Burns: general information

Burns - damage to the skin and other soft tissues as a result of thermal, radiation, chemical or electrical influences. Burns are distinguished in depth (grade I, damage to part of the dermis and the entire thickness of the dermis) and the percentage of affected skin areas from the total surface area of the body. Complications include hypovolemic shock, rhabdomyolysis, infection, scars and joint contractures. Patients with large burns (more than 15% of the body surface area) need adequate fluid replenishment. Burns are treated with local antibacterial drugs, regular sanitation and, in some cases, cutaneous plasty. When joints burn, development of movements and splinting are necessary.

ICD-10 code

Burns depend on the area and depth of the lesion. The localization of burns and the nature of the damaging factor are:

• T20.0-7 head and neck.
• T21.0-7 trunk.
• T22.0-7 area of the shoulder girdle and upper limb, excluding wrist and hand.
• T23.0-7 wrist and hand.
• T24.0-7 of the hip joint and lower limb, excluding the ankle and foot.
• Т25.0-7 areas of the ankle and foot.
• T26.0-9 limited to the eye area and its adnexa.
• T27.0-7 respiratory tract.
• T28.0-9 other internal organs.
• T29.0-7 several areas of the body.
• TZ0.0-7 unconfirmed localization.

In the US, as a result of burns, about 3,000 people die each year and about 1 million seek medical help.

Burns - a very common type of traumatic injury, ranks second in the overall structure of injuries. Thus, in Russia more than 300 thousand cases are registered annually. The frequency of burns also increases in the conditions of modern wars. Inpatient care is needed by 30% of the victims. Despite some successes achieved over the past 20-25 years in the treatment of burns, the lethality remains high enough and exceeds 8%. In connection with the above-mentioned problem, thermal damage is given great importance, it is a subject of close attention of both scientists and practicing doctors.

Depending on the nature of the damaging agent, thermal, chemical and electrical burns are released. The most widespread are the first.

Chemical burns are caused by strong acids and bases (nitric, sulfuric, hydrochloric, acetic acids, caustic potassium and sodium, quicklime, etc.) - Burns of the exposed surfaces of the body are more common, but if ingested, the internal organs burns (for example, reception of acetic acid with suicide attempt). Acids, as a rule, form surface burns with the formation of a dry scab. Alkaline burns are usually deeper and form a damp scab. Bubbles do not form during chemical burns. Burn disease does not develop, but when exposed to poisonous and aggressive media poisoning of the organism can be noted.

Degrees of burns

In Russia, burns are classified according to the depth of tissue damage (adopted in 1960 at the XXVII Congress of Surgeons). According to this classification, the following degrees of burns are distinguished:

• I degree is characterized by the onset of edema and hyperemia of the skin of varying severity. The latter is kept from several hours to 2-5 days and ends with the rejection of the epidermis.
• The second degree is characterized by the appearance of bubbles filled with a light yellow transparent liquid, in violation of the integrity of which the wound surface of pink color sensitive to touch is exposed. The depth of the lesion is the death and detachment of the epidermis to the basal (growth) layer. Burns burn for 7-12 days.
• IIIA degree is characterized by superficial necrosis of the skin, which is represented by a wound surface of pale pink or whitish color with reduced sensitivity. Subsequently, after 2-3 days, a thin light brown scab forms. Such burns heal due to the preserved epithelial elements of the appendages of the skin (hair follicles, sweat and sebaceous glands, their excretory ducts) in the period from 21 to 35 days.
• IIIB degree is characterized by necrosis of all layers of skin and subcutaneous fat, together with epithelial elements, with burns represented as a deadly pale wound surface, insensitive to pricking with a needle or touching a ball with alcohol.
• IV degree is characterized by necrosis of all layers of the skin and deeper tissues (fascia, muscles, tendons, bones). As with grade IIIB, a dense scab of dark brown or black color with thrombosed veins in its thickness is formed on the burn site, the edema of the surrounding tissues is expressed.

Burns I, II, IIIA degree are regarded as superficial, under the influence of conservative treatment, lesions are epithelialized at various times after injury (from 2-4 days to 3-5 weeks). Burns IIIB and IV degree are classified as deep - if their area is large enough, then independent healing is impossible, they need surgical treatment.

Diagnosis of the depth of burns to the skin often causes difficulties. This is especially true for burns IIIA and IIIB degree. Anamnesis data helps to clarify the diagnosis. The victim, if his condition permits, ascertain the circumstances of the injury, the nature of the attacking agent, the duration of its impact. It is known that burns with boiling water and steam are often superficial. However, in situations where a person falls into a container with boiling water or some other hot liquid with a prolonged exposure to the action of the thermal agent, one should suspect that there is a deep lesion. The same applies to burns, obtained as a result of exposure to a flame. If burns by a voltaic arc or when flammable liquids ignite because of the short duration of the action, as a rule, they are superficial, the burns that occur when the clothes are burned on a person are always deep.

The depth of the burn depends on the level of tissue heating: if the temperature of the attacking agent does not exceed 60 ° C, wet or colliquated necrosis occurs, which is typical for prolonged exposure to boiling water. With more intense warming, high-temperature agents (flame) develop dry or coagulative necrosis. Extensive burns have an intensity of tissue warming at different sites is not the same, therefore, the victim is more likely to find burns of different degrees: in the center of the wound - IIIB-IV degree, with distance from him - IIIA, then II and I.

Often in the first days after the injury, IIIA grade IIIB burns are difficult to distinguish. In these cases, the diagnosis is clarified later (7-10 days) after removal of nonviable tissues. The IIIA degree burns are characterized by islet epithelization, and IIIB is the filling of the wound defect with a granulation tissue.

To clarify the depth of the lesion, the definition of pain sensitivity (needle prick or touching the wound surface of a ball moistened with ethanol) helps: with superficial burns, this causes pain, with deep burns it does not.

In diagnostics, the determination of the burn area is very important. The most common method is the "rule of nine" and the "rule of the palm." With extensive lesions, it is more expedient to use the first, in which the area of each anatomical region in percent of the entire surface of the body is a multiple of 9. The following areas are distinguished: head and neck, arm, front surface of chest, back, abdomen, waist and buttocks, thigh, and stops equal to each 9%; The perineum and the genitals make up 1% of the body surface. With limited lesions using the "rule of the palm," according to which its area in an adult is about 1% of the body surface. Using these rules, it is possible to accurately calculate the burn area, especially since with extensive burns exceeding 30% of the body surface, a measurement error of + 5% can be neglected, since this discrepancy will not have a significant effect on general treatment tactics.

In children, the age features are taken into account to determine the burn area.

The most accurate and objective method for determining the severity of a state from the data of a physical investigation is the calculation of the Frank index, according to which 1% of the surface burn is conventionally taken as a unit, and 1% as a deep one for three.

If the amount is from 30 to 70 units, the condition of the patient is of medium severity, from 71 to 130 - heavy, from 131 and more - extremely heavy. With the concomitant inhalation injury, 15 units are added to the Frank index, with a slight lesion, 30 - an average, and 45 - with a heavy one.

Limited burns are accompanied mainly by local impairments, and when extensive in the body of the affected there is a complex of general and local disorders causing burn disease. It develops with superficial burns of more than 20-25% of the body surface, or at deep - more than 10%. The severity of the course, complications and outcome are directly proportional to the area of deep burns. In children and patients of elderly and old age, burn disease can develop and with a smaller area of damage.

[1], [2],

Determination of burn area

Three methods are used to determine the burn area.

1. The method of Glumov (the rule of the palm) is based on the fact that the human hand is 1% of the body area.
2.  Wallace's method (rule of nine) is based on Glumov's method, since individual parts of the adult body are multiples of 9% of the total body area: head and neck - 9%, upper limb - 9%, lower limb - 18%, anterior surface of the trunk - 18 %, the posterior surface of the trunk - 18%, the perineum and the palm - 1%.
3.  G.Vilyavin's method (filling of the skits) is based on a graphic image of the burn on a person's scheme of 1: 100 or 1:10 with reflection of prevalence and depth (each degree of burn is reflected by a separate color).

[3], [4], [5],

Further management

Patients who have undergone extensive (more than 20% of the body surface) deep burns, after discharge from the hospital in need of supervision specialist kbustiologa, sanatorium and resort and physiotherapy treatment, exercise physiotherapy. Many of them need reconstructive and recovery operations.

Approximate terms of incapacity for work

The period of incapacity for work varies widely: from 7-10 days for 1st degree burns in a limited area to 90-120 days with deep burns on an area of more than 20% of the body surface.

Most patients who have received deep burns on an area of 25-30% of the body surface become disabled.

[6], [7], [8], [9],

What is the prognosis of burns?

The prognosis and the outcome of the lesion are determined after assessing the surface area of the surface and deep burns and clarifying the diagnosis. The most simple prognostic method of determining the severity of a burn is "the rule of a hundred." If the sum of the age in years and the total area of the lesion in percent is equal to or exceeds 100, the forecast is considered unfavorable, from 81 to 100 - doubtful, from 60 to 80 - relatively unfavorable, to 60 - favorable.