Understanding Burn Injuries: Types, Treatment, and Recovery

Posted on Feb 21, 2025 in Medicine & Health

Burns: Classification and Types

Burns are classified according to the depth and size of the burn:

  • 1st degree (superficial): Affects only the outer layer of skin.
  • 2nd degree (partial-thickness): Damages the top two layers of skin. Healing time is typically 2-3 weeks.
  • 3rd degree (full-thickness): Extends through all skin layers and may involve fatty tissue.
  • 4th degree: Damages skin, fat, muscle, and even bone. These burns require extensive treatment, often result in severe scarring, and cause loss of normal range of motion.

A patient’s palm represents approximately 1% of their total body surface area.

Types of Burns

  • Thermal Burns: The most common type, caused by fire, hot liquids, or hot surfaces.
  • Chemical Burns: Result from direct contact with strong acids, alkaline agents, gases, or other chemicals.
  • Freeze Injuries: Includes frostbite and injuries from substances like propane and Freon.
  • Radiation Burns: Caused by large doses of radiation.
  • Electrical Burns: Often cause extensive internal damage, potentially continuing from the point of contact and causing damage over time. There may be little external damage visible.
  • Inhalation Injury: Injury to the respiratory tract caused by smoke inhalation and carbon monoxide toxicity, potentially leading to brain injury or death.

1st and 2nd-degree burns are commonly caused by thermal sources like hot liquids or radiation (e.g., sunburn). 3rd and 4th-degree burns typically result from fire, flame, or electrical sources.

Adjustment to Burn Injuries

Approximately 85% of individuals return to their former activities within 6 months. However, 15% may require extensive, intermittent reconstructive or cosmetic surgery for about 2 years.

Burn Injury Recovery

Skin Grafts and Advanced Treatments

  • Skin Grafts: Taken from the individual’s healthy skin.
  • Cadaver Skin: Skin recovered from the back and legs of cadavers (only the top 1.5 layers) can be used as a temporary dressing.
  • TransCyte: An artificial, temporary skin covering (human fibroblast) primarily for 2nd-degree burns. It’s making a comeback after being unavailable for 15 years. It is derived from the foreskin of newborns.
  • RECell: A technique where a small skin sample is processed, and the cells are sprayed onto the burn area.
  • Meshing: A process where a small skin graft is passed through a mesher to create a lattice-like pattern, expanding its coverage.
  • Tilapia Skin: Used in some countries, tilapia skin provides proteins and collagen that aid in healing.

Additional Recovery Considerations

  • Pressure Garments: Worn 23 hours/day for a year to help with scarring and mobility.
  • Pain Management: Burn pain can be similar to neuropathic pain and may persist for years.
  • Infection Control: Infections, such as *Pseudomonas* (historically more deadly) and MRSA (currently more common but less deadly), are a concern.
  • Stretching: Essential to prevent contractures (shortening of tissues or scarring).
  • Temperature Regulation: Can be difficult, especially with 3rd-degree burns.

Vocational Planning After Burn Injuries

Key considerations for vocational planning include:

  • Assessing the ability to perform past or potential future jobs.
  • Addressing cosmetic appearance concerns.
  • Managing pain.
  • Evaluating range of motion.

Speaker Notes

Returning to work can be a significant challenge, especially with facial burns. Individuals may need to initially take on different roles, such as phone-based jobs, to demonstrate their capabilities. The term “Big Burn” is slang for a complete facial burn. Feelings of isolation are common, making occupational engagement beneficial.

Common Functional Limitations

  • Mobility: Contractures can limit movement.
  • Lower Extremity Limitations: Difficulty with walking, climbing, and balancing.
  • Upper Extremity Limitations: Challenges with reaching, fingering, and handling.
  • Cosmetic Disfigurement: Impacts self-image and social interactions.
  • Heat Tolerance: Reduced ability to tolerate heat.
  • Skin and Joint Trauma: Sensitivity and vulnerability of injured areas.