Degree of burns

1. First Degree
   • A first-degree burn is like a sun burn.
   • The area is red, pink and painful.
   • No blisters

   Applying skin moisturizers helps the healing process and controls the pain. Some peeling occurs, but there is no scarring. Most first-degree burns heal after a few days

2. Second-degree burns
   • The area is red and painful
   • Blisters are present
   • Swelling is present

   Second degree burn destroys the top layers of skin, which causes blistering. It is best to keep them covered using a clean, non-stick bandage and seek medical attention. These burn usually heal with regular dressings and if it does not heal within 21 days, would require skin grafting.

3. Third-degree burns
   • The area can be white, black, deep red or charred skin
   • May be painful but could be numb

A third-degree burn goes very deep into the skin, causing it to feel dry and hard. These burn cannot heal well without a surgery and skin grafting.

With any type of burn, make sure you keep yourself hydrated

Prevent from scald burn -hot water, tea, coffee

1. Guard your children and Educate them about the dangers of burns
2. Test hot water in sinks, showers and bathtubs with your elbow.
3. Never leave children alone in the tub, shower or sink–they may turn the hot water on.
4. Don't bathe a child under running water–the temperature can change very quickly.
5. Keep the handles on cooking utensils turned in.
6. Keep cups and bowls with hot contents out of reach.
7. Don't hold or pass hot liquids over children.

Management of Burns

Patients with burn are managed depending on severity of the burn. Each kind of burn needs special care and attention to decide the treatment. Apart from type of burn, we always look for the depth of burn and the percentage of surface area of body covered by the burn injury.

1. Minor burns can be treated at home and usually heal within 2 to 3 weeks with regular dressings.
2. If there is more than 10% of body surface area involved, admission in a dedicated ward for burn patients is advised. They may need specialized dressings and skin grafts for treatment.
3. More than 50% burn is usually very difficult to manage and chances of survival are not very good.

First is to re-hydrate the patient with lots of IV fluids and to avoid further fluid loss by dressings. Pain medications are to be given along with antibiotics and anxiety medications.

Once initial treatment is done, regular dressings are done every alternate day

The time taken in healing and the need for surgical or medical treatment is different in different degrees of burn.

First-degree burns require only application of topical soothing agents and pain killers, if needed.

Second-degree burns need dressings with topical antibiotic creams and ointments. They usually heal by dressings only within 2 to 3 weeks without leaving much scar. Specialized dressings for burn wounds are available which are impregnated with nano crystalline silver, collagen protein or antibiotics which help in preventing wound infection and hasten the healing process. Advanced dressings are now used to initiate early healing process. Deeper second-degree burns form a raw area after regular dressings in few cases which would require skin grafting.

Third-degree and fourth degree burns require surgical procedures for cleaning of wound, removal of dead skin followed by coverage with skin graft or flap. In a patient with thermal burn or flame burn, depending on the time of contact with fire- few areas are superficial, few are deep and of third degree. This distinction between superficial and deep burn is never visible immediately and is usually seen after 3-4 days of burn. The superficial areas heal with regular dressings and deeper areas require regular dressings for longer duration and may be skin grafting or flap at joints in future.

In cases of thermal burn of third degree or deep second-degree burn, where it is known and anticipated that the areas would definitely require grafting in future, early primary excision of the area and coverage of the area with skin graft can prevent a lot of complications like septicaemia, infection and help in faster recovery of the patient and earlier discharge from the hospital.

If the burn area which does not heal on its own or within a month should ideally be grafted with skin. These raw areas if not grafted lead to-

1. Unstable area formation (recurrent breakdown, itchy skin)
2. Recurrent ulcers even after healing
3. Development of white patches over the area
4. Quality of skin is not good.
5. Development of contractures if across joints
6. Tendency for hypertrophic scars and keloid over such raw areas

Skin grafting is the transfer of thin skin sheet, usually taken from thigh, to cover the raw areas of the burn. Once the wound is healthy, skin grafting may be done if defect is not much deep and vitals structures are embedded in granulation tissue. In such cases, dressing is done every alternate day after surgery. Patient may be discharged after 5-6 days, and regular follow-up is required. The area gradually heals and need compression garment later to avoid hypertrophy of scars and to reduce the swelling.

Thermal burns usually require skin graft only for healing and would require flaps in exceptional cases. Cases of electric burn require flaps as the area of burn is quite deep.

Once patient has healed completely, physical and occupational therapy is required to rehabilitate the patient. This will include various exercises, pressure garments and surgical procedures, if any, to correct the deformities caused due to burn.

Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.

MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)

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