How To Classify Severity of Burns


Severity of burns can be classify by the depth of the burn injury (i.e how deep has the burn injured the skin) and by calculating the total area of the body injured.


Burn depth can be divided into:


First Degree or Superficial burn : The injury only affects the top most layer of the skin and the patient presents with pain, redness of the skin with some mild inflammation. The injury usually last for a few days and the skin will start to peel as it heals.


Second Degree or Dermal burn : The burn affects the deeper layer of the skin. The skin will have blisters, redness and in some cases where the injury is deeper, patches of pale pink skin can appear.


Deep burn wound after debridement and skin grafting.


Complications of Burn Injuries

Complications on burn injured areas can happen during the immediate time of injury of after the burn wounds have healed. 


Immediate complications are :

1. Infection.
2. Bleeding.
3. Delayed healing.



Secondary complications are :
1. Hypertrophic scarring.
2. Keloids.
3. Burn contracture.



Treatment for secondary complications of burn injury can be difficult and prolong. Hypertrophic scarring and keloid are treated with the use of pressure garments, silicone gel or sheet and triamcinolone (steroid) injections to soften and flatten the scars. Occasionally surgical excision with skin grafting is employed for the more severe scars.


Burn contracture are bands of hard scars that crosses joints. They can cause restriction of movement between those joins and also deformity of the limbs and fingers. They will more often require surgical correction.



​The area injured is expressed as a percentage of body surface area, Total Body Surface Area (TBSA). This can be measure either by using the Lund and Browder chart, rule of nine (9s) or using the palm of your hand (estimate to be 1% of your body’s surface are).


Burn injuries are one of the most common household injuries that can occur especially in children. Burn injuries can be categorized according to the cause:


1. Scalding - hot liquid (water or oil).
2. Thermal - injuries by flame.
3. Contact burns - touching hot metals such as iron or cooking pans.
4. Chemical burns - exposure to certain chemicals (acids or alkali).
5. Electrical burn – high voltage electrical burns or low voltage household electricity.
6. Sunburn



Fortunately most burn injuries are minor and can be treated as outpatients. These patients are usually given pain killers and the burn area cleaned and dressed until it heals. In a small number of patients hospital admission and more aggressive treatment are required.


They are;


1. Burns that affect deeper or/and larger areas of the body.
2. Burns affecting “important” parts of the body such as the face, hands, feet and genitalia.
3. Patient who sustained inhalational injury due to them breathing-in  noxious or poisonous smoke.
4. Patients who suffered electrical burns.

Burn Contracture of the fingers before and after release of contracture and full thickness skin grafting​

BURN INJURY

Treatment of Burn Injuries


The first step to treating the burn injured patient begins where the injury happened either at home, the work place or outside.


Remove the material that is causing the burn injury (items of clothing or hot metal), cool down the injured area by running tap water over it for 15 to 20 minutes. Do not use use cold water or ice, tap water will do. After 15-20 minutes if it is a small, superficial wound , can apply antibiotic ointment and bandage for a few days.


For deeper and larger wounds cover the area with a clean towel or piece of cloth and bring the person for a medical consult.

For burn injuries that require hospital admission, they will be treated with pain-killers, intravenous fluids and wound dressings. Deeper burn wounds might require wound debridement and skin grafting.

​• Third degree or Full Thickness burn : The burn has injured the full thickness of the skin involving both the epidermis and dermal layer. The injured skin is usually pale, insensate and feels dry and hard. This kind of burn injury requires hospital admission and surgical management.


MALAYSIAN SOCIETY OF PLASTIC RECONSTRUCTIVE SURGERY

DR FAIZAL ALI

Plastic,reconstructive AND COSMETIC  Surgeon

Plastic Cosmetic Surgery

Johor Bahru


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MILD BURNMODERATE BURNSEVERE BURN
ADULT
<10 %10 - 20%>20 %
CHILDREN<5 %5 - 10%> 10 %












​Classification of burn injuries into mild, moderate and severe will help the doctors to decide on the management of the patient.