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CHAPTER OBJECTIVES

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At the end of this chapter, the learner will be able to:

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  1. Classify burn wounds according to the depth of tissue injury using the American Burn Association terminology.

  2. Estimate the percentage of total body surface area of a burn using the “rule of nines.”

  3. Appreciate the different mechanisms of burn injuries.

  4. Recognize the critical aspects of the initially evaluation and assessment of a burn injury.

  5. Be able to estimate the fluid and caloric requirements of a burn patient.

  6. Understand the different nonsurgical and surgical treatment modalities for burns and identify when surgical treatment is required.

  7. Distinguish the discrete complications that can occur after a burn injury and how they are managed.

  8. Be conscious of the major physical and psychological objectives of rehabilitation in a burn patient.

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INTRODUCTION

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Epidemiology

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The World Health Organization estimates that almost 2,00,000 deaths annually are attributed to burns, and the vast majority of burn morbidity worldwide is related to nonfatal burn injuries.1 In the United States alone over 45,000 patients each year require hospitalization for burns,2 creating a significant burden for the health care system. Over 90% of the burn injuries are deemed preventable occurrences. Mortality has significantly decreased with the development of regional burn units, establishment of multidisciplinary treatment teams, and improved critical care strategies focused on optimizing resuscitation and nutrition. The American Burn Association reports the current survival rates are greater than 96%.2 With increasing survival of this patient population, greater emphasis has been placed on long-term rehabilitation geared at restoration of function and activities of daily living, correction of esthetic deformities, and improvement of the psychosocial well-being.

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Pathophysiology

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Thermal injury to the skin is the result of the direct energy to the tissue in relation to temperature and contact time. Transfer of heat to cellular structures of the skin results in denaturation of proteins, vaporization of water, and thrombosis of cutaneous blood vessels, thus resulting in tissue and cell death. This process may be immediate in the case of high temperature and/or prolong contact time, but may also be potentiated by the patient’s premorbid condition, injury status, and local inflammatory factors.

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Zones of Injury

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In 1953, Douglas M. Jackson published a classic article in the British Journal of Surgery describing three histological zones of dermal burn injury. These “zones of injury” have been adapted by burn literature and are still applied today (FIGURE 10-1).3

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Figure 10-1

Jackson’s Concentric Zones of burn tissue Jackson’s burn theory classifies three concentric zones in relation to the potential viability of the tissue. These regions from the center of the wound to the periphery were labeled as the zone of coagulation, zone stasis and the zone of hyperemia. The center zone of coagulation is the area of maximum contact to the thermal ...

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