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Thermal Burns


First-, second-, and third-degree burns (diagram)

Thermal burns can be roughly broken down into three categories: first-degree, second-degree, and third-degree burns.

First-degree burns are typically caused by sunburns or a very short flash of heat. They are red and painful, but typically there is no blistering of the skin and no long-term scarring. Sunburns should be avoided through the proper use of sunscreen to prevent skin cancers from forming later in life.

Second-degree burns are further divided into two categories: superficial second-degree and deep second-degree burns.

  • Superficial second-degree burns are painful, but should heal within ten days or so. It is important to keep the burned area clean with daily washing and covered with a burn ointment such as bacitracin. It is also important to keep the burned are mobile by stretching and performing a full range of motion for all joints several times per day. Like first-degree burns, superficial second-degree burns rarely require surgery.
  • Deep second-degree burns take more than ten days to heal. Depending on the area burned, the long-term functional and cosmetic outcomes might be improved by surgery. Sometimes it takes several days of observing the burn wound to determine if surgery is indicated or not. The types of surgery that one might need include skin grafts taken from a different part of the body, or skin grafts with temporary skin or skin grown in the lab. The goal is to improve the cosmesis, or final appearance, of the burned area. The second goal is to make sure that all joints have full range of motion and that scar formation does not hinder the range of motion of any joint. These problems are more common with deep second-degree burns and may require additional therapy, additional surgical procedures, or outpatient scar management.

Third-degree burns always require surgery to heal and have all the characteristics of deep second-degree burns as discussed above. The major goal is to achieve the best cosmetic and functional outcomes possible by using skin grafts taken from a different unburned part of the body.

A particularly concerning patient is one who has extensive burns over a major portion of the body. These patients need admission to the burn intensive-care unit, where all the different hospital specialties will work together to try to save the life of the patient with the best appearance and body function possible.