First vs Second vs Third Degree Burns
A burn is an injury to the flesh caused by heat energy due to electricity, open flame, chemicals, radiation or friction. Most of the time only the two layers of the skin are involved, but on occasions, muscle, nerves and soft tissues are also involved. Burns can be treated with first aid, but need to be followed up depending on the extent and the depth of the burn area. Burns may be just a small injury or an extensive debility, causing many physiological and psychological problems. The differences of the 1st, 2nd and 3rd degree burns will be discussed in the context of source of the burn, features of the burn and management strategy.
First Degree Burn
A first degree burn involves the epidermis of the skin, and there is erythema on the exposed tissues with pain, tenderness, mild swelling and dryness over the tissues. Healing takes only about one week or so. These types of burns are without complications.
Second Degree Burn
A second degree burn involves the dermis of the skin, which contains the connective tissues, vessels, and nerves. This type of burn can be divided into two categories; superficial partial thickness and deep partial thickness. The superficial partial thickness, which extends up to papillary dermis with clear blister formation on top, and blanching tissues on pressure. The textures of these burns are usually moist, and cause pain. These heal by 3 weeks duration, and it is complicated by local infection and cellulitis. The next category is the deep partial thickness burn type, which envelops the whole of the dermis up to reticular layer, where there is blood filled blisters; they also cause a lesser amount of pain. The surface of these tissues is moist, and causes some degree of pain. For the healing process it takes over 3 weeks. It may be complicated with scarring and contracture formation, which might require excision and grafting.
Third Degree Burn
A third degree burn involves the whole of the dermis, which gives the exposed areas a dry leathery appearance. There is no pain due to the cauterization of the free nerve ending receptors. This definitely requires excision and reconstructive surgery with skin grafting, and is complicated with contractures and amputations.
What is the difference between First and Second and Third Degree Burns?
These variant burn types gradually increase in complications, also the depth of the burn involved. All the burns are painful, except for the third degree burns. The first degree burns do not require any surgery as it heals with no scarring by 1 weeks duration. The second degree burns form scarring, unless properly removed, and the third degree requires a skin graft. The first aid management is common to all burn injuries, and management with analgesics when there is pain. Due to the exposed areas of the body, and the vasodilatation and fluid loss, resuscitation with the appropriate type of fluid is very important. The exposure of the tissues allow for inoculation of the organism like clostridia, which can be countered by tetanus toxoid. Also depending on the extent, feeding has to be started as soon as possible to correct the nitrogen balance.
Thus, the initial management is common, and what only differs is the depth, and is associated variations due to the anatomy involved. The depth is not the only determinant of the severity, but also the extent of the burn (surface area).
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