technology Lipido-Colloid) creates a moist environment, favourable to the healing process. Additionally, the unique composition of TLC stimulates the proliferation of fibroblasts, key cells in the healing process. This unique property of TLC dressings has been demonstrated in vitro.

TLC dressings do not adhere to the wound, enabling atraumatic care of newly formed tissue and painless dressing removal.


These advices or recommendations do not replace expert opinion based on a full diagnosis.

Prompt action can help control the severity of a burn. The patient must be immediately removed from contact with the source of the burn. No attempt should be made to remove clothing that is stuck to the burn or to pierce blisters or remove burnt skin. Blisters must then be quickly removed by a health care professional only. Burns should be treated by cooling the skin with water.

Always seek medical advice if:  

  • A first- or second-degree burn covers an area larger than 5-8 cm in diameter.
  • The burn is on the face, over a major joint (such as the knee or shoulder), on the hands, feet or genitalia.
  • The burn is a third-degree burn, these always require immediate medical attention
  • The burn is an electrical burn

In the case of a chemical burns the affected area must be washed with copious amounts of water.

Prevention

Taking care and using common sense can help prevent many burns.

In the home caution should be applied when handling hot liquids and cooking or ironing and hot objects should never be within the reach of small children.

When handling corrosive substances, protective clothing such as goggles, gloves and lab coats/overalls should always be used.


These advices or recommendations do not replace expert opinion based on a full diagnosis.

Infected Burns

Not infected burns

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These advices or recommendations do not replace expert opinion based on a full diagnosis.
Last update : December 9, 2017