General Assessment of Burns

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Clinically, burns are assessed primarily according to the percentage of the body surface involved and the depth of the burns. The former is principally of use in predicting the likelihood of systemic complications and death (see later). The latter

Fig. 9.1. Estimating the surface area of the body burned (rule of nines).

determines how the wound will heal and whether skin grafting likely will be necessary. The extent of burns in adults is determined by the rule of nines910 (Figure 9.1). In infants the head accounts for 18% and each lower limb 13.5%.11

Burns are categorized by depth into first, second, and third degree. First- and second-degree burns are both partial thickness, whereas third-degree burns involve complete destruction of all skin appendages. The most superficial type of heat-related damage, erythema, usually resolves in a few days. Even extensive first-degree burns usually heal in 10 to 14 days with no scarring. They are accompanied by blistering and are very painful. Second-degree burns heal more slowly, are relatively painless, and heal with scarring if not treated. Third-degree burns are painless, heal by granulation tissue, and scar if left untreated.12 Occasionally, most often in black-skinned races, burns are complicated by keloid scar formation characterized by tumor-like growth extending beyond the original injury.

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