Burns

 Burns damage the skin, and sometimes underlying tissues, caused by contact of the skin with a hot substance.

Most burns (95%) are of thermal origin but can also be electrical and chemical.

The prognosis in terms of life or death depends on the extent of the burn.

The prognosis in terms of function depends on the depth and the location.

 

A distinction is made between 4 depths:
  •   An epidermal burn (first-degree burn) refers to a burn that affects the superficial layers of the epidermis with no basal lesions. It is recognised by the lack of any separation (no phlyctena or blisters) and the presence of painful erythema. Spontaneous healing occurs within 2 to 3 days with no residual effects.
  • A superficial dermal burn (2nd degree burn) is a lesion affecting almost all of the epidermis, including part of the basement membrane and Malpighi cells. Morphologically, it is recognised by the continuous presence of blisters, the base of which are red following excision , well vascularised and very sensitive. Spontaneous healing normally occurs within 1 to 2 weeks with no residual effects, but there is still some risk of an indelible scar, particularly in children, non-caucasian skin and more generally when healing is delayed by a complication (usually local infection).
  • A deep dermal burn (deep 2nd degree burn) consists of complete destruction of the epidermis and the superficial dermis. All that remains intact is the deep dermis and skin appendages (hair, sweat and sebaceous glands). These burns, like superficial second-degree burns, have blisters, but following excision, the base of the blisters look whitish-pink, are poorly vascularised and have reduced sensitivity. Spontaneous healing is possible but slow (2 to 4 weeks). The general condition of the patient or a local secondary infection can frequently deepen the lesions by destroying the few surviving epidermal cells preventing normal spontaneous healing.
  • A full thickness burn (3rd degree burn) consists of complete destruction of the skin with a minimum inclusion of the entire epidermis and the dermis. It looks like an adherent cutaneous necrosis, without phlyctena, of more or less dark colour (from white to brown to black), with total loss of sensitivity. The complete disappearance of epidermal cells does not allow spontaneous healing and definitive cutaneous healing can only be obtained by autograft, ie: by the import of autologous epidermal tissues, taken from an area of intact skin. Skin-grafting is only possible following excision of the cutaneous necrosis.