Thermal burn

Thermal burn is an open tissue damage caused by exposure to heat, irritants, radiation and electrical energy.

The uniform international classification of Kreibich (S. Kreibich - 1927) is accepted according to the depth of the defeat. In Russia; it was approved at the 27th Congress of Surgeons in 1960 as a working one. It is distinguished by four degrees of depth.

• 1 degree is characterized by the defeat of only the epidermis of the skin.
• 2 degree is characterized by the defeat of the epidermis and subepidermal layer.
• 3 degree is divided into two groups.
  • 3 A degree is determined by the retention of the papillary (basal) layer, in which the nerve endings and vessels are located, as well as the regenerating epithelium, they are exposed and manifested with a sharp soreness.
  • 3 A degree is characterized by a lesion of the basal layer, as a result of which the nerve endings are perishing, they are almost painless.
• 4 degree is determined by the defeat of all layers of the skin.

With thermal burns of muscles and bones, the term "charring" is used. Thermal burns 1-3 A degree are classified as superficial, since they retain elements of regeneration and they heal by primary tension. Thermal burns of 3rd-4th degree are defined as deep, as they heal by secondary tension, often by a rough deforming scar, and require prompt treatment at early stages. Local changes depend on the depth of the lesion.

With thermal burns of 1 degree, diffuse hyperemia, insignificant swelling of tissues in the zone of the factor (flame, steam, boiling water, sun rays, etc.) is observed. This is accompanied by sharp pains, especially with movements. The duration of the acute period is 3-5 days, after which the clinical manifestations disappear, there is a profuse exfoliation of the epidermis. Rarely formed little-expressed skin pigmentation, which disappears within a month. As a rule, thermal burns of the 1st degree, even with a large lesion area, do not give general clinical manifestations.

Thermal burns of 2 degrees at the initial moments give; sharp pain, severe congestion and swelling. A characteristic feature is the formation of blisters that form during the first hour after the injury due to exudation in the subepidermal layer of the skin. The contents are initially light, serous, on the 2nd-3rd day becomes turbid due to protein coagulation. If the blisters are not opened surgically, they are opened by themselves (they can get nagged). The surface is quickly cleaned. Epithelialization comes from a completely preserved basal layer of the skin, healing takes place without scarring, within 7-10 days full regeneration occurs. But within a month, there may be persistent hyperemia and pigmentation of the skin in the area of damage, which do not require special treatment.

Thermal burns of 3 A degree are also accompanied by sharp pains, the formation of blisters, and immediately after the injury, but they are usually filled with serous-hemorrhagic contents, quickly opened themselves.

After their opening, an exuding surface with pinpoint hemorrhages is exposed; After 5-7 days, islet necrosis, usually white, is discarded and begins islet epithelization from the basal layer and epidermal epithelialisation from the margins. This thermal burn heals by primary tension; But most often between the preserved islets of the basal layer are formed and granulation, which determine the development of hyaline scarring (the outcome, in most cases, depends on the quality of treatment, keloids can also form). The healing process is long, sometimes months. After regeneration, there remains a long pigmentation that lasts for several years. The skin area is hypersensitive to sunlight and elevated temperature.

Thermal burns 3 Degrees also form bubbles filled with hemorrhagic exudate, which are quickly opened. But unlike the superficial, deep thermal burns are not accompanied by sharp pains, due to damage to the nerve endings of the basal layer of the skin, they are diffuse and are associated with an increasing edema that compresses the deep-seated nerve trunks and endings. A characteristic feature is the formation on the 3-5th day after a thermal burn of a dense scab of brown color. Healing under it takes a long, months, with the formation of a keloid scar. At the area of such damage more than 10 square meters. Cm, hospitalization in the centers is necessary, as epithelization from the edges does not go and skin plastic is needed.

Thermal burns of the 4th degree can produce the formation of bubbles, which are immediately opened, but more often charring of the skin is noted. The zone of damage is painless. But the reactive changes in the form of edema are significant. By the 3-5th day a dense scab in the form of a shell is formed. Thermal burns up to 10 square meters. Cm can heal under the scab, but the process is long, the optimal option is the early skin plastic.

General manifestations depend not only on the depth, but also on the area of damage. The age of the victim is of great importance, since children and old people endure them much more severely. In young and healthy affected (it is relatively) superficial to 20% and deep - up to 10% of the body surface proceed as a local process. In case of damage to a larger area, a burn disease develops.