Burns: Overview

Burns can be classified into:

1. Superficial (first degree): involves only the superficial epidermis; 3-7 days to heal with no scarring

2. Superficial partial-thickness (second degree): involves the epidermis and varying depths of dermis but not the hair follicles, sweat glands or sebaceous glands; heal in less than 21 days with minimal scarring

3. Deep partial-thickness (second degree): involves epidermis and dermis; more than 21 days to heal and may develop severe scarring

4. Full thickness (third degree): involves total destruction of the epidermis, dermis, hypodermis and may involve additional tissue; presents as charred painless surface known as an eschar; may require skin grafting

5. Deep full thickness (fourth degree): involves fat, nerve endings, muscle, and/or bone; may require flap coverage
   

The rule of 9s is used to calculate the body percentage of burns, for Total Body Surface Area (TBSA). Minor burns are under 15% TBSA. Moderate burns are 15-25% TBSA. Major burns are over 25% TBSA. For example, almost all electrical burns are classified as full thickness burns.

Burn complications can include:

1. Contractures (shortening of muscles, tendons, joint capsule)

2. Hypertrophic scars with disfigurement

3. Pruritus usually during first year post burn

4. Eye injuries, especially ectropion (invert, prevent eye closing)

5. Loss of facial members (nose, ears)

6. Hair loss (usually from full thickness burn)

Functional disabilities include:

1. Physical: functional impairments will not progress over time; contractures can reduce range of motion, but be improved with physical therapy or reconstructive or orthopedic surgery

2. Psychosocial: depression is common early in the healing process, but outlook is positive later on

Complications in the acute phase:

1. Smoke inhalation, lung injury

2. Sepsis due to necrotic tissue, bacterial infection

3. Urinary tract infection from catheter contamination

4. Gastrointestinal issues from nasal feeding tubes

5. Toxic exposures from fire/fumes, chemicals

Complications in the post-acute phase:

1. Contractures: may require dynamic splinting, serial casting, ultrasound diathermy, and may be permanent

2. Hypertrophic scars: can be reduced by pressure over the healing burn area compressive dressing, elasticized garments and after skin grafting. May require reconstructive surgery.