Burns

What Is a Burn?

A burn is damage caused to the skin and underlying tissues as a result of exposure to various energy sources. When the body is exposed to heat or comes into contact with chemicals:

• Cell proteins denature
• Cell membranes are disrupted
• Vascular permeability increases
• Local inflammatory response begins
• Tissue death may develop

Burns are a common health problem. They are more common in children, the elderly, and certain occupational groups. Early intervention and appropriate treatment are lifesaving.

Types of Burns (By Cause)

Thermal (Heat) Burns

The most common type of burn.

Flame Burns

• Contact with open flame
• Fire accidents
• Home accidents (kitchen, stove)
• Lead to deep burns

Scald Burns

• Contact with hot liquid or steam
• Most common type in children
• Tea, water, food, soup
• Usually superficial but extensive

Contact Burns

• Contact with hot objects
• Iron, stove, radiator
• Usually limited area
• Depth may vary

Cold Burns (Frostbite)

• Extremely low temperatures
• Freezing injuries
• In peripheral tissues (fingers, ears)

Electrical Burns

• Low voltage (<1000 V): Household electricity
• High voltage (>1000 V): Industrial
• Lightning strike
• May cause deeper damage than visible
• Risk of cardiac arrhythmia

Chemical Burns

• Acids: Strong acids (sulfuric, hydrochloric)
• Bases (alkalis): Sodium hydroxide, bleach
• Organic compounds: Petroleum derivatives
• Contact with household cleaning products
• Work accidents
• Treatment: Washing with plenty of water

Radiation Burns

• Sunburns (UV)
• Radiation therapy
• Industrial radiation
• May also present in late stages

Friction Burns

• High-speed friction
• Traffic accidents (asphalt burns)
• Sports injuries
• Usually superficial

Burn Depth (Classification)

Burns are classified into stages according to their depth.

First-Degree Burn (Superficial Epidermal)

A burn in which only the epidermis is affected.

Characteristics

• Skin is red and dry
• No blisters
• Painful
• Turns pale with pressure
• Typical example: Sunburn

Healing

• Full recovery in 3-6 days
• Does not leave scars
• Peeling may occur

Second-Degree Burn (Partial Thickness)

Superficial Second-Degree Burn

A burn in which the epidermis and superficial part of the dermis are affected.

• Skin is red, moist, and shiny
• Blisters (bullae) present
• Very painful
• Blanches with pressure
• Heals in 10-14 days
• Usually does not leave a scar

Deep Second-Degree Burn

A burn in which the deep part of the dermis is affected.

• Skin is red or whitish
• Less pain (nerves damaged)
• Dry wound base
• Less blanching with pressure
• Heals in 3-6 weeks
• Leaves scar, may require skin graft

Third-Degree Burn (Full Thickness)

The entire dermis is damaged.

• Skin is white, yellow, brown, or black
• Dry and hard (like charred)
• No pain (nerves destroyed)
• Skin thickening (eschar)
• Cannot heal on its own
• Skin graft required
• Leaves significant scar

Fourth-Degree Burn

Muscle, tendon, and bone tissues beneath the skin are affected.

• Most serious type of burn
• Charred appearance
• Muscle, tendon, even bone may be visible
• Requires surgery
• Amputation may be necessary
• High functional loss

Burn Extent (Body Surface Area)

The extent of the burn is critical for treatment planning.

Rule of Nines (in Adults)

Body surface area is roughly calculated:

• Head and neck: 9%
• Each arm: 9% (total 18%)
• Front of torso: 18%
• Back of torso: 18%
• Each leg: 18% (total 36%)
• Perineum (genital area): 1%

In Children

Since children's body proportions are different, different tables are used:

• Larger head, smaller legs
• Lund-Browder charts adjust by age

Hand Method

The patient's own palm (including fingers) makes up approximately 1% of body surface area. Can be used for quick estimation in small burns.

Burn Severity

The severity of a burn is evaluated by combining multiple factors:

Mild Burn

• Superficial second-degree <15% (adult)
• Superficial second-degree <10% (child)
• Third-degree <2%
• Outpatient treatment

Moderate Burn

• Superficial second-degree 15-25% (adult)
• Superficial second-degree 10-20% (child)
• Third-degree 2-10%
• Hospital treatment

Severe Burn

• Superficial second-degree >25% (adult)
• Superficial second-degree >20% (child)
• Third-degree >10%
• Face, hands, feet, perineum, joint burns
• Inhalation injury
• Electrical burns
• Burn center treatment

Burn Complications

Early Complications

Hypovolemic Shock

• Widespread fluid loss
• Increased vascular permeability
• Rapid fluid resuscitation required
• First 24-48 hours critical

Inhalation Injury

• Involvement of airways
• Carbon monoxide poisoning
• Respiratory failure
• Emergency intervention required

Infection

• Burn infections
• Sepsis
• Most important cause of death

Compartment Syndrome

• Tissue pressure in circumferential burns
• Blood circulation impaired
• Emergency escharotomy required

Burn Shock

• Systemic inflammatory response
• Multi-organ failure
• Requires intensive care

Late Complications

Hypertrophic Scar and Keloid

• Excessive scar tissue
• Thick, red, itchy
• Aesthetic and functional problems

Contractures

• Shrinkage of scar tissue
• Joint mobility restriction
• May require surgical correction

Pigmentation Disorders

• Changes in skin color
• Hypo- or hyperpigmentation

Psychological Effects

• Post-traumatic stress disorder
• Depression, anxiety
• Affecting quality of life

Marjolin's Ulcer

• Skin cancer development in long-standing scar
• Rare but serious

Burn Diagnosis

Event History

• Cause of burn (heat, chemical, electrical)
• Exposure duration
• First aid applications
• Accompanying injuries
• Medical history

Physical Examination

• Location and extent of burn
• Depth assessment
• Evaluation of burn shock
• Airway control
• Accompanying injuries

Laboratory Tests

• Complete blood count
• Electrolytes
• Blood gas analysis
• Carboxyhemoglobin (in inhalation injury)
• Creatine kinase (in electrical burn)
• Urine myoglobin

Imaging

• Chest X-ray
• Bronchoscopy (in inhalation injury)
• ECG (in electrical burn)
• CT (in accompanying trauma)

First Aid

General Principles

1. Remove from danger
2. Eliminate burn source
3. Cool the burn
4. Apply covering
5. Take to emergency service

In Thermal Burns

• Cool with plenty of running water for 10-20 minutes (room temperature water)
• DO NOT USE ice or very cold water
• DO NOT POP blisters
• DO NOT USE toothpaste, yogurt, or oil (these are harmful!)
• Cover with a clean cloth
• Keep the patient warm

In Chemical Burns

• Wash with plenty of water for 20-30 minutes
• Brush off dry chemicals before water contact
• Remove clothing containing the chemical
• Go to emergency service

In Electrical Burns

• First, cut off electricity
• Ensure safety before touching the person
• CPR may be required
• Damage may be deeper than visible
• Always take to hospital

Burns That Should Be Taken to Emergency Service

• Any burn in children and elderly
• Burns larger than 10%
• Third-degree burns
• Face, hands, feet, joint, and genital area burns
• Electrical and chemical burns
• Inhalation symptoms
• Accompanied by multiple trauma
• Suspected burns (abuse)

Burn Treatment

Acute Phase Treatment

Fluid Resuscitation

Critical in severe burns:

Parkland Formula

• 4 ml/kg/burn percentage × % body surface area
• In the first 24 hours
• Half is given in the first 8 hours
• Ringer's Lactate is preferred

Airway Management

• Intubation if inhalation injury is suspected
• Oxygen therapy
• Bronchoscopy may be required

Pain Control

• Intravenous analgesics
• Opioids may be used
• Pre-medication before dressing

Infection Prevention

• Tetanus vaccine check
• Prophylactic antibiotics (when necessary)
• Sterile technique
• Local antimicrobial creams

Wound Care

In Superficial Burns

• Skin cleaning
• Moisturizing creams
• Pain control
• Management of blisters

In Deep Burns

• Debridement: Removal of dead tissue
• Antimicrobial dressings
• Regular dressing changes

Wound Dressings

• Silver sulfadiazine cream: Classic choice
• Mafenide acetate cream: In deep infections
• Hydrogel dressings
• Hydrocolloid dressings
• Silver-containing dressings
• Biological dressings (temporary skin substitute)

Negative Pressure Wound Therapy (VAC)

• Accelerates wound healing
• Reduces edema
• Increases granulation tissue

Surgical Treatment

Escharotomy

• In circumferential deep burns
• Cutting of skin thickening
• Prevents compartment syndrome
• Emergency procedure

Fasciotomy

• In deep tissue pressure increase
• To protect muscles and nerves

Early Debridement and Grafting

• In third-degree burns
• Within 3-7 days
• Removal of dead tissue
• Skin graft application

Skin Graft Types

Autologous Graft (Patient's Own Skin)

• Best result
• Usually taken from thigh or buttocks
• Permanent solution
• Donor area healing is required

Allograft (From Donor)

• Cadaver skin
• Temporary cover
• Bridging tissue

Artificial Skin

• Integra, Biobrane
• Provides preparation tissue
• Autologous graft is performed later

Cultured Skin Cells

• From the patient's own cells
• In extensive burns
• Expensive and takes long time

Plastic and Reconstructive Surgery

• Scar revision
• Contracture correction
• Flap operations
• Tissue expansion (tissue expander)

Supportive Treatment During Healing

Nutritional Support

• High calorie and protein
• Vitamin and mineral supplements
• Fluid balance
• Early enteral nutrition

Physical Therapy and Rehabilitation

• Early movement
• Prevention of joint contracture
• Exercise programs
• Scar massage

Scar Management

• Pressure garments: Control scar shrinkage
• Silicone gel and sheet
• Scar massage
• Steroid injections (in keloid)
• Laser treatments
• Surgical correction

Psychological Support

• Treatment of post-traumatic stress
• Individual and group therapy
• Family support
• Social assistance

Post-Burn Care

Hospital Treatment

• Intensive care follow-up (in severe burns)
• Regular wound dressing
• Multidisciplinary team approach
• Staged surgery

After Discharge

• Regular check-ups
• Home dressing education
• Scar care
• Activity recommendations
• Psychological follow-up

Long-Term Follow-Up

• Scar maturation (1-2 years)
• Skin care
• Sun protection
• May require repeated surgery
• Lifestyle adjustments

Burns in Children

Pediatric burns are of special importance:

Characteristics

• Same burn size more dangerous than in adults
• Body surface area calculated differently
• Fluid loss is faster
• Psychological impact is great

Prevention

• Child-safe home
• Hot drinks out of reach
• Stove and oven protection
• Bath water control
• Matches and lighters should be hidden

Treatment

• Pediatric burn centers
• Family involvement is important
• Long-term follow-up
• Education and psychological support

Burn Prevention

Home Safety

• Use of fire alarms
• Keeping a fire extinguisher
• Care when cooking on the stove
• Caution with hot food and drinks
• Adherence to smoking rules

Child Safety

• Keeping children away from stove and oven
• Hot drinks out of children's reach
• Checking bath water
• Protecting electrical outlets
• Storing chemical products in locked places

Work Safety

• Use of protective equipment
• Training and awareness
• Safe use of chemical substances
• Electrical safety
• Emergency plans

Sun Protection

• Sunscreen (SPF 30+)
• Staying in shade (between 10:00-16:00)
• Protective clothing and hat
• Children especially should be protected