Burn and wound classifications

Major burns can present a substantial physical assault to the body, affecting multiple organ systems. Burn patients may require resuscitation, hemodynamic stabilization, oxygen support, nutritional support, protection against infection, and extensive wound care. The attentions of a dedicated burn team may be necessary to provide the services and support required to manage the physiological, social, and psychological needs of a seriously burned individual.

The average hospital stay for patients admitted for burns is 24 days, although the most severely burned patients may require several months of hospital intervention. Survivors of extensive burns will require rehabilitation periods up to seven times the length of their hospitalization. Over the last ten years, improvements in burn wound care and the pressures of DRG systems in various European countries have resulted in reductions in the average hospital stays for burn patients.

The traditional classification for burns (first to fourth degree) has been superseded by classification as partial-thickness, full-thickness, and complete burn wounds.

Old and New Classification Systems for Burns

Source: MedMarket Diligence, LLC; Report #S247.

Burns classified under the old system as first degree are not included in the current classification system unless they include injury to greater than 30% of the total body surface (TBS). These wounds are fiery red, very painful, not blistered and can be expected to heal uneventfully in three to five days.

Partial-thickness burns, formerly second degree, extend through the epidermis and may penetrate into the dermis. Partial-thickness wounds will heal by regeneration and should regain full function and appearance.

Full-thickness (third degree) burns penetrate the dermis and may involve subcutaneous tissue. Skin appendages such as hair follicles, sebaceous glands, and sweat glands are destroyed and healing will occur through scar formation and re-epithelialization from the wound borders, or grafting if the wound is extensive. In addition to visible effects, scarring leads to permanently compromised performance of the skin and articulation of the surrounding tissue. The scarred skin is inelastic and the underlying metabolism is compromised by the surface changes. Often, badly scarred tissue needs to be resected and re-engineered by transplantation to reverse these adverse effects. This takes time, is costly, and very traumatic to the patient.

A number of types of burns are referred to burn centers, including partial-thickness burns exceeding 20% of body surface area and full-thickness burns exceeding 10% of body surface area in the adult, along with burns involving the face, hands, feet, perianal area, genitalia, or joints; also circumferential burns of an extremity or chest wall, chemical burns, electrical burns, inhalation burns, and burns complicated with another major injury.

Complete burns (fourth degree burns) extend into the subcutaneous tissue to include muscle, fascia or bone. A complete burn may initially resemble a full-thickness burn and caution must be exercised to confirm the burn severity. Complete burns may generate systemic toxic reactions or rapidly lead to infection or sepsis. Between 44 degrees and 51 degrees Celsius, the rate of cellular destruction doubles with each degree increase in temperature. Above 51 degrees C, brief exposure produces rapid tissue destruction; whereas at 70 degrees C and above a one-second exposure causes full-thickness burns. Burns may also be induced by electricshock, radiation, or toxic chemicals.

Burn wounds, by comparison to other types of wounds, are not growing at a high rate. Wounds that are growing in number at a faster rate are those driven by increasing complexity of surgical procedures that are expanding the caseload (i.e., surgical wounds), cancer related wounds, and wounds like ulcers that are driven in part to an aging demographic and in part to increasing prevalence of diabetes.

Worldwide Wound Prevalence by Etiology

Source: MedMarket Diligence, LLC; Report #S247.

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