Burns

Ryan M. Garcia

Michael S. Gart

INTRODUCTION

Demographics
- 1 200 000 burn cases in the United States per year
- Increased survival secondary to critical care measures has led to an increased need for reconstruction.
Criteria for patient transfer to a burn center based on guidelines from the American Burn Association
- Any burn to the hands, feet, genitalia, perineum
- Chemical or electric burns
- Third-degree burns or second-degree burns of >10% total body surface area (TBSA)
- Burns associated with additional trauma or associated medical comorbidities
- Burns in children
Burn histology (moving from central area to the periphery)
- Zone of coagulation—tissue necrosis, nonviable, requires excision and grafting
- Zone of stasis—surrounds the zone of coagulation, viable, requires aggressive resuscitation to avoid transitioning to tissue necrosis
- Zone of hyperemia—peripheral most zone, viable, preserved with resuscitation

EVALUATION

History
- Timing of injury
- Type of burn (chemical, electrical, flame, contact, etc.)
Physical examination
- Airway assessment
- TBSA burned
- Depth of burn
- Evaluate for compartment syndrome and for circumferential eschars that diminish limb perfusion
  - Consideration of deep compartment syndrome in electrical burn patients given the pathway of injury
Imaging
- None indicated unless concomitant injuries are present
Classification of burns
- Based on depth of penetration (superficial to deep penetration)
  - First degree
    - Epidermis only—behaves like a sunburn
    - Erythema, digital pressure leads to blanching, no blisters
  - Second degree (subclassified into superficial and deep)
    - Superficial
      - ▲ Papillary dermis involved
      - ▲ Skin appendages (ie, hair follicles) spared, blistering, sensate
    - Deep
      - ▲ Reticular dermis involved
      - ▲ White in color without capillary refill, blistering, diminished sensation
  - Third degree
    - Entire dermis involved
      - ▲ Insensate, black to brown in color, no blistering

ACUTE MANAGEMENT