Ryan M. Garcia

Michael S. Gart


  • 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


  • 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


May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Burns
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