Burns

Picture of second degree burns to a hand

Burns

Burns to the skin are very common and can occur at home, at work, or anywhere there may be something hot or electrical. We discuss in this article how burn injuries can happen, how they might be treated, and what problems burn injuries to the skin can cause.

How do people get burns to their skin?

Burns can happen in many different ways, but probably the most commonly recognised way to get burns is in the form of sunburn. Burns in adults can also be from hot cooker surfaces, ovens, barbecues, house fires, cigarettes, exploding aerosols…..the list is endless. Children can also suffer burns in a number of ways, but the most common is probably scalds of the skin, often when a young child reaches up to a hot cup of coffee and pulls it over. 

Burns may also occur from chemicals, such as cement or household cleaning agents and unfortunately some burns are caused purposely, such as when acid is thrown at someone. Electrocution can also cause burns that can often be severe and even life-threatening. 

Are all burn injuries the same?

Apart from the different ways that burns can happen, an important factor in skin burns is the size of the burn and the depth of injury to the skin.

The size of the burn is worked out as a percentage of the ‘total body surface area’. As a rough guide, the skin of your palm and fingers are about 1% of your body surface area. In adults the head is about 9%, arms 9% each, legs 18%, back 18% and chest/abdomen 18%. The reason for being concerned about the size of the burn is that the higher the percentage of burn, the more serious it may be. Intravenous fluids (through a ‘drip’) are often needed for burns larger than 10% in children and 15% in adults. 

The depth of injury refers to the depth of skin that has been injured. In the UK, these are termed ‘superficial’, ‘partial thickness’ or ‘full thickness’ burns and in America the burns are termed First, Second or Third degree burns respectively. First degree burns are painful and form blisters that may burst. Third degree burns tend to look brown and leathery and won’t tend to blister – they aren’t usually painful as the nerve endings to the skin have been burned so pain can’t be felt. Second degree burns are somewhere in between the two.

The reason for wanting to know the skin depth of a burn injury is to help direct treatment. First degree burns tend to heal well on their own in a week or two, and so may be cleaned and dressed only. Third degree burns, however, take a long time to heal on their own and tend to heal with scarring. A large third degree  burn can also make the patient very sick, and so Burn specialists often opt to take away the area in the first few days. Second degree burns can form a dilemma, as they may heal on their own or with poor scarring – judging which direction a skin burn will go can be extremely difficult, even for the experts.

How is burn depth assessed?

Sometimes the burn depth can be easily assessed by eye, although this is usually best done by experts in burn injury. Second degree burns can be very hard to judge though, even by experts. Burn centres may employ the use of devices to help diagnose the burn depth, and the most common at the moment is by Laser imaging. The machine uses light to ‘look at’ the skin and can help show the clinician where the blood is flowing through the skin, which can help diagnose burn depth.

The problem with burn injuries, though, is that they can be dynamic. This means that a burn that appears fairly superficial at first can progress over the next few days to become a deeper burn. Deeper appearing burns can in time become more superficial appearing, although this is less common. 

A larger burn injury is also rarely the same depth throughout the whole area. Some parts of the burn, such as the periphery, may be superficial whilst the centre may be deeper. This can make it very difficult to tell which parts of the burn need treatment and which don’t.

How are burns treated?

First degree burns are often treated with cleaning and dressings. These dressings may be simple non-stick dressings or ones which contain silver to fight bacteria, agents to promote healing etc.

Third degree burns will usually require surgery, either in the first few days or further along. Once the burn has been removed, the skin will need to be replaced with either a skin graft, artificial skin, or other form of reconstruction. 

A partial thickness burn may be monitored for the first few days to allow it to show itself as being one that will heal with dressings or needing operative treatment. 

As described earlier, larger burns are given intravenous fluids (usually over 10% surface area burns in children or 15% in adults). A catheter may also be required so that urine production can be monitored, which informs the clinician of how well hydrated the patient is. 

 

What are the long term issues from burn injury?

Scarring – whilst first degree burns often heal without scarring, third degree burns will usually heal with scarring. The extent of these scars can vary according to location, burn depth and size of burn. Additionally, any surgery that is needed will leave scars. 

Scar contracture – if a third degree burn heals on its own and forms scars across a joint, then as the scar matures it may contract (shrink). This may lead to an inability to fully move the joint, and so surgery may be needed to release the scar. 

Slow healing – deeper burns can take many weeks to heal on their own, and so burns specialists may use a skin graft to help healing. Occasionally a burn can heal up but with a thin, unstable scar – this can easily break down again and again, so surgery may be needed to try to get the area to heal fully.

Disfigurement – deeper burns, whether operated on or not, can leave scars that are very noticeable to the patient or to others. This is especially so when the burns are to the face. Whilst scarring can be improved by surgery or other means, there is unfortunately no way to completely remove them. The recent advances made in face transplant surgery may, however, provide hope for those with the most severe types of facial burn injuries.

This information is for general information only. If you have any concerns about your health or are considering any treatments, you should seek advice from a healthcare specialist

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