Burn definition
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I now have solid textbook content from multiple surgical references. Here is a comprehensive answer:
Burn - Definition
A burn is an injury to the skin and/or underlying tissues caused by contact with heat, cold, chemicals, electricity, or radiation. The depth and severity depend on the temperature (or intensity) of the agent and the duration of exposure, as well as the body region involved due to differences in skin thickness and blood flow.
- Mulholland and Greenfield's Surgery, 7e, p. 721-722
- Schwartz's Principles of Surgery, 11e, p. 279-280
Causes (Etiology)
Burns are produced by multiple modalities:
| Cause | Share of hospital admissions (2008-2017) |
|---|---|
| Fire / Flame | 41% |
| Scald (hot liquid) | 35% |
| Contact (solid object) | 10% |
| Electricity & Chemicals | 7% |
- Mulholland and Greenfield's Surgery, 7e, p. 721
Classification by Agent
1. Thermal Burns
Caused by fire, flames, scalds, or hot contact objects. The most common type, with the highest mortality (especially flame burns, due to associated inhalation injury and CO poisoning). Subdivided into:
- Flame burns - flammable liquids, house fires, motor vehicle crashes
- Scald burns - hot water or liquids; water above 156°F (69°C) causes a full-thickness burn in just 1 second
- Grease/tar burns - temperatures of 400-500°F, almost uniformly causing deep partial- or full-thickness burns
2. Chemical Burns
Comprise ~3% of admitted burns. Mechanisms differ by agent:
- Acid burns - cause coagulation necrosis
- Alkali burns - cause liquefactive necrosis (penetrate deeper)
- Hydrofluoric acid (exception) - causes liquefactive necrosis AND systemic hypocalcemia; treated with calcium gluconate
3. Electrical Burns
Comprise ~3% of hospital admissions. Special concerns include cardiac arrhythmia, compartment syndrome, and rhabdomyolysis. High-voltage injuries (>1000 V) carry risk of long-term neurologic symptoms and cataract formation.
4. Radiation Burns
Ultraviolet radiation (e.g., arc welding, excessive sun) can cause corneal burns (keratitis); ionizing radiation can cause cutaneous radiation injury.
- Schwartz's Principles of Surgery, 11e, p. 280
- Bailey and Love's Short Practice of Surgery, 28e
Classification by Depth (Burn Depth)
Based on Dupuytren's original classification (1832), burns are graded by depth of tissue destruction:
| Degree | Layer Involved | Clinical Features |
|---|---|---|
| Superficial (1st degree) | Epidermis only | Painful, erythematous, blanches, no blisters, intact skin barrier |
| Superficial partial-thickness (2nd degree) | Superficial papillary dermis | Blisters, very painful, erythematous, blanches to pressure |
| Deep partial-thickness (2nd degree) | Reticular dermis | Less painful, less erythematous, less blanching |
| Full-thickness (3rd degree) | Through entire dermis | Leathery, painless, non-blanching |
| 4th degree | Underlying soft tissue, muscle | Extends beyond skin |
| 5th / 6th degree | Through muscle to bone / charred bone | Rare, severe |
Note: Superficial (1st degree) burns are NOT included in calculations of %TBSA burned.
- Schwartz's Principles of Surgery, 11e, p. 280
- Sabiston Textbook of Surgery, p. 841
Zones of Burn Injury (Jackson's Model)
Following any burn, three concentric zones of tissue damage exist:
- Zone of coagulation - central, most severely burned; tissue is non-viable
- Zone of stasis - surrounding area of compromised perfusion; potentially salvageable
- Zone of hyperemia - outermost zone; increased blood flow, recovers fully
Burn wounds continue to evolve over 48-72 hours after injury, which is why early depth assessment can be imprecise.
- Schwartz's Principles of Surgery, 11e, p. 280
Key Clinical Points
- Burns >10% TBSA in adults (>15% in children) require IV fluid resuscitation
- Children <2 years are at special risk due to thinner skin and a larger surface area-to-body mass ratio
- Inhalation injury must always be considered alongside any flame burn
- Prophylactic antibiotics are not indicated; tetanus vaccination status should be checked
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