Burns

A burn is an injury to body tissues caused by exposure to high temperature (thermal burn), chemicals (chemical burn), electric current (electrical burn), or ionizing radiation (radiation burn).

The severity of a burn is determined by the depth of tissue damage and the total body surface area (TBSA) affected. Treatment strategy, the need for hospitalization, and overall prognosis are guided by these two parameters.

Classification by Depth of Injury

In clinical practice, burns are classified into four degrees according to the depth of tissue necrosis.

• First-Degree Burns. Only the most superficial layer of the skin — the epidermis — is affected. The burn manifests as erythema, mild swelling, and pain.
• Second-Degree Burns. The epidermis and superficial layers of the dermis are involved. A characteristic feature is blisters filled with clear or yellowish fluid.
• Third-Degree Burns. Necrosis of all layers of the skin (dermis) develops. In third-degree burns (A), some deeper dermal structures (hair follicles, sweat glands) remain viable; the lesion may heal spontaneously. In third-degree burns (B), the skin undergoes complete destruction.
• Fourth-Degree Burns. Necrosis extends beyond the skin to underlying tissues — the fatty layer of the subcutaneous fat, muscles, tendons, and even bone.

Clinical Significance

Thermal burns require proper first aid. Exposure to the injuring factor should be ceased immediately; the burned area should be cooled with cool running water for 10–15 minutes. Note that ice, oil, or greasy ointments are prohibited. After cooling, the wound should be covered with a clean, dry dressing.

Medical advice is required in the following cases:

• Second-degree burns or deeper, exceeding the size of the patient’s palm.
• Burns of the face, hands, feet, joints, or perineum.
• Electrical and chemical burns.
• Burns in children and elderly patients.
• Signs of airway burns (hoarseness, coughing with soot, difficulty breathing).

Severe burns are treated in a hospital setting, with primary focus on combating burn shock, preventing infection, and restoring lost integument, often through surgical methods such as necrectomy and skin grafting.