DR ALI MUJTABA RESIDENT BURN & RECONSTRUCTIVE SURGERY PIMS, ISLAMABAD

1. CLASSIFICATION OF BURNS
DR ALI MUJTABA
RESIDENT BURN & RECONSTRUCTIVE SURGERY
PIMS, ISLAMABAD

2. DEFINITION
Injury to the tissues of the body caused by heat,
chemicals, electric current, or radiation.

3. • Human skin can tolerate temperatures up to 42-440 C
(107-1110 F) but above these, the higher the temperature
the more severe the tissue destruction
• Below 450 C (1130 F), resulting changes are reversible
but >450 C, protein damage exceeds the capacity of the
cell to repair

4. • About 2.4 million people suffer burns annually
• Account for an estimated 700,000 cases visits per
year and 45,000 require hospitalization
• Between 8,000-12,000 burn patients die, and
approximately one million will sustain substantial
or permanent disabilities
INCIDENCE

5. ETIOLOGY
• Thermal injury
• Electrical injury
• Chemical burns—acid/alkali
• Cold injury—frost bite
• Ionising radiation
• Sun burns

6. CLASSIFICATION OF BURNS
1. Classification of burns by causative agents
2. Classification according to the depth of tissue destruction
3. Classification according to the extent of body surface area
injured

7. CLASSIFICATION OF BURNS BY CAUSATIVE
AGENTS
Thermal Burns
• It is the most common type of burn
• Caused by:
1. Flame
2. Flash
3. Scald
A. Immersion
B. Spill Over
4.Contact with hot objects

8. Chemical Burns
• Result from tissue injury and destruction from
necrotizing substances (chemicals)
• Caused by both Acid and Base
Chemical (Acid) Burns

9. ELECTRICAL BURNS
• Intense heat generated from an electrical current
• May result from direct damage to nerves and vessels
causing tissue anoxia and death
• Severity of injury depends on the amount of voltage,
tissue resistance, current pathways, surface area, and
on the length of time of the flow

10. COLD INJURY (FROSTBITE)
• Usually affects fingers, toes, nose, and ears
• Numbness, pallor, severe pain, swelling, edema
• Result from prolonged exposure to freezing
or subfreezing temperatures.

11. CLASSIFICATION ACCORDING TO THE DEPTH
OF TISSUE DESTRUCTION
1. Superficial
2. Partial thickness
Superficial partial thickness
Deep partial thickness
3. Full thickness

12. 1.Superficial Burns
(first degree burn):
• Involves epidermis
• UV rays, Sun burn, minor flash injury, mild
radiation.
• Skin color pink/bright red

13. 2. Superficial partial-thickness
(Second degree burn):
• In a superficial partial-thickness burn, the epidermis is
destroyed or injured and a portion of the dermis may be
injured.
• The damaged skin is painful and appear red and dry, as in
sunburn, or it may blister (very minimal).
• Healing in 3-7 days

14. 2. Deep partial-thickness injuries (second
degree burn):
• A deep partial-thickness burn involves destruction
of the epidermis and upper layers of the dermis and
injury to deeper portions of the dermis.
• The wound is painful, Large blisters over an
extensive area, appears red, and exudes fluid.
• Capillary refill follows tissue blanching. Hair
follicles remain intact.
• Healing in 2-3 weeks
• Result in hypertrophic scars.

15. 3. Full-thickness injuries (third degree burn):
• A full-thickness burn involves total destructionof
epidermis and dermis and, in some cases, underlying
tissue as well.
• The burned area is painless ,because nerve fibers are
destroyed.
• The wound appears leathery; hair follicles and sweat
glands are destroyed

16. Typical Characteristics for Full-thickness burn
• Deep, red, black, white, yellow, or brown area
• Edema
• Tissue open with fat exposed
• Little to no pain
• Requires removal of eschar and skin grafting
• Scarring and contractures are likely
• Takes weeks to months to heal

18. CLASSIFICATION ACCORDING TO THE EXTENT
OF BODY SURFACE AREAINJURED
• Various methods are used to estimate the TBSA (total body
surface area) affectedby burns; among them are:
1. Rule of nines.
2. Lund and Browder method
3. Palm method.

19. RULE OF NINES

20. LUND AND BROWDER METHOD

21. PALM METHOD
• In patients with scattered burns, a method to estimate the
percentage of burn is the palm method.

22. CRITERIA FOR CLASSIFYING THE EXTENT OF BURN
INJURY(AMERICAN BURNASSOCIATION)
1. Minor Burn Injury
• Second-degree burn of less than 15% TBSA in adults or less than 10%
TBSA in children.
• Third-degree burn of less than 2% TBSA not involving special care
areas (eyes, ears, face, hands, feet, perineum, joints)
• Excludes electrical injury, inhalation injury, concurrent trauma, all
poor-risk patients (eg, extremes of age, concurrent disease)

23. Moderate, Uncomplicated Burn Injury
• Second-degree burns of 15%–25% TBSA in adults or 10%–20% in
children.
• Third-degree burns of less than 10% TBSA not involving special care
areas.
• Excludes electrical injury, inhalation injury, concurrent trauma, all
poor-risk patients (eg, extremes of age, concurrent disease)

24. Major Burn Injury
• Second-degree burns exceeding 25% TBSA in adults or 20% in
children
• All third-degree burns exceeding 10% TBSA
• All burns involving eyes, ears, face, hands, feet, perineum,
joints
• All inhalation injury, electrical injury, concurrent trauma,
all poor-risk patients

25. Thank you