Burn Wounds

CHAPTER 9
Burn Wounds
Burn is one of the major types of acute wound, caused exposed nerve endings, lost barrier function of
by thermal, chemical, or electrical contact, radiation, the skin, and inflammation (Fig. 9.2).
etc., which results in tissue damage. Burn wounds are • Deep second-degree burn: Involves epidermis,
highly variable based on the severity and affected tissue papillary dermis, and deep reticular dermis. It is
type. Following the burn injury, a systemic response oc- characterized by blister formation, mild edema,
curs and alters the normal physiological state of the pain, intact hair follicle, and extensive disruption
body [101]. of sensory nerves (Fig. 9.3).
There are various types of burns depending on the • Third-degree burn or full-thickness burn: Involves
causative agent: the epidermis, the dermis, and the hypodermis. It
• Physical may extend to the underlying muscle, bone, and
• Thermal burns interstitial tissues. It is characterized by dry dark
• By dry heat leather-like appearance without blister. It is usually
• By wet heat painless because of irreversible damage of nerves
• Electrical burns [101e103] (Fig. 9.4).
• Radiation burns Fig. 9.5 shows the different degrees of burn wound
• Laser burns schematically.
• Chemical (acid burns, alkali burns, others) [102].
TYPES OF BURN
Burn wounds can be classified based on severity, type of
involved tissues, and depth, as follows:
• First-degree burn: A localized injury causes damage
to the epidermis, characterized by localized pain,
edema, and erythema, and usually without blister.
First-degree burn does not disrupt the barrier func-
tion of the skin and is not a life threatening condition
(Fig. 9.1).
• Second-degree burn: Involves the epidermis and
variable thickness of the dermis. It is subclassified as
follows:
• Superficial second-degree burn: In which the
epidermis and papillary dermis are damaged. It is
characterized by pain, early blister formation, FIG. 9.1 First-degree burn caused by sun exposure.
Atlas of Wound Healing. https://doi.org/10.1016/B978-0-323-67968-8.00009-4

Copyright © 2019 Elsevier Inc. All rights reserved. 101
102 PART II Wound Healing Case Reports and Treatment Protocol
FIG. 9.2 Blisters formed in a superficial second-degree wound.
FIG. 9.3 Deep second-degree burn wounds.

CHAPTER 9 Burn Wounds 103
FIG. 9.4 Third-degree burn wounds.
FIG. 9.5 Degrees of burn wound.
RULE OF NINES Moreover, the percentage in rule of nines may be altered

The rule of nines, also known as Wallace rule of nines, is by the patient’s body mass index (BMI) and age.
a practical technique for calculating the percentage of According to the rule of nines, each part of the body
total body surface area (TBSA) in patients with partial- has a certain percentage of nine or a multiple of nine
thickness or full-thickness burns. Patients with (Fig. 9.6) [104].
second-degree and third-degree burns lose massive fluid
and suffer from dehydration due to the damage or Wound Care Management and Early
removal of the skin as barrier. Hence, it is crucial to Treatment for Burn Wounds
specify the wound severity and fluid resuscitation re- 1. Estimate degree of burn (first, second, or third)
quirements for better wound care management. 2. Estimate the extent of burn based on rule of nines
FIG. 9.6 Rule of nines refers a certain percentage to each part of the body.
3. According to the burn severity patient should be Case Reports

hospitalized and receives appropriate medical care, Figs. 9.7 to 9.25 show the treatment process for burn
including debridement, ulcer bed preparation, and wounds.
skin grafts.
4. Apply antiseptic solutions and provide appropriate
wound dressing for home care.
FIG. 9.7 Burn.
FIG. 9.8 Burn.

FIG. 9.9 Burn.
FIG. 9.10 Burn.

FIG. 9.11 Burn.
FIG. 9.12 Burn.

FIG. 9.13 Burn.
FIG. 9.14 Burn.

FIG. 9.15 Burn.
FIG. 9.16 Burn.

FIG. 9.17 Burn.
FIG. 9.18 Burn.

FIG. 9.19 Burn.
FIG. 9.20 Burn.

FIG. 9.21 Burn.
FIG. 9.22 Burn.

FIG. 9.23 Burn.
FIG. 9.24 Burn.

FIG. 9.25 Burn.

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CHAPTER 9

Atlas of Wound Healing. https://doi.org/10.1016/B978-0-323-67968-8.00009-4

FIG. 9.2 Blisters formed in a superﬁcial second-degree wound.

FIG. 9.3 Deep second-degree burn wounds.

FIG. 9.4 Third-degree burn wounds.

FIG. 9.5 Degrees of burn wound.

RULE OF NINES Moreover, the percentage in rule of nines may be altered

3. According to the burn severity patient should be Case Reports

FIG. 9.7 Burn.

FIG. 9.8 Burn.

FIG. 9.9 Burn.

FIG. 9.10 Burn.

FIG. 9.11 Burn.

FIG. 9.12 Burn.

FIG. 9.13 Burn.

FIG. 9.14 Burn.

FIG. 9.15 Burn.

FIG. 9.16 Burn.

FIG. 9.17 Burn.

FIG. 9.18 Burn.

FIG. 9.19 Burn.

FIG. 9.20 Burn.

FIG. 9.21 Burn.

FIG. 9.22 Burn.

FIG. 9.23 Burn.

FIG. 9.24 Burn.

FIG. 9.25 Burn.

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