Our skin is the largest organ of our body. It is our protection from injury and harmful substances. It prevents moisture loss, regulates our internal temperature, shields us from germs, protects us from the sun’s harmful ultraviolet rays, and allows us to feel sensations such as touch.

Burns are common trauma wounds that disrupt skin’s protective function. The consequences of that disruption range from minor to fatal. A burn may be caused by heat, electricity, chemicals, friction, and radiation. Providing proper burn wound care as soon as possible will benefit treatment.

Burns wounds are often treatable at home, but more severe burn injuries require medical attention. Of these, most are treated in an outpatient setting. The need for referral to a burn center is determined by burn depth and the amount of total body surface area involved (TBSA). There are three methods that clinicians use to estimate percentage of total body surface area affected by a burn: The Lund-Browder chart, Wallace Rule of Nines, and The Palmer Method.

Burns to the face, hands, joints, or genitals are more likely to need an evaluation at a specialized burn center.

Burn categories

Effective burn wound care begins with first identifying and understanding what type of burn is present before beginning treatment.

Superficial (first degree) burns damage only the epidermal layer of skin. Superficial burns are normally able to be treated at home with simple first aid care and over the counter pain relievers. Superficial burns cause redness, pain, and swelling. Theses burns do not blister.

According to the American Academy of Dermatology Association, treatment of a minor burn should include cooling the burn with cool, wet compresses following the injury. A thin layer of petroleum jelly and a sterile, nonstick bandage will protect the burn as it heals. Superficial burns normally heal within a week.

Partial Thickness (second-degree) burns have two categories: superficial and deep.

Superficial Partial Thickness: These burns extend from the epidermis down into the dermal layer. These burns are painful, red, and blanch with pressure. They typically form blisters and may weep fluid. It is important that blisters are not popped. Blisters may rupture on their own or reabsorb and flatten out. Blisters should only be opened by a medical professional using sterile instruments.

Superficial partial thickness wounds require a moisture dressing such as petroleum gauze or a hydrogel and gauze dressing. These dressings help to maintain a moist wound environment and prevent contamination that may lead to infection. Superficial partial thickness burns typically heal within one to three weeks and are normally treated by an outpatient medical professional.

Deep Partial Thickness: These burns proceed deeper into the dermal layer of skin. The affected skin may look yellow or white. This type of burn appears dry and does not blanch when pressure is applied. This level of burn has minimal pain due to damage to the nerve endings of the skin. Deep partial thickness burns usually require a referral to a specialty burn center or burn surgeon for possible excision.

Treatment includes moist, sterile dressing changes and possible serial debridement of necrotic tissue. Healing typically occurs within two months. Due to the depth of injury with this type of burn, deep partial thickness burns will heal with a scar.

Full Thickness (third degree +) burns extend through the entire dermal layer and into the subcutaneous tissue. They may damage underlying structures such as muscle and bone. Hair follicles, sweat glands, and nerve endings are also damaged.

For this reason, full thickness burns are painless at the site of the burn but can be significantly painful in the surrounding tissue. Full thickness burns may appear white or black. They are also dry and leathery. This type of burn is referred to a specialty burn center where advanced burn treatment and skin grafting is available. Full thickness burns take more than eight weeks to heal.

Burn complications

Complications from a burn are varied and depend on different factors:

  1. Depth of the burn
  2. Areas of the body affected
  3. Percentage of skin affected
  4. Age of the burn victim
  5. Cause of the burn (heat, chemical, electricity, radiation)
  6. Any additional injuries such as fracture or blunt force trauma
  7. Inhalation of gasses or smoke

The most common complications from a burn injury are:

  1. Infection, ranging from a mild infection to life-threatening sepsis
  2. Fluid loss, which causes dehydration and hypovolemia in the patient with more severe injuries
  3. Hypothermia from loss of protective function
  4. Scarring — more severe scarring can lead to multiple surgical revisions, can be disfiguring, and limit mobility (especially when scarring is present over a joint or large muscle)
  5. Breathing difficulty and lung damage if the patient has inhaled smoke or gasses

Because of the profound complications of burn wounds, it is critical that deep partial thickness burns and full thickness burns be evaluated and treated by burn specialists at a burn center. Specialty burn centers can provide advanced treatments such as specialty wound dressings, hydrotherapy, specialized pressure garments, modified nutrition services, rehabilitation, intravenous antibiotics, pain control, and surgical skin grafts.

Skin grafts are used in treatment of more severe burns. Grafts may be donated from a healthy skin site of the patient, another person, an animal, or a manufactured skin substitute. Skin grafts are part of the reconstruction process of severe burn treatment.

At-risk populations

According to the National Institute of Health, burns in children continue to be a significant source of morbidity and mortality. Burns in the pediatric population are often due to household accidents involving water and flames. Often, children are at higher risk of burns due to gaps in adult supervision and, at times, mistreatment.

Elderly adults are at risk for burns due to mobility issues, changes in cognition, smoking, medication side effects, decreased coordination, and slower reaction times.

Diabetics are at increased risk of complications from burns due to neuropathy and higher risk of infection. Certain occupations can put a person at higher risk of burns, such as fire fighters, foodservice workers, construction workers, and factory workers.

Burn wound care training

Burn wound injuries impact thousands across the U.S., and complications such as infection, scarring and chronic wounds can lead to long term disability. Fortunately, burn care has evolved over the years to improve morbidity and mortality. Staying abreast of current best practice guidelines for the management of patients with burns in all care settings is key for wound care nurses.

If you're interested in expanding your knowledge of wound care, networking with colleagues, or seeing the latest wound care products and technology, register for the Wild on Wounds (WOW) conference August 14–17 in Phoenix, Arizona.

Register Now

Tara Call Triplett, RN, WCC, CHFN

Tara Call Triplett has over 20 years of experience as a registered nurse and is the founder of Call to Health Communications. She is nationally certified in both wound care and heart failure. Triplett currently leads an amazing team of clinicians at an award winning outpatient wound care clinic. She has a passion for teaching and mentoring the next generation of wound care clinicians.

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