Burns - Degrees and Complications

When we talk about burns of the skin, soon we come to the head thermal burns, however, there are other types of burns, namely burns chemical, electric, radiation, cold and even friction.

Burns degree
Burns degree

Degree of burn

Burns are classified according to their depth and size, and are usually measured by the percentage of the body surface affected.

Classically the burns are classified in 1st, 2nd and 3rd degrees, according to the layer of skin involved.

First degree burns: also called superficial burn, are those that involve only the epidermis, the most superficial layer of the skin.

The symptoms of first-degree burn are intense pain and local redness, but pale on the skin when touched. The lesion of the 1st degree burn is dry and does not produce blisters. Usually they improve after 3 to 6 days, they can peel and leave no sequelae.

Second degree burns: currently divided into 2nd degree superficial and 2nd deep degree.

The 2nd degree superficial burn is one that involves the epidermis and the more superficial portion of the dermis.

The symptoms are the same as those of 1st degree burn, including the appearance of blisters and a damp appearance of the lesion. The healing is more delayed taking up to 3 weeks; does not usually leave a scar, but the site of the lesion may be clearer.

Deep 2nd degree burns are those that affect the entire dermis, being similar to 3rd degree burns. As there is a risk of destruction of the nerve endings of the skin, this type of burn, which is much more serious, can even be less painful than the superficial burns. The sweat glands and hair follicles can also be destroyed, making the skin dry and lose its hairs.

Healing takes more than 3 weeks and usually leaves scars.

Third-degree burns are deep burns that affect the whole dermis and reach subcutaneous tissues, with total destruction of nerves, hair follicles, sweat glands and blood capillaries, and can even reach muscles and bone structures. They are whitish / grayish, dry, painless and deforming lesions that do not heal without surgical support, requiring grafts.

Burn extension

In addition to the depth of the burn, the extent of the lesion is also important. All patients with lesions of 2nd or 3rd degree should be evaluated in relation to the percentage of the corporal area reached, according to the diagram exposed to the side. The greater the extent of burns, the greater the risk of complications and death.

The diagram has no value for 1st degree burns or sunburn. No need to panic if after a sunny day you get over 50% of the body burned.

If burns do not affect an entire region of the body, a simple way to calculate the extent of injury is to use the area of a palm as 1% of the body surface.

The severity rating is made as follows:
a) Light burn:
  • Less than 10% of the body surface of an adult with 2nd degree burns
  • Less than 5% of the body surface of a child or elderly with 2nd degree burns
  • Less than 2% of the body surface with 3rd degree burns

b) Moderate burn:
  • 10 to 20% of the body surface of an adult with 2nd degree burns
  • 5 to 10% of the body surface of a child or elderly with 2nd degree burns
  • 2 to 5% of the body surface with 3rd degree burns
  • Suspected respiratory tract burns due to inhalation of hot air
  • Light burns in patients with diseases that predispose to infections such as immunosuppression, diabetes or sickle cell anemia
  • Burns in circumferential shape, type bracelet, necklace or bracelet

c) Serious burn:
  • Over 20% of the body surface of an adult with 2nd degree burns
  • More than 10% of the body surface of a child or elderly with 2nd degree burns
  • More than 5% of the body surface with 3rd degree burns
  • Electrical burns by high voltage
  • Proven burns of the respiratory tract by inhalation of hot air
  • Significant burns on the face, eyes, ears, genitals or joints
  • Other serious injuries associated with burn, such as fractures and trauma

Complications of major burns

The skin is the largest organ of our body, serves as a barrier against the invasion of germs from the outside and against the loss of heat and liquids, being essential for the control of body temperature. Any patient with criteria for moderate or severe burns should be hospitalized for immediate treatment, as there is a serious risk of complications.

The first problem with burns is the breakdown of the protective barrier against germs in the environment, favoring the infection of wounds by skin bacteria and the development of sepsis.

Another complication is the great loss of liquids from burnt tissue. When the burn is extensive, the water outlet from the vessels is so intense that the patient can get into circulatory shock. Acute kidney failure is also a serious complication in large burns as well as hypothermia due to the body's inability to retain heat due to large areas of burned skin.

When the chest and neck area are affected by deeper burns, healing makes the skin very stiff and retracted, which can disrupt breathing movements. In this case a scar incision is necessary, a surgical incision of the skin in order to prevent that the lack of elasticity of the same cause compression of the internal structures. Because the hands are areas of intense joint and movement, burn scarring can be very limiting. Therefore, this type of burn should always be evaluated by a physician.

Circumferential burns are dangerous because there is risk of compression of structures hospitalized due to the swelling that any burn causes. No limbs can compress nerves and vessels. In the neck can compress the airways.

Another serious complication is the hot air inhalation burn which can prevent the patient from breathing properly, either by direct injury of the lungs or by edema and obstruction of the airways.

When the lesions are of 3rd degree the skin is not able to cure itself, being necessary the implantation of grafts of skin so that the interior of the organism is not exposed to the external environment. Vaccination against tetanus is also essential.
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