Overview
Clinical Meaning
Burns are classified by depth affecting skin layers and total body surface area (TBSA) involved.
Burns are classified by depth affecting skin layers and total body surface area (TBSA) involved. Superficial (first-degree) burns affect the epidermis only, presenting with erythema and pain without blisters (sunburn). Partial-thickness (second-degree) burns extend into the dermis: superficial partial-thickness involves papillary dermis with painful, moist, pink wounds with intact blisters; deep partial-thickness involves reticular dermis with decreased sensation and dry, pale appearance. Full-thickness (third-degree) burns destroy the entire dermis and may extend into subcutaneous tissue, presenting as painless, leathery, white, brown, or charred tissue. The Rule of Nines estimates TBSA in adults: each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%. Jackson's burn model describes three zones: zone of coagulation (irreversible necrosis), zone of stasis (potentially salvageable), and zone of hyperemia (will recover). Fluid resuscitation using the Parkland formula (4 mL × kg × %TBSA) is critical for burns > 20% TBSA to prevent burn shock.
