Skin burn 3 degrees: chemical, thermal

Such a serious injury, as a burn of the third degree, is characterized by deep damage to the layers of the skin with the formation of areas of their necrosis. In addition to the skin, you can also suffer from muscle tissue, and even bone.

When a third degree burn victim is necessarily necessary to be hospitalized, because such a trauma is considered very serious and requires qualified medical intervention.

[1], [2], [3]

Epidemiology

According to various data, third degree burns can account for approximately 15% of the total number of burns.

In addition, there are a number of interesting statistical facts:

• The overall incidence of all burns among other injuries is approximately 6%;
• half of all diagnosed burns occur as a result of direct contact with the flame;
• 20% of the total number of burns occur due to exposure to boiling liquids or hot steam;
• 10% of the total number of burns is caused by damage caused by contact with incandescent objects;
• More than 70% of all burn injuries are damage to various parts of the hands;
• one of every three victims of a burn is a child.

[4], [5], [6], [7], [8], [9],

Causes of the third degree burn

A third degree burn can occur for a number of reasons:

• after exposure to high temperature;
• after exposure to aggressive-irritating chemical fluids;
• under the influence of an electric current;
• under the influence of a large dose of radiation.

Thermal burn can be the result of direct exposure to fire, boiling liquid or steam, as well as direct contact with incandescent objects.

The chemical type of burn is always caused by chemical preparations and concentrates, with the content of acids or caustic alkali.

Electric burn can be obtained from current, after short-term contact with conductive elements.

From accidental burn, as they say, no one is insured - the trauma can be obtained at home (for example, in the kitchen) and at work.

The most common risk factors that can lead to a third degree burn are:

• non-observance of safety rules in the kitchen while cooking;
• non-observance of the rules for storage of chemical solutions, acids and caustic alkalis;
• ignoring safety rules at work.

[10], [11]

Pathogenesis

The impact of the damaging factor leads to the complete or partial destruction of cells and the violation of their functionality. In this case, the degree of damage may differ, depending on the duration of exposure, on the temperature index, on the density of the skin at the lesion site, and on the quality of tissue conductivity.

Wound surface with a burn of grade 3 is usually a complete destruction of the epidermal layer, dermis and skin appendages. The lesion in most cases is dry, compact, painless, not prone to self-healing.

A significant role in the pathogenesis of a burn is played by an inflammatory process that occurs in response to traumatic injury. At the initial stage, vasoconstriction develops, which quickly passes to the dilatation stage. In tissues that have been burned, vascular permeability is expressed. As a consequence of this process, the wound surface is quickly filled with proteins and serum elements, which visually manifests itself in the form of an increasing edema.

Against the background of increased vascular permeability in the wound, neutrophils, platelets and monocytes accumulate, which cause the development of post-fire hypermetabolism.

[12], [13], [14], [15], [16]

Symptoms of the third degree burn

Burn 3 degrees are divided into two versions of the flow, depending on the pathogenetic and clinical features:

• Degree 3-a - is characterized not only by the epidermal layer, but also by a separate part of the hair follicles, sweat and sebaceous glands. There is a necrosis of tissues against the background of vascular damage and local edema. After a burn of degree 3a, a crust of grayish or brownish hue is formed, with the preliminary appearance of different sizes of bubbles with liquid. Without medical assistance, such a wound heals slowly and problematically.
• Degree 3-b - burn injury extends to all underlying tissues, including the subcutaneous fat layer. Visually attract the attention of large-sized blisters containing fluid and blood elements. Such a burn is not always accompanied by pain, due to damage to the pain receptors. It is pointless to count on an independent healing of such a wound.

Types of burn injury	Pathogenetic features	First signs
3rd degree	The entire epidermal layer undergoes trauma, up to partial damage to the dermis.	A dry or malleable burn cortex is formed of a gray or brownish hue.
3-b degree	Damage affects the entire epidermal layer, the dermis, up to partial damage to the hypodermis.	Formation of compacted dry scab of a brownish hue is observed.

• Edema in the third degree burn is a natural reaction of the body to traumatic damaging effects, with a violation of the integrity of tissues and the vasculature. In itself, edema is the result of accumulation in the skin layers of excess fluid - the effusion of damaged blood supply vessels. Visually, edema in the third degree burn is a small tumor (swelling of the skin) with characteristic redness. Simultaneously with the increase in edema in the tissues, an inflammatory reaction develops, which does not allow the swelling structures to recover.
• The temperature at the third degree burn may indicate the development of toxemia, a pathological condition caused by intoxication of the body with residual products of protein decomposition and toxins entering the bloodstream from damaged tissues. The main sign of this state is the increase in temperature - up to 38-39 ° C: in this case, the higher the temperature, the less favorable it should be considered the forecast. Toxemia in most cases is found in the victims with burns of 3 degrees, which occupy an area of more than 5% of the skin surface.
• A third-degree face burn always heals very hard, since the damaged skin is necrotic and subsequently rejected. Because of the increased blood supply of tissues on the face, the probability of joining a purulent infection is high. In most cases, the temperature rises, the processes of epithelization go slowly. If the area of the nose or ears is damaged, then there is a danger of chondritis and necrosis of the facial bones. In case of third degree burns of any localization, scars are formed and tissues are deformed.
• A burn of the esophagus of the third degree is considered very serious and represents a certain danger for the life of the victim. With such a burn, the patient is worried, he groans, it is difficult for him to swallow not only food, but his own saliva. The condition is often accompanied by shortness of breath, pale skin, blue lips. If the chemical burn (and this happens in the vast majority of patients with esophagus burns), then you can pay attention to damage to the oral mucosa, tongue, corners of the mouth.
• A leg burn of grade 3 is always accompanied by edema - and this is considered a normal reaction of the body to burn injuries, since in this case, not only the skin, but also the vessels and underlying tissues are damaged. Symptoms of a burn of a leg of 3 degree: watery dense bubbles, formation of a scab, dying of tissues, sometimes - suppuration of a wound surface. After treatment, scars are usually left on the burn site.
• Burn 3 degree brush is most often a lesion of the fingers, less often - the wrist zone. In the vast majority of cases, because of a small layer of subcutaneous and muscle tissue, bones and joints of fingers and hands can suffer. Such a burn, according to statistics, is most common.

Third degree burn in children

In children, third-degree burn injuries occur at least as often as in adults. Especially it concerns children up to 3 years of age.

However, according to statistics, the severity of such injuries in childhood is always higher. The fact that the skin in small patients is much more tender and sensitive than any adult, and the system of blood and lymph circulation is very developed, and therefore, conducts heat faster. Because of this, and also because compensatory and regulatory reactions in the child are still imperfect, a third-degree burn practically always leads to the appearance of a burn disease.

Therefore, any burn injuries in childhood have a more severe course, as in children, such complications as circulatory insufficiency, electrolyte and white metabolism disorders, and the function of the main organs - the liver and kidneys - are disrupted.

Forms

Burns are divided into different types, depending on the nature of the attacking agent and the depth of the injury.

The damaging agent can be boiling water, fire, hot steam, chemicals, electric current, etc.

The depth of the burn injury is distinguished by:

• surface burns (1,2 and 3a degrees);
• deep burns (3b and 4 degrees).

Thermal burn 3 degrees - this is a trauma, obtained after contact with any thermal carrier - both liquid or dense, and vaporous. Burns obtained by contact with open sources of fire are most often diagnosed; Less common are burns with boiling water and electric current.

Burn 3 degree boiled water is less common than the first two degrees, because in most cases boiling water has time to cool down on the body even before the lesion reaches deep tissues. However, cases of combined tissue damage are common, when a burn is a combination of several degrees. In this situation, the doctor determines the condition of the victim, depending on what area the wound surface has in the deepest affected areas.

A chemical burn of the third degree always heals much more heavily than similar burns obtained as a result of thermal or electrical impact. The rejection of dead tissue (scab, crust) begins only by the fourth week, and the wound itself is tightened very slowly, with the formation of dense deforming scars. Sensitivity after a chemical burn of grade 3 is usually lost.

A third-degree eye burn is not diagnosed as often: a similar injury is possible in fires or when a chemical fluid or an aerosol with an aggressive fill is applied to the face. A burn can lead to a marked decrease in visual acuity (up to its complete loss). Also, cases of development of corneal leukoma, cicatrical deformation of the eyelids, increased intraocular pressure, atrophy of the affected organ of vision are not uncommon.

[17], [18]

Complications and consequences

Possible complications after a burn of grade 3 can be divided into several groups:

• The development of a burn disease, which consists of several stages, namely:

1. period of shock (lasts about 48 hours, sometimes - up to 72 hours);
2. period of toxemia (ingress of toxins into the bloodstream as a result of decomposition of damaged tissues);
3. septicotoxemia period (development of purulent process);
4. recovery period (wound healing).

• The development of endogenous intoxication associated with the accumulation of toxic substances due to disruption of the liver and kidneys.
• Development of sepsis and infection, due to infection from outside and the formation of secondary immunodeficiency.

How many burns burn 3 degrees?

The healing period of the third degree burn usually lasts from 6 weeks to 6 months, and for a degree 3b burn up to 12 months. In most cases, the wound surface does not heal completely, since there are tissues that have undergone necrosis - such areas can not be dragged on independently. In order to ensure complete healing, you should consult a surgeon who will perform skin transplants from healthy areas to the burn surface.

[19], [20], [21]

Diagnostics of the third degree burn

The diagnosis of a third-degree burn is usually not complicated: the doctor determines the area of injury and depth (by the method of assessing pain sensitivity). As a rule, the deeper the burn, the less painful the sensitivity.

Sometimes, to clarify the diagnosis and the appointment of the right treatment, the doctor suggests the victim to hand over such tests:

• blood for the degree of folding;
• blood for anemia;
• blood on the quality of electrolytic metabolism;
• urine for general analysis.

According to the data obtained as a result of the surveys, it is possible to judge the degree of intoxication, blood loss, as well as the work of the liver and kidneys.

Instrumental diagnosis is performed only if there are internal damages. For example, with esophageal burn, endoscopy can be prescribed.

[22],

Differential diagnosis

Differential diagnosis is performed between burn injuries of degrees 3a and 3b. By the way, such differentiation presents certain difficulties and is finally possible only after the process of rejection of dead tissue.

[23], [24], [25]

Treatment of the third degree burn

Medical measures for a third degree burn should consist of a whole range of methods, the main objectives of which are:

• elimination of pain;
• prevention of anemia;
• prevention of hypoxia;
• normalization of metabolic and equilibrium processes in the body;
• elimination of intoxication;
• prevention of violations of the cardiovascular system;
• prevention of violations of the liver and kidneys;
• stabilization of the body's energy potential.

Treatment of third-degree burns in the hospital is mandatory - it can be a burn department or center. The doctor, applying anesthesia, processes the burn and assesses his condition, while making a decision on how the treatment will be administered - in a closed or open method.

	Pros	Minuses
Closed method of treatment of burn injuries	Minimized risk of infection of the wound surface. Minimized risk of mechanical damage.	The dressing process delivers additional discomfort to the patient. Enhanced decomposition of dead tissue leads to additional intoxication.
Open method of treatment of burn injuries	Forming a dry crust is faster. It is much easier to observe the course of the healing process.	There is a constant loss of moisture from the affected tissues. The open method has a much higher cost.

Medicines for dressings are, in the vast majority of cases, antiseptic drugs:

• Etacridine lactate - used in the form of solutions 1: 2000, and with the appearance of irritation on the skin, a solution of 1: 1000 can be used. Sometimes it is allowed to use Etacridin as a powder on the wound.
• Furacilin - used for irrigation and wet dressings, in the form of an aqueous 0.02% solution. In some cases, the drug may cause allergies.
• Silver nitrate 0,5% is applied not longly, as the preparation can cause a change in skin color (as a result of accumulation of metallic silver).

In addition, the treatment of the wound surface with infrared and UV rays is prescribed - this helps prevent the development of wet necrosis, stop the purulent infection and accelerate epithelization.

Ointments for third-degree burns start to be used only after exudation in the wound is completed. Usually prescribed such external drugs:

• Synthomycin 10% applied directly to the wound, or under the bandage. Synthomycin is avoided for prescribing to infants, since the drug may cause an allergic reaction.
• Furatsilinovaya ointment 10% of her apply under the bandage. Rarely, this ointment can provoke the development of allergic dermatitis, but most often it is well perceived by the body.
• Gentamicin ointment - it is applied directly to the affected area of the skin, 3-4 times a day. Continue treatment with ointment 1-2 weeks, if there is no allergy to the drug.
• Levomekol - used for the treatment of burns in adults and children, starting from 3 years of age. Ointment is not recommended for long-term use. It is advisable in 5-7 days to change this drug to another, in order to avoid the development of osmotic shock in healthy tissues.

In addition to ointments, with a third-degree burn, Aerosol with an antibiotic is used. Olazole is a preparation based on sea-buckthorn oil, boric acid, benzocaine and chloramphenicol, which helps to heal the wound. Olazole is applied daily or once every two days, depending on the degree of tissue damage and the stage of their recovery.

Ointments and other means for treating burns should not irritate the wound surface - on the contrary, they must have a softening and analgesic effect. Ointment dressings are replaced daily, or every other day.

Systemic antibiotics for burns of 3 degrees are prescribed only individually, and only in cases where the area of damage is more than 10% of the total surface of the skin. Sometimes antibiotics are administered intramuscularly, and only in very severe cases - intravenously. As a rule, medicines of a wide spectrum of antibacterial activity are prescribed:

• preparations of cephalosporin group;
• penicillin preparations;
• sulbactam with cefoperazone;
• fluoroquinolone group preparations.

When joining a fungal lesion, levorin or diflucane is prescribed, and for anaerobic infection, metronidazole is prescribed.

Help with burn 3 degrees

First aid rules for a probable third degree burn are such recommendations:

• The first thing to do is to remove the source that triggered the burn: to extinguish the fire, to pour the affected area of the body with water, remove burning items of clothing, etc.
• "Stirred" to the body, clothes can not be forcibly removed!
• If the victim is unconscious, the witnesses should be interviewed about how the injury occurred, and also call the caretaker as soon as possible.
• It is recommended that the affected limb be placed under running cold water for 15 minutes.
• The surface of the burn should be covered with gauze or bandage to avoid infection.
• Strongly affected limbs are fixed with tires.
• With a large burn area, the victim should be given as much water as possible (tea, juice, etc.).
• In the presence of severe pain, you can give the person an analgesic (baralgin, ibuprofen, etc.).
• If the victim is unconscious, the need for artificial respiration and indirect heart massage should be assessed.

Vitamins

• Tocopherol is taken to prevent the formation of gross scars on the skin. Children are prescribed from 100 to 300 IU, and to adult patients - from 200 to 800 IU. The drug is taken throughout the treatment of the burn.
• Retinol is taken in order to facilitate the absorption of tocopherol, 25,000 IU daily.
• Ascorbic acid will help prevent excessive nervousness and anxiety, increase immune defenses and stimulate the healing process. The dose of ascorbic acid for a third degree burn is 500-1000 mg daily.

In addition, doctors advise taking multivitamin preparations with a high content of B vitamins (for example, Undevit). A good stimulating and strengthening effect is the regular use of brewer's yeast.

Physiotherapeutic treatment

Physiotherapeutic procedures for burns of 3 degrees help to ease pain and stop the development of the inflammatory process, and also speed up the restoration of the skin.

• After the end of the acute period - about 3-4 days - for the removal of pain you can use Lenar, Transair, El Esculap medteko, which work by the method of transcranial electrostimulation.
• During the formation of the scab, the treatment of the wound surface with the Hesk apparatus is used - 2 sessions per day, for 25 minutes, for 14-20 consecutive days.
• In the period of active reduction and formation of granulations, use is made of:

1. electrostimulation (14-15 sessions);
2. franklinizatsiyu (daily for a month);
3. ultraviolet therapy with suberitemic doses (10-12 sessions, every other day);
4. magnetotherapy low-frequency (35 minutes daily, for 15 days);
5. magnetotherapy constant with the use of elastomagnet sheets (15 five-hour procedures);
6. laser therapy (helium-neon, 20 daily sessions of 20 minutes).

• At the stage of formation of cicatricial changes appoint:

1. electrophoresis with lidase;
2. paraffin applications (temperature regime 50 ° C);
3. hydrocortisone by means of ultraphonophoresis (12 sessions).

Treatment of burns of 3 degrees at home

A third degree burn is a serious enough injury that can not be cured at home in a quality manner. Alternative treatment can be useful only as an additional method, along with traditional medical care.

With a burn, especially 3 degrees, special attention should be paid to the presence of vitamins E and C in the diet - they help stop the inflammatory reaction and restore injured tissue structures. In addition, ascorbic acid takes an active part in the formation of collagen fibers, which are the main components of scar tissue. The necessary vitamins are found in fresh vegetables, berries, fruits and unrefined vegetable oils.

In the healing stage of the wound surface, the juice of the aloe plant can help - it usually speeds up the regeneration processes and maintains the primary tension of the tissues. The simplest recipe for using aloe is to drop a few drops from the thick part of the leaf onto the affected area of the skin.

Some time after receiving the burn, when the acute period of trauma is left behind, you can apply compresses from fresh grated potatoes - about 1-1.5 hours daily.

Accelerate the healing of the lotion from green tea - and it is known to be an excellent antioxidant. The lotions are moistened in strong brewing and applied to the wound.

At the stage of healing, you can use a calendula based ointment. To prepare it mix the pharmaceutical tincture of calendula and Vaseline in the proportion of 1 to 2.

Treatment with herbs can be used only if it is approved by the treating doctor. For example, often patients use such popular recipes:

• The leaves of black elder are covered with boiling water and after cooling they are applied to the affected area.
• 100 g of St. John's wort is boiled in 0.5 liters of vegetable oil (for half an hour), after which it is filtered and cooled. They are used for burning burns.
• Prepare a decoction from the rhizome of Kalgan (on 1 tbsp root - 250 ml of water). Used for lotion on the wound.
• The leaves of the plantain are covered with boiling water, cooled and applied to the burn injury site.

Homeopathy

Usually, when getting lighter burns - for example, 2 degrees, but with the formation of vesicles with fluid - it is recommended to use Arnica 30, Aconite 30 and Kantaris 30, with individually selected dosage.

With a third degree burn, with pronounced necrosis of the tissues, stronger homeopathic remedies may be required:

If the victim is in a state of shock and does not complain of pain, then the drug Opium 1m should be used;

When chemical burns with acid or alkali concentrates, Sulfuricum Acidum 30 is recommended.

If a homoeopathic doctor does not prescribe another dosage, then take 2 tablets of the listed drugs every half an hour, but not more than three times. Already for 2 hours the victim's condition should improve. If the preparations have a greater dilution than 30 (for example, 6 or 12), then they are given every 15 minutes.

Operative treatment

The most common operation after a third degree burn is skin transplantation, which consists of three consecutive procedures:

• removal of the transplanted material (as a rule, skin from healthy areas of the patient is suitable);
• preparation of the wound surface (cleansing, rinsing with isotonic solution, drying);
• directly transfer of material to the wound.

Transplantation is performed using general anesthesia. Skin grafts are fixed with bandages or seams, pre-perforated to improve survival. The average time to implant the transplanted skin is one week.

In addition to skin grafting, after third degree burns, surgical interventions are sometimes used to remove scarring and deformity of the skin. Scars after a third degree burn are excised, and skin deformations are replaced with a healthy material - a graft.

Rehabilitation after third degree burns

Rehabilitation after a burn injury grade 3 is carried out after relief of acute symptoms and prevention of possible complications. The rehabilitation period implies the use of procedures and methods that contribute to the final healing of the wound and restore the victim's ability to move around fully and lead a normal lifestyle (or at least self-service their needs).

Nevertheless, this period is still accompanied by:

• metabolic disorders (eg, anemia and dysproteinemia);
• disorders of the heart and blood vessels (eg, low blood pressure);
• disturbances in the function of the respiratory system (difficulty breathing, shortness of breath);
• disorders of the digestive system (lack of appetite, constipation);
• a violation of renal function.

In addition to measures to prevent possible adverse effects and to accelerate the recovery of the body, procedures are in place to prevent skin cicatricial changes.

Nutrition for burns of 3 degree

Immediately after receiving the third degree burn, the patient is recommended to maintain a sparing diet, with the predominant use of dairy products, broths, freshly squeezed juices, vegetable oil. In a few days, you should gradually increase your calorie intake by regularly eating carbohydrate foods - cereals, fruit purees, berry jelly. If the water-electrolyte balance is disturbed, as well as to accelerate the excretion of toxic substances from the body, it is recommended to drink a sufficient amount of liquid - mineral water, compotes, herbal teas, kissels, morses.

Diet should be enriched with foods that contain enough vitamins B, ascorbic acid, vitamins D and A.

In cases of burns, expressed in terms of area and depth, and also with dysphagia, sounding is used.

Prevention

In order to prevent a third-degree burn, doctors advise paying attention to such advice:

• be careful in the kitchen when cooking, especially if the family has children;
• pots with boiling liquids should be placed on distant burners from the edge of the plate;
• It is unacceptable to keep matches and other means for ignition in places accessible to children;
• if there are small children in the family, it is necessary to isolate open sockets, extension cords and places with accumulation of electric wires;
• It is inadmissible to have bare wires and loose switches or sockets in the house;
• chemical solutions must be in a special container, on which a label with a description of the contents must be affixed;
• storage sites for chemicals and liquids should be closed to children;
• Do not smoke: by this you will reduce the risk of fires and burns by almost half;
• the fire extinguisher must be present in the house: it must be placed in a place where small children can not reach them, but the adult can easily use the tool in any situation.

[26], [27], [28], [29]

Forecast

With the timely provision of medical care, the 3-degree burn forecast can be relatively favorable, however it depends on how profound and extensive the tissue damage was. A third degree burn can be accompanied by a positive prognosis if the following measures were applied to the victim:

• quality first aid;
• surgery;
• physiotherapeutic procedures;
• rehabilitation methods and recommendations for the further care of the damaged zone.

If the third-degree burn had a relatively small size and was shallow, then the prognosis for its complete cure can be considered favorable.