Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter III: Burn Injury
Depth of Injury
United States Department of Defense
The depth of thermal injury can be determined with certainty only by histologic examination. However, the clinical criteria in Table 1 will permit an initial, usually quite accurate differentia. (ion between second- and third- degree burns. The total percentage of skin surface involved in second-degree and third-degree burns is the primary concern during resuscitation. Differentiation between second-degree and third-degree burns is more important later in the postburn course as related to the duration of hypermetabolism, the anticipated functional result, and the ultimate need for autograft closure of the burn wound.
Table 1. - Diagnosis of depth of burns.
Criteria Second-degree Burns Third-degree Burns Cause Hot liquids, flashes of flame Flame, electricity, chemicals Color Pink or mottled red Dark brown or black charred, translucent with thrombosed superficial veins visible, pearly white ± Surface Vesicles or weeping Dry and inelastic Pinprick Painful Anesthetic Those areas of thermal injury that are waxy-white, soft and pliable, yet nonpainful formerly were regarded as full-thickness injuries, but in actuality are deep, partial-thickness burns; they frequently heal without the need for grafting if protected from invasive infection by topical chemotherapy. Charring with thermal injury of subcutaneous and deeper tissues is infrequent, but may occur in the unconscious victim, in individuals trapped by burning debris or in a burning vehicle, or in individuals with high-voltage electric injury. Injuries of less than partial thickness, that is, first-degree burns (erythema of intact epidermis), are important only so far as patient comfort and vasomotor lability are concerned and are, with few exceptions, treated symptomatically without need for resuscitation.
The depth of thermal injury after a thermonuclear explosion is dependent upon the intensity and duration of the thermal pulse, but burns also may be sustained from ignition of clothing or burning debris. These burns do not differ from burns of other etiology except for the associated effects of ionizing radiation, which decrease survival for a given size burn.