Burns(Thermal injury): Degree of burns

Introduction:

• It is defined as tissue injury due to application of heat in any form to the external or internal body surfaces.
• Section 324 & 326 I.P.C. specifies any ‘hurt’ or ‘grievous hurt’ which  is caused by ‘fire or any heated substance’ or ‘corrosive’ or ‘explosive substance’ is  punishable more severely in comparison to unspecified means.
• Simple burns are caused by application  of dry heat. The  minimum  temperature  for  producing  a burn  is  about  44⁰ C for  an exposure  of  about  5-6 hours. 
• At  65⁰C,  two  seconds  are  sufficient to  produce  burns, and  full  thickness  destruction  of skin  occurs  within  seconds  above  70⁰  C.

Classification & Degree of Burns:-

Dupuytren  classified  burns  into  six  degrees,  which  can  be  merged  into  three  degree  by Wilson.

(A)  Wilson’s Classification (merged) : can be categorized into 3 types depending upon body layer involved.

1)    Epidermal: (first-and  second-degree  dupuytren)

• The  affected  part is  erythematous  (red) and blister formation,  there  is  capillary dilatation  and  transudation  of fluid  into  the  tissue  causing swelling.
• Repair  is  complete  without  scar  formation.  These  are painful  burns’.

 2)    Dermo epidermal : (third  and  fourth  degrees  dupultren)

•   Whole thickness  of  skin is  destroyed  with  destruction  of  dermal  appendages.
•  These  burns  appear  as  shriveled, depressed  areas of coagulated  tissue,  bordered by  reddish  blistered skin.
•   Pain  and  shock  are  greater  than  in  first-degree  burns.

 3)    Deep: (fifth  and  sixth  degrees) 

•  When deeper tissues below skin are involved viz. subcutaneous tissues, muscles   and bones etc.
• These are relatively less painful owing to destruction of nerve endings and  heal with scar and contracture formation.
• Disfigurement and loss of function chiefly when near a joint.

(B) Degree of burns  (Dupuytren):

Degree I:

• when low degree heat is applied for very short duration, there occurs an erythema or redness over area of contact and is painful.
• The covering superficial layer of epidermis may get devitalized and sheds off in few days.

Degree II:

• The epidermis is affected completely.
• Blister formation(subepidermal) which contain serous fluid  which is rich in protein and chloride.
• Very painful may produce hypovolumic shock. heal in 1-3 weeks, may rupture & get infected.

Degree III

• Epidermis is completely destroyed with involvement of dermis, blister formation with red line.
• Ulcerate and may get infected, extremely painful. They heal with formation of scar.

Degree IV

• Whole thickness of skin is involved.
• not much painful owing to destruction of nerve ending.
• followed by sloughing after some days.

DegreeV

• Depth of lesion extends further and subcutaneous tissue is involved.
• less painful owing to total destruction of sensory nerve endings.
• Heal with deep scarring, produce contractures and when close to a joint.

Degree VI

• In this muscles and bone are also involved.
• There occurs charring of  the limb and heal with much difficulty with contracture formation.

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