Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter III: Burn Injury

Depth of Injury

United States Department of Defense

The depth of thermal injury can be determined with certainty only by histologic examination. However, the clinical criteria in Table 1 will permit an initial, usually quite accurate differentia. (ion between second- and third- degree burns. The total percentage of skin surface involved in second-degree and third-degree burns is the primary concern during resuscitation. Differentiation between second-degree and third-degree burns is more important later in the postburn course as related to the duration of hypermetabolism, the anticipated functional result, and the ultimate need for autograft closure of the burn wound.

Table 1. - Diagnosis of depth of burns.

Those areas of thermal injury that are waxy-white, soft and pliable, yet nonpainful formerly were regarded as full-thickness injuries, but in actuality are deep, partial-thickness burns; they frequently heal without the need for grafting if protected from invasive infection by topical chemotherapy. Charring with thermal injury of subcutaneous and deeper tissues is infrequent, but may occur in the unconscious victim, in individuals trapped by burning debris or in a burning vehicle, or in individuals with high-voltage electric injury. Injuries of less than partial thickness, that is, first-degree burns (erythema of intact epidermis), are important only so far as patient comfort and vasomotor lability are concerned and are, with few exceptions, treated symptomatically without need for resuscitation.

The depth of thermal injury after a thermonuclear explosion is dependent upon the intensity and duration of the thermal pulse, but burns also may be sustained from ignition of clothing or burning debris. These burns do not differ from burns of other etiology except for the associated effects of ionizing radiation, which decrease survival for a given size burn.

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001

Health Care in Military Settings

This web version is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

Contact Us  ·  ·  Other Brookside Products