Burns and You

Burns are not an uncommon occurrence. With BBQs, popularity of outdoor activities, and many occupations surrounding hot objects, you probably know of someone who has experienced some form of burn; if not yourself. Im also fairly certain you have heard various terminologies in regards to burns. The question is if you truly understand the terminology. Thermal injuries can come from chemicals and electricity, not just from fire OR the sun.

Burns are typically classified into 3 categories depending on severity and what the skin looks like: First degree, Second Degree, and Third Degree. However, there is a 4th degree.

Classification:1-4

1st Degree Burns:

This is more of your basic mild sunburn. The skin is red (erythematous) with no blister formation noted. These are termed partial thickness burns meaning the damage to the skin does not go beyond the superficial layers of the epidermis (outer most layer of skin).

Treatment:1

  • Aloe Vera topical ointment for soothing
  • Benadryl (other antihistamine) for itching
  • NSAIDs for pain control if needed

2nd Degree Burns:

Still considered a partial thickness but may vary in depth of injury and so it can be further categorized into superficial and deep. Hair follicles and sweat glands are spared but blisters are most likely present. The blisters are a key difference between this and 1st degree.

  • Superficial erythema with some blister formation. The area may weep and these injuries are painful.1 Blanches with pressure
  • Deep does not blanche with pressure. Area is white with red patches. The injury may be wet OR dry. Some times these are painless.4

Treatment:

  • Aloe Vera
  • As mention in prior blogs, leave blisters alone if not rupture and cover with a nonadherent dressing that will not irritate. If blisters have rupture then remove loose tissue and cover with dressing.
  • NSAIDs for pain as needed.

3rd Degree Burns:

These are full thickness burns. This means the injury has extended past the epidermis into the dermis and subcutaneous tissues. Dermal structures such as hair follicles and sweat glands are destroyed. These are usually painless due to the destruction of the cutaneous nerves. These injuries do not blanche with pressure and appear white OR charred.

  • These are most likely to become infected.4
  • Clinical signs of infection following a burn: discoloration of the wound (from darkening to a green hue), erythema surrounding and spreading from the wound, spreading necrosis into adjacent areas of the injury, and breakdown of the eschar. The most common organisms found are Staph and Strep, although Pseudomonas is often cited as the most common which would explain any green hue within the wound.

Treatment:

  • Cleansing the injured area and removing all loose non-viable tissue
  • Applying topical antibiotic OR a silvadene cream with a nonadherent dressing.
  • Possible oral antibiotics for further coverage against bacterial infection
  • Daily wound care by a professional team

4th Degree Burns:1,3

  • This is very similar to 3rd degree except now the injury has extended past the subcutaneous tissue and muscle, fat, and bone are destroyed.
  • The same risks of infection are present
  • Treatment is the same as for 3rd degree burns
  • Risk of amputation is extremely high.

Other things to consider about burns besides depth of injury are:3

  1. Percentage of body surface involved
  2. Internal injuries from inhalation of hot and toxic fumes
  3. Promptness in managing infection, fluids, and electrolyte levels.

The Rule of 9s: this is the classic method of determining total surface area injured.1

Segmental body parts are in multiples of 9:

  • Each arm is 9%
  • The head is 9%
  • Each leg is 18%
  • The torso, both front and back, are each 18%
    • The palm is 1%
  • Helps measure/estimate injured area
  • Each foot is 3.5%
  • NOTE: only used for adults. The percentages are slightly different in children.

A major burn is classified as follows:

  • <10 y/o or >50 y/o and covering >10% of the body
  • 10-50 y/o >20% of the body

A minor burn is classified as follows:

  • <10 y/o or >50 y/o covering less than 10% of the body
  • 10-50 y/o covering <20% of the body

Treatment can be summarized by the 5 Cs:1

  1. Cut cut away clothing that is burned. Adhered clothing may need to be surgically removed
  2. Cool cooled, sterile saline soaked gauze. Ice can be used but one need be aware of potential frostbite. The purpose of this step is to stop cellular death and decrease pain/hyperthermia.
  3. Clean remove any and all loose tissue. This can be done gently with a soft towel or washcloth, mild soaps, chlorhexidine. A whirlpool may be used. Blisters are debrided completely. Anesthesia may be needed.
  4. Chemoprophylaxis application of antibacterial ointments/creams such as silvadene
  5. Cover nonadherent, occlusive dressing followed by loose application of a gauze wrap.

Severe burns that are left untreated can lead to extreme disability and loss of function. Severe burns require hospitalization until the individual is stabilized. Further treatment involves daily wound care and the possibility of skin grafting OR amputation.

If you or someone you know has recently suffered a burn to their lower extremity and are in need of care, please contact Dr. Bowman at 713-467-8886 or visit www.houstonfootspecialists.com

References:

  1. Banks et al. McGlamrys Comprehensive Textbook of Foot and Ankle Surgery. 3rd Edition, Volume 2.
  2. Coughlin et al. Surgery of the Foot and Ankle. 8th Edition, Volume 2.
  3. Kumar et al. Robbins Basic Pathology. 8th Edition.
  4. Warren Joseph. Handbook of Lower Extremity Infections. 3rd Edition.

Category: Foot Health

Tags: Blisters, Burns, Feet