What does it mean to be burned?

This depends on the depth of the burn. Burns part way through the skin will heal within 2 – 3 weeks from the base upwards. Burns all the way through the skin will only heal from the periphery to the centre so healing time depends on the size of the burn and can take from 6 weeks to many months. This time can be shortened by having a skin graft.

Scarring, discolouration, disfigurement, itching and pain are the long term legacy of deep burns to the body. Many survivors will have the prospect of further skin grafting and skin releasing operations in future years to come. Other than the scarring and disfigurement, there may be ongoing pain, the skin may no longer be elastic, and the it may become very sensitive to the sun.

Superficial (or 1st Degree)

• burns only affect the outer layer of the skin (epidermis)
• redness and swelling seen with sharp burning pain but skin will recover naturally leaving no scarring within a week or so. This is like a bad sunburn.

Partial Thickness (or 2nd Degree)

• both the outer layer (epidermis) and the deeper layer (dermis) are affected by the burn
• blistering, redness, swelling and severe pain felt; with treatment the skin can heal without skin grafts but may leave scarring if it takes longer than 2 weeks to heal.

Full Thickness (or 3rd Degree)

• both the layers of skin are totally destroyed and deeper tissue layers – muscles and even bone – can also be affected by the burn skin can appear white or charred black
• pain at the burn site is often reduced as the nerve endings can be completely destroyed but the surrounding burn area may be extremely painful where the burn is less deep
• surgery and skin grafts are usually necessary for healing and in some cases, survival

A skin graft can be partial thickness or full thickness. In partial thickness skin grafts, sheets of skin with the epidermis and a small amount of dermis are harvested using special machines called dermatomes. The donor sites heal from the base up (like a partial thickness burn) and can be re-used once healed. In a full thickness graft, the donor site can only heal from the periphery so is usually closed surgically. This limits the size of a full thickness graft that can be taken. The advantage of full thickness grafts is that the skin often retains its elasticity whereas partial thickness skin grafts often lose this if applied to wounds where all layers of the skin have been destroyed by the burn.

A simple way to work out the likelihood of dying from burns is to use this simple calculation: Age of patient + percent of body surface area burned. The lower the result the better but high numbers equate to poor prognosis. This calculation is less relevant for children and young adults.