Burn treatment

Third-degree burns represent a severe form of injury necessitating specialized medical treatment. These burns inflict harm upon your skin or underlying tissues, often due to exposure to extreme temperatures, chemicals, or intense light sources.

Such burns extend their damage to multiple layers, including the outermost layer of skin (epidermis), the middle layer (dermis), and the layer of fat beneath the skin (hypodermis). Moreover, third-degree burns can impair sweat glands, hair follicles, and nerve endings. It’s important to note that immediate pain may not be felt in the case of a third-degree burn, as these burns often result in the destruction of nerve endings.

Types of Burns

The number of each degree of burn identifies how many layers of damage your body has, including:

First-degree burn: Damage to the top layer of skin.
Second-degree burn: Damage to the top and middle layers of skin.
Third-degree burn: Damage to the top and middle layers of skin and the fatty layer (hypodermis).

While less common, extremely serious burns can extend past three degrees and could include:

Fourth-degree burn: Damage past your hypodermis into subcutaneous fat, nerves and tendons.
Fifth-degree burn: Damage to your muscle.
Sixth-degree burn: Damage to your bone.

Symptoms of Burns

Characteristics associated with a third-degree burn comprise:

Tough, leather-like skin.
Dry and parched skin.
Skin discoloration, which may appear as white, black, or bright red.
Swelling.
Formation of blisters.
Skin exhibiting a glossy, moist texture.
Skin discoloration varying from deep red to dark brown.

Causes of Burns

Common causes of a third-degree burn include:

Flames from a fire.
Explosions and mines.
Touching a hot object.
Ultraviolet radiation and sunburn.
Boiling water or steam.
Chemicals (like acids and bases).
Radiation.
Electricity.
Dry ice, liquid nitrogen or other sources of intense cold (such as aerosol sprays).

Diagnostics of Burns

Your healthcare provider will examine the burn to determine the degree or severity. This process involves estimating the percentage of the body affected by the burn and its depth.

Your doctor may classify the burn as:

Minor: First- and second-degree burns that cover less than 10% of the body are considered minor and rarely require hospitalization.
Moderate: Second-degree burns that cover about 10% of the body are classified as moderate. Burns on the hands, feet, face or genitals can range from moderate to severe.
Severe: Third-degree burns that cover more than 1% of the body are considered severe.

Complications of Disease

Deep or extensive burns can result in various complications, such as:

Bacterial infection, potentially progressing to a bloodstream infection (sepsis).
Loss of bodily fluids, leading to reduced blood volume (hypovolemia).
Dangerously low body temperature (hypothermia).
Respiratory issues due to inhaling hot air or smoke.
Formation of scars or raised areas resulting from excessive scar tissue growth (keloids).
Bone and joint complications, including skin, muscle, or tendon shortening and tightening due to scar tissue (contractures).

Treatment of Severe Burns

Burn surgery can be broadly categorized into two main types: acute and reconstructive.

Acute burn care is administered immediately following the injury and is typically overseen by a team of trauma surgeons, who specialize in this area. A burn surgery team usually comprises a burn surgeon, general surgery resident, burn advanced practice clinician, anesthesia specialist, operating room scrub tech, OR nurse, and an OR health care assistant.

Escharotomy – This procedure involves making an incision in the burn area to alleviate pressure and restore proper blood circulation. It is commonly employed for the treatment of circumferential burns and cases of compartment syndrome.
Fasciotomy – In this surgical intervention, an incision is made in the fascia to relieve pressure and enhance blood flow. It is frequently utilized to address severe circumferential burns and cases of compartment syndrome.
Release – A surgical technique aimed at freeing scar tissue to improve range of motion and functionality. In some instances, a skin graft may be necessary to complete this procedure.
Tracheostomy – A surgical procedure performed by a surgeon in which an incision is made in the neck to facilitate the placement of a tube into the lungs, assisting the patient with breathing.
Amputation – In extremely severe cases, a patient may require amputation, which involves the removal of a body part. If this becomes necessary, your burn care team will closely collaborate with you throughout the process. It’s important to note that amputees can still lead healthy and fulfilling lives.
A graft refers to skin that is surgically transplanted onto a deeply burned area or used to cover an open wound. Various types of grafts include:
- Allograft – This involves using skin grafts obtained from a skin bank (cadaver skin) and placing them on the patient’s burn to aid in the healing process. Allografts are not permanent solutions.
- Autograft – Autografts entail taking a thin layer of donor skin from an unaffected part of the patient’s body and grafting it onto the burned area. Autografts are considered permanent grafts.
- Mesh Graft – A skin graft that undergoes a special meshing process using a specific machine. Meshing allows the skin graft to be stretched, making it suitable for covering larger areas.
- Split Thickness Auto Graft (STAG) – This technique involves taking a thin layer of donor skin from an unburned part of the body and meshing it to expand its coverage. The meshing creates small slits in the skin, which enhance its bonding with the burned skin.
- Sheet Grafts – Sheet grafts consist of a thin layer of donor skin that is not meshed and lacks the distinctive pattern found in meshed grafts. These grafts result in a smoother appearance and are commonly used on hands and faces. Sheet grafts take longer to heal and necessitate restricted movement and activity during the recovery process.
Reconstructive burn surgery comes into play once the initial burn wounds have healed. This type of care is typically provided by plastic surgeons with the primary objectives of enhancing both the functional and cosmetic aspects of burn scars. Achieving these goals involves modifying scar tissue through a combination of non-operative and operative treatments. The relationship between a burn patient and their reconstructive burn surgeon can span many years, as scar tissue treatments often require several months to yield results. Additionally, new scar contractures may develop, particularly in young patients who are still experiencing growth.