 | Janet M. Cusick RN, MS has been involved in burn care and education since 1977, working as a staff nurse and outreach education coordinator in two regional burn centers. In 1987, she became the first woman to be hired as a full-time firefighter / EMT-D with the Lincoln (NE) Fire Department where she worked for three years. Her primary role as Burn Outreach Education Coordinator for Via Christi Burn Center involves developing, implementing, presenting, and coordinating all aspects of outreach education relating to the care and prevention of burns. Highlights of her accomplishments include frequent invitations to speak at local, regional, national, and international burn and fire conferences. She has had the opportunity to be involved in international burn education teaching in Hong Kong, Trinidad, and Newfoundland. In 1996, she was awarded the American Burn Association Burn Prevention Award, was the chair of the ABA Burn Prevention Committee from 1997 to 2001 and is a member of the editorial board of the Journal of Burn Care and Rehabilitation. Janet has been an instructor and national faculty for the Advanced Burn Life Support and Pre-hospital Burn Life Support courses for many years. She can be reached by e-mail at the Burn Outreach Education Office at: janet_cusick@viachristi.org or by phone at (316) 268-5292. |
Health & Medicine
2002-04-01 11:59:00
Third degree burns
Question: What happens to the body and skin with a third degree burn on a small area of the body? What should one watch for during its healing?
Answer: A simple definition for a burn is "damage to the skin and underlying tissue caused by heat, chemicals, or electricity"--- a very simple description of an extremely complex injury that effects every major organ system of the body. The person with burn injuries must overcome both physical and emotional obstacles during what typically is a long road to recovery. Fortunately, almost every burn survivor is able to return to his or her home, family, work, school, leisure activities, and enjoy an excellent quality of life.The depth of burn is determined primarily by two different factors.First, the temperature to which the skin is exposed--the hotter the burning agent, the deeper the burn. The patient, family, rescuers, or health care providers have no control over this factor. The second factor--the duration the burning agent is in contact with the skin--can be controlled. If the person immediately moves away from the heat source, removes any smoldering clothing, jewelry or metal, and cools the burn for three to five minutes, the duration of contact is shortened and the burning process (and tissue destruction) ceases.To understand depth of burn, a person must have a basic knowledge of skin anatomy. The skin is divided into two layers, the epidermis and dermis. The epidermis is the thin outer layer. The dermis is the deeper, thicker layer. Under these layers lie the fat, muscle and bone. Partial thickness burns include first- and second-degree burns. Because the epidermis will regenerate, partial thickness burns will heal without surgical intervention. Full thickness burns, also known as third-degree burns, destroy both the epidermis and dermis including the cells necessary to grow new skin. Full thickness burns may appear charred, whitish, gray or leathery. Because the nerve endings have been destroyed, the person with deep burns may not have feeling or sensation in those areas. Full thickness burns will require surgical removal of the dead tissue and skin grafting for those areas to heal.Although there are many new products and techniques available to burn centers that facilitate healing, the "Gold Standard" for the healing of full thickness burns is autografting, which is transplantation of the person's own unburned or healed skin onto the area of full thickness burn.The person is taken to the operating room where all the dead tissue is surgically removed. Skin is taken from an unburned or healed part of the person's own body and grafted or transplanted to the clean burn area. In seven to fourteen days, this grafted skin adheres and becomes the person's permanent skin. The donor site (the place from which the skin was harvested) is treated like a partial thickness burn and heals in 10 to 14 days.Small, half-dollar-size, full thickness burns may eventually heal without surgical intervention. Because both layers of the skin have been destroyed, the healing process will take many weeks, leading to an increased risk of infection because the area is open for a long period of time. The area is more prone to develop scarring, limiting motion and function of the affected area, especially if the burn is over a joint. Cosmetically, the slow healing may lead to a less attractive appearance in that area. All full thickness burns should be seen by a burn care physician.Deep partial thickness burns that heal slowly and full thickness burns that require grafting will have permanent scarring to varying degrees. How much a person scars depends on many factors including genetics, heredity, the area burned, infection, and the rate of healing. Donor sites may also leave minor scars.
