Third Degree Burn Injury

A third degree burn is the most severe of the burn injury classifications. It is known as a full thickness burn A third degree burn is so deep it completely destroys the epidermis and dermis, and then the damage can extend into the fatty tissue, ligaments, tendons, muscles, and bones. These burns can also destroy hair follicles and sweat glands. The road back from a third degree burn can be slow and painful. It requires a great amount of tenacity and strength of character to recover completely from a third degree burn.

Third Degree Burn Overview

Incredible as it sounds, third degree burns are not as painful as second degree burns because the injury has destroyed the nerve endings. There is swelling and blistering, caused by the loss of fluid from damaged blood vessels. Severe fluid loss can cause shock. Blood transfusions may be needed. When the burn covers more than 20% of the body, fluid resuscitation is done by intravenous drip. Fluid resuscitation is required during the first 24 hours. Patients who do not receive fluid resuscitation essentially die.

In the second 24 hours, the burn wounds will be cleaned, the dead skin will be removed by a process called debridement (scrubbing), and the dressing will be changed at regular intervals. The debridement process will continue until they get down to an area that starts bleeding. They then take steps to stop the bleeding. All of the dead skin needs to be removed because dead skin is a great place for bacteria to live. It always causes infection if not thoroughly removed.

Once the dead skin is completely cleaned from the wound, new skin may start to form in some areas and skin grafting treatment will begin where needed. Skin will be removed from an undamaged part of the body. The grafts may be put through a machine to expand the piece of skin. When this is done it leaves a permanent mesh design in the grafted skin.

Any grafted skin or skin that grows over the wound will be thinner than normal skin. That is because it is only epidermis cells. The dermis does not regenerate. The thinner skin will continue to cause complications and inconveniences for life.

  • Dryness will be a problem, due to the permanent damage to oil glands.
  • The thinner skin will be prone to eczema because if exposed to any irritating agent, it will break down and become scaly.
  • The skin is hot and cold intolerant. Any extreme temperature is uncomfortable for the thin skin, sometimes even painful.
  • The burned area is prone to wrinkles. It is parchment thin, dry, and lacks the elasticity of the dermis layer.

Stages of Healing

The first phase of healing is where you have an open wound that gets new skin on it or grafted over it. As soon as the graft takes and the skin is pink, that is the end of the first stage of healing.

The second stage of healing is where the body tries to make scar tissue. Then over a period of time those chemical signals that tell the body to make scars decrease and the tissue gets soft and pliable. This stage can last from 6 months to 3 years depending upon the individual.

Complications

Here are some of the complications following a third degree burn:

  • After a major burn injury, heart rate and blood pressure may increase. This is due to the chemical reaction in the tissue and the massive fluid shift in the body. They should return to normal after 24 hours.
  • Infection is another major complication of burns. It is because the integrity of the immune system has been broken down with major sections of skin missing. The skin barrier is replaced by eschar. Eschar is a moist, protein-rich substance that does not have a blood supply and promotes microbial growth.
  • Burn wounds are susceptible to tetanus. A booster shot is required if the victim has not had a tetanus shot in the last 5 years.
  • When burns completely encompass an extremity, circulation may be compromised. The limb(s) should be elevated to prevent swelling.
  • In a severe third degree burn, the damaged muscles and red blood cells can release myoglobin and hemoglobin that can lead to kidney failure. This is also a side effect if fluid resuscitation has not been achieved.

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