Third Degree Burns

A third degree burn, also called a full thickness burn, is a burn that has penetrated the epidermis and dermis and extended into the subcutaneous fat of the hypodermis. Third degree burns are usually the result of large fires (forest or house fires), certain chemicals (hydrochloric acid), or high-voltage electrical burns (down power lines).

Symptoms

Coloration: Third degree burns destroy the upper layers of skin, including the layers where a majority of the skin’s blood vessels are found. As a result, third degree burns do not appear red like first or second degree burns do.  Instead, third degree burns turn white or brown in appearance. The lack of blood supply in the surface area also means that third degree burns will not exhibit signs of blanching.

No pain: Along with the destroying blood vessels, third degree burns destroy the nerve endings in the affected area. As a result, the nerve endings cannot transmit any signals to the brain, so there is little to no pain at the sight of the burn. In some cases, third degree burns may come in conjunction with second degree burns in the surrounding tissue. If this is the case, the victim may experience an absence of pain in localized regions but still suffer severe pain on the whole.

Dryness: The site of third degree burns will also be dry. The body’s natural defense mechanism of sending fluid to the injured area becomes impaired because of the destruction of the dermis. Additionally, glands within the skin are injured or destroyed and cannot produce natural oils.

Leathery texture: In addition to removing moisture from the burn area, third degree burns damage the collagen in the surrounding area. Collagen is the main structural component in the skin’s connective tissue. The destruction of collagen breaks down the skin’s ability to hold its shape and gives the remaining skin a leathery texture.

Complications

While all burns have the potential of causing other medical complications, third degree burns (or higher) have a heightened probability of serious medical complications. It is often the complications of third degree burns that are fatal instead of the burns themselves. Understanding these complications is an important aspect of properly treating victims of third degree burns.

Breathing: When third degree burns are the result of a fire, it is likely that the victim is exposed to smoke. Smoke inhalation is the leading cause of inhalation injuries and greatly increases the mortality rates among burn victims. Irritants may cause swelling or blockages in the airways leading to asphyxiation.

Hypovolemia: Blood vessels in the vicinity of third degree burns are typically severely damaged. If they are not cauterized by the burn, damaged blood vessels lead to loss of blood volume in the body—hypovolemia. This in turn puts the victim into a state of shock which increases heart and breathing rates. Severe hypovolemia can lead to unconsciousness or death.

Hyper/Hypothermia: The skin is the primary organ used in maintaining a consistent body temperature. The destruction of skin from third degree burns places the victim at a heightened risk of developing hyperthermia, a dangerously high body temperature, or hypothermia, a dangerously low body temperature. Either condition leads to confusion and impairs the victim’s decision making capabilities. Extreme cases are fatal.

Sepsis: The skin is also the primary organ for preventing infections from entering the body. Sepsis is a whole-body inflammation caused by severe infection. Infection can damage vital organs and induce fevers or shock.

Treatment

All third degree burns should be assessed and treated by medical professionals. The absence of pain makes self-treatment especially dangerous since the victim is unable to feel the affected areas. There are a few steps that one can take to begin the treatment process before medical attention arrives. If you are assisting a third-party, ensure your own safety before beginning to assist others.

Remove the victim from the source of the burn, but limit the removal of any burned clothing. Clothing may have become seared into the victims flesh and removal could lead to tissue damage or bleeding, leading to hypovolemia.

Check the victim’s vital signs. Third degree burns are often accompanied by complicating factors which can cause a loss of circulation, such as smoke inhalation. Signs to look for include breathing, coughing, or movement. If the victim is not exhibiting signs of circulation, begin CPR.

If possible, have the victim drink fluids to compensate for fluid loss. Cover any exposed burn areas with a cool, clean bandage or cloth. Dampening the bandage in cool water is fine, but avoid cold water as temperature extremes are likely to put the victim into hypothermia or shock.

Take steps to avoid shock. Place the victim in the shock position—lying on his back with his legs raised about 12 inches. The shock position creates optimal blood flow to the internal organs and reduces blood flow to the site of the burn (provided the burn is on an extremity.) If any wound is causing blood loss, apply pressure and raise the injury above the heart to slow the rate of blood loss.

Above all, seek medical attention as soon as possible.

Skin Grafts

Skin grafts are used to help third degree burns heal because the underlying tissue is too damaged for skin to regenerate on its own. Surgeons remove healthy skin from another source and attach it to the wounded area. Healing can take a long time and is very painful. Current skin grafting methods leave scarring, but medical researchers are developing methods that may be able to prevent scarring in the future.

There are three predominant sources that surgeons use to obtain healthy skin. Xenografts use skin taken from animals. The body rejects xenografts within 3-5 days because of the difference in the make-up of human and animal skin. Xenografts used to provide immediate, short-term protection of damaged areas.

The second method is to use use skin taken from a human other than the patient—usually a cadaver. These are called Allografts and are also rejected by the body because of biological differences between the patient’s body and the source. Allografts last slightly longer than zenografts and can take up to 10 days before they are rejected.

Long term skin grafts come from healthy areas on the patient’s body and are called autografts. There are potential downsides to autografts as well. First, to be viable the patient must have sufficient healthy skin on other locations of their body. Burn victims who suffer burns covering substantial percentages of their body, as in 70% or more, may not have enough accessible healthy skin to create a skin graft of sufficient size to cover their burns. Second, surgically removing skin from healthy areas creates additional injuries that the victim must recover from. The body must now try to recover from the initial burn plus the surgery. This can lead to extended recovery times and discomfort for years to come.

Sources

Center for Disease Control and Prevention

Diagnostic and Clinical Care Services

Mayo Clinic

U.S. Fire Administration

University of Maryland Medical Center

University of New Mexico Hospitals