Burn injuries are extremely common and can occur at home, at work, or in fact anywhere there may be something hot or electrical. Whilst a large number of burn injuries occur in adults, children are also vulnerable and can easily be accidentally burned.
Below we discuss how burn injuries can happen, how they are treated, and what problems burn injuries can pose.
How do people get burn injuries?
Burns can happen in a multitude of ways, in an almost infinite number of scenarios. Probably the most commonly known way to get a burn injury is in the form of blistering sunburn. Adults may also be burned by hot cookers, barbecues, house fires, exploding aerosols.....the list goes on. Children can also be burned in a number of ways, but the most common is probably scald injuries - it only takes a few seconds for a young child to reach up to a hot cup of coffee and pull it over.
Burns may also occur from chemicals, such as cement or household cleaning agents. 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 burns is the size of the the burn and the depth of injury.
The size of the burn is worked out as a percentage of the 'total body surface area'. As a rough guide, 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 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 (in the USA the burns are termed 1st, 2nd or 3rd degree burns respectively). Superficial burns are painful and form blisters that may burst. Full thickness burns tend to look leathery and won't tend to blister - they aren't painful as the nerve endings to the skin have been burned so pain can't be felt. Partial thickness burns are somewhere in between the two.
The reason for wanting to know the depth of a burn injury is to help direct treatment. Superficial burns tend to heal well on their own in a week or two, and so may be cleaned and dressed only. Full thickness burns, however, take a long time to heal on their own and tend to heal with scarring. A large full thickness burn will also make the patient very sick, and so Burn specialists often opt to take away the area in the first few days. Partial thickness burns can form a dilemma, as they may heal on their own or with poor scarring - judging which direction a 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. Partial thickness 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?
As described earlier, larger burns are given intravenous fluids (usually over 10% surface area burns in children or 15% in adults). Fluids may also be given to patients with other injuries sustained at the time of the burn, airway injuries, etc. A catheter may also be required so that urine production can be monitored, which informs the clinician of how well hydrated the patient is.
Superficial 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.
Full-thickness 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.
What are the long-term consequences of a burn injury?
Scarring - whilst superficial burns often heal without scarring, full thickness burns will heal with scarring. Additionally, any surgery that is needed will leave scars.
Scar contracture - if a full thickness 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.
Other SurgeryWise articles
You may also be interested to read our articles on first degree burns, second degree burns, third degree burns, improving scars, or skin grafts.
The information provided is as a guide only and you should discuss matters fully with your specialist regarding any treatment required. Please also read our disclaimer