BURNS DR. WALID AMIN AL - MEKHLAFI 202 2 OUTLINES INTRODUCTION ETIOLOGY OF BURNS PATHOLOGY OF BURNS MANAGEMENT OF BURNS SPECIAL TYPES OF BURNS PROGNOSIS INTRODUCTION A burn is one of the most serious injuries to the body It has physical and psychological effect How to prevent or reduce the incidence of burns? Layers of the skin Functions of the skin ETIOLOGY OF BURNS Burns can result from a variety of thermal injuries: o Scalds (boiled liquids) affecting mostly children o Flame burns o Electrical burns o Chemical burns (acids or alkali) o Inhalation burns PATHOLOGY OF BURNS EXTENT • This is the percentage of burnt skin surface area in relation to the whole - body surface area. • Rule of 9 or the Palm rule • Classified into: 1. Major burn > 30 % 2. Intermediate burn (adult 15 - 30 %) (children 10 - 30 %) 3. Minor burn (adult < 15 %) (children < 10 %) DEPTH • First degree burns e.g., sunburns • There is erythema of the epidermis • Heal rapidl y • Second degree burns • The epidermis and portion of the dermis is involved • Healing occurs from the epithelial remnants • If no infection is found, they heal within 3 weeks • If infection is present, there is delay in healing or may progress into full thickness burn • They are divided into: 1. Superficial partial thickness 2. Deep partial thickness ▪ Third degree burns ▪ Called also full thickness burns ▪ Complete destruction of the epidermis and dermis ▪ Heals slowly after 3 week s Difference between partial and full thickness burns • Appearance (moist and erythema) (dry and black eschar) • Presence of pain (painful) (painless) • Rate of healing (within 3 weeks) (> 3 weeks) Fourth degree Involves the deeper structures such as fascia, muscles and bones Heat burns occur by two ways: 1. Immediate direct cellular injury 2. Delayed injury due to progressive dermal ischemia The degree of tissue destruction is related to both temperature and duration of exposure to the source Cell damage is due to protein denaturation Histologically the burn skin is divided into 3 zones: Central zone (zone of coagulation) Intermediate zone (zone of stasis) Outer zone (zone of hyperemia) The rate of burn healing depends on the density of the surviving adnexal epithelial structures The partial thickness burn heals with epithelization within 3 weeks The deep thickness burn first has separation of the eschar on the 3 rd week leaving granulation tissue Then either grafting or healing by fibrosis and scarring