The Safety Net
The Nature and Characteristics of Burns
The Basics of Burns
A burn is damage to the skin and underlying tissue caused by heat, chemicals or electricity. The temperature to which the skin is exposed, the length of time of skin exposure, and skin thickness determine the depth of injury. Very deep burns may damage muscle or bone.
Burns range in severity from minor injuries requiring no medical treatment to serious, life-threatening, or fatal injuries. Scalds result from the destruction of one or more layers of the skin due to contact with hot liquids or steam.
Burns damage or destroy one or more layers of the skin. The surface layer of the skin is called the epidermis. The second layer, the dermis, provides a strong backing for the epidermis. The dermis has its own blood supply, and embedded in it are hair, sweat glands, and nerve endings for sensation. Underneath the dermis is the third, or fat, layer that contains blood vessels and nerves leading to the skin.
Burn Depth and Degree
As shown below, burns are categorized by degree. Partial thickness injuries to the skin include first and second degree burns; full thickness injuries encompass third degree, deeper burns. Seriousness of the burn injury is also determined by the percentage of skin affected and the areas of the body sustaining the burn. Burns of the face, hands, neck, perineum, and feet are in this category.
- Minor damage to the skin
- Skin is dry without blisters
- Color is pink to red
- Generally heals in 3-5 days with no scarring
- Damages, but does not destroy, top two layers of skin
- Skin is moist, wet, and 'weeping'
- Blisters are present
- Significant swelling (edema)
- Color is bright pink to cherry red
- Very painful
- Generally heals in 10-21 days
- Destroys all layers of the skin
- May involve fat, muscle, and bone
- Charred veins may be present
- Color may be very bright red or dry and leathery, charred, waxy, white, tan, or brown
- Person is unable to feel touch in areas of injury
- Requires skin grafting for healing
Substantial fluid loss occurs with a serious burn. When blood vessels are damaged from a deep burn, blood nourishment to the skin is severely limited. Fluids need to be pumped back into your body during the first 24 hours to replace fluid loss. In addition, swelling occurs. At times, cuts need to be made through the burned tissue to release pressure caused by swelling. This procedure is called escharotomy. Swelling typically subsides within a week or two.
With the exception of very small burns, full thickness burns require skin grafts for healing. Removal of dead skin, debridement, is necessary to create a clean, raw place for grafting. A skin graft is a surgical procedure where skin is taken or harvested off an unburned or healed part of that person’s body and then grafted or transplanted to the clean burn area. Within 7-10 days, the grafted skin adheres to the area and becomes the person’s permanent skin. The donor site (location of skin harvesting) is treated as a partial thickness burn and heals within 1-14 days.
American Burn Association
The Shriners Hospitals
The American Red Cross
U.S. Fire Administration