The healing process of a 3rd degree burn. Prevention of sunburn. Further treatment in children and adults

Third-degree burns are divided into two subgroups - third-degree "A" burns and third-degree "B" burns. Moreover, a burn of the third "A" degree is still referred to as superficial burns, and the third "B" degree is already a deep burn, the difference seems to be quite small, only a few millimeters, but it is, in fact, very significant - it's all about the germ skin layer. If the germ layer is damaged, the burn becomes deep by definition, which means that such a burn wound will not heal itself - skin restoration will be required here surgical methods is a complex and lengthy process. A 2nd degree burn can also be compared and understand the fundamental differences.

Symptoms when examining a 3rd degree burn

On examination, a third-degree burn can be identified by the bursting of the blisters. Superficial burns from the first to the third "A" degree are usually caused by hot liquids - this is water, tea, broths. With the third "A", pain sensitivity is still preserved in the burn area, because not all nerve endings die and this is also certain diagnostic sign. If pain is not felt when touching the wound, then there is a loss pain sensitivity- this is a sign of a deep burn - that is, the third "B" or already the fourth degree. Deep burns are caused by exposure to flames, hot metals, so when the clothes on the victim ignite, 95% of the burns can be deep. Chemical burns can also become deep, especially when high concentration acids or alkalis.

Deep burns, as a rule, are accompanied by the development of burn shock, the victims are excited, rush about in pain, poorly oriented in place and situation, try to escape, blood pressure first rises slightly, and with the development of shock, it begins to progressively decrease. In this case, excitation is replaced by prostration. For burn shock, thickening of the blood is especially characteristic, due to massive plasma loss.

If the fact of a burn is not difficult to establish, then it can be quite difficult to determine the depth and even the area of ​​the burn. The determination of the area is carried out according to the well-known rule of "nines" or according to the rule of "palms". When the blisters on the skin burst, against the background of fragments of the epidermis, the skin is pale with a clear relief (“pigskin”), hair on such skin is usually absent.

Third degree burn treatment

Emergency care for third-degree burns begins, as with other degrees, with the elimination of the damaging agent. That is, you need to bring down the flame and tear off the burning clothes, then proceed to adequate anesthesia. If compared with a 1st degree burn, then it immediately becomes clear that there are serious intentions in the treatment of this degree. This is very important point, since in the third degree of a burn, pain often serves as a triggering moment of burn shock. It is possible to perform anesthesia with narcotic analgesics and for these purposes, a 1% solution of morphine, a 2% solution of promedol or pantopon is used, if it is impossible to administer narcotic analgesics, any available ones can be used, but their effect is of course inferior. At the same time it is necessary to enter antihistamines(diphenhydramine, suprastin, tavegil), local burns can be treated with 33% alcohol and sterile bandages applied. The burn surface can be sprayed with a 0.5% solution of novocaine through a syringe needle for 5-19 minutes until the pain subsides. With extensive burns, as well as with the risk of developing burn shock for another prehospital stage need to start antishock therapy, which primarily consists in compensating for the lost liquid part of the blood, that is, the volume of circulating blood is corrected. The volume of fluid injected can be determined by adding two zeros to the burn area figure. To do this, you can use solutions of glucose, polyglucin, as well as solutions with anti-shock action - venofundin, gelofusin. In the presence of excitation, sedatives are prescribed - Seduxen, Relanium. With prolonged transportation, the administration of painkillers can be repeated as the effect decreases.

Such a serious injury as a 3rd degree burn is characterized by deep damage to the layers of the skin with the formation of areas of their necrosis. In addition to the skin, muscle tissue and even bone can also be affected.

In case of a 3rd degree burn, the victim must be hospitalized, because such an injury is considered very serious and requires qualified medical intervention.

ICD-10 code

T20-T32 Thermal and chemical burns

Epidemiology

According to various sources, 3rd degree burns can account for approximately 15% of total cases of burns.

In addition, there are a number of interesting statistics:

• the overall incidence of all burns among other injuries is approximately 6%;
• half of all diagnosed burns occur as a result of direct contact with a flame;
• 20% of the total number of burns occur due to exposure to boiling liquids or hot steam;
• 10% of the total number of burns are injuries caused by contact with hot objects;
• more than 70% of all burn injuries are injuries various parts hands;
• one out of every three burn victims is a child.

Causes of a 3rd degree burn

A 3rd degree burn can occur for a number of reasons:

• after exposure to high temperature;
• after exposure to aggressively irritating chemical liquids;
• under the influence of electric current;
• exposed to high doses of radiation.

Thermal burns can result from direct exposure to fire, boiling liquid or steam, or direct contact with hot objects.

The chemical type of burn is always caused by chemicals and concentrates containing acids or caustic alkali.

An electric burn can be obtained from exposure to current, after a short-term contact with conductive elements.

As they say, no one is safe from an accidental burn - you can get injured both at home (for example, in the kitchen) and at work.

The most common risk factors that can lead to a 3rd degree burn are:

• non-compliance with safety rules in the kitchen during cooking;
• non-compliance with the rules for storing chemical solutions, acids and caustic alkalis;
• disregard for safety regulations at work.

Pathogenesis

Exposure to a damaging factor leads to complete or partial destruction of cells and disruption of their functionality. In this case, the degree of damage may differ, depending on the duration of exposure, from temperature indicator, on the density of the skin at the site of the lesion, on the quality of tissue conductivity.

The wound surface with a 3rd degree burn usually represents a complete destruction of the epidermal layer, dermis and skin appendages. The affected area in most cases is dry, compacted, slightly painful, not prone to self-healing.

A significant role in the pathogenesis of burns is played by the inflammatory process that occurs in response to traumatic injury. On the initial stage vasoconstriction develops, which quickly passes to the stage of dilation. In tissues that have undergone a burn, vascular permeability is markedly increased. As a result of this process, the wound surface is quickly filled with proteins and serum elements, which visually manifests itself in the form of increasing edema.

Against the background of increased vascular permeability, neutrophils, platelets and monocytes accumulate in the wound, which cause the development of post-burn hypermetabolism.

3rd degree burn symptoms

A 3rd degree burn is divided into two variants of the course, depending on the pathogenetic and clinical features:

• Grade 3-a - characterized by damage not only to the epidermal layer, but also to a separate part hair follicles, sweat and sebaceous glands. Tissue necrosis occurs against the background of vascular damage and local edema. After a 3a degree burn, a crust of a grayish or brownish tint is formed, with the preliminary occurrence different sizes bubbles with liquid. Without medical care such a wound heals slowly and problematically.
• Degree 3-b - burn injury extends to all underlying tissues, including the subcutaneous fat layer. Visually noteworthy are bubbles of significant size containing fluid and blood elements. Such a burn is not always accompanied by pain, due to damage to pain receptors. It is pointless to count on self-healing of such a wound.

• Edema with a burn of the 3rd degree is a natural reaction of the body to a traumatic damaging effect, with a violation of the integrity of tissues and the vascular network. Edema itself is the result of accumulation of excess fluid in the skin layers - effusion of damaged blood vessels. Visually, edema with a 3rd degree burn looks like small tumor(swelling of the skin) with characteristic redness. Simultaneously with the increase in edema, an inflammatory reaction develops in the tissues, which does not allow the swollen structures to recover.
• The temperature with a 3rd degree burn may indicate the development of toxemia - pathological condition caused by intoxication of the body with residual products of protein decomposition and toxins that enter the bloodstream from damaged tissues. The main sign of such a state is considered to be precisely the increase in temperature - up to 38-39 ° C: at the same time, the higher the temperature, the less favorable the forecast should be considered. Toxemia in most cases is found in victims with burns of the 3rd degree, which occupy an area of ​​​​more than 5% of the skin surface.
• A 3rd degree facial burn always heals very hard, as damaged skin undergoes necrosis and is subsequently rejected. Due to the increased blood supply to the tissues on the face, there is a high probability of attachment purulent infection. In most cases, the temperature rises, the epithelialization processes are slow. If the area of ​​the nose or ears is damaged, then there is a danger of developing chondritis and necrosis facial bones. With burns of the face of the 3rd degree of any localization, scars are formed and tissues are deformed.
• A 3rd degree burn of the esophagus is considered very serious and poses a certain danger to the life of the victim. With such a burn, the patient shows anxiety, he groans, it is difficult for him to swallow not only food, but also his own saliva. The condition is often accompanied by shortness of breath, blanching of the skin, blue lips. If the burn is chemical (and this happens in the vast majority of patients with burns of the esophagus), then you can pay attention to damage to the mucosa oral cavity, tongue, corners of the mouth.
• A 3rd degree leg burn is always accompanied by swelling - and this is considered normal reaction organism to a burn injury, as in this case damaged not only the skin, but also the vessels and underlying tissues. Symptoms of a 3rd degree leg burn: dense watery blisters, scab formation, tissue death, sometimes suppuration of the wound surface. After treatment, cicatricial changes usually remain at the site of the burn.
• A 3rd degree burn of the hand is most often a lesion of the fingers, less often of the carpal zone. In the vast majority of cases, due to the small layer of subcutaneous and muscle tissue, the bones and joints of the fingers and hand may be affected. Such a burn, according to statistics, occurs most often.

3rd degree burn in children

In children, burn injuries of the 3rd degree occur no less than in adults. This is especially true for children under 3 years of age.

However, according to statistics, the severity of such injuries in childhood is always higher. The fact is that the skin of young patients is much softer and more sensitive than that of any adult, and the blood and lymph circulation system is very developed, and therefore conducts heat faster. Because of this, and also due to the fact that the child's compensatory and regulatory reactions are still imperfect, a 3rd degree burn almost always leads to the appearance of a burn disease.

Therefore, any burn injuries in childhood have more severe course, since complications such as circulatory failure, electrolyte and protein metabolism disorders develop very quickly in children, and the function of the main organs - the liver and kidneys - is also impaired.

Forms

Burns are classified into different kinds, depending on the nature of the damaging agent and the depth of the injury.

The damaging agent can be boiling water, fire, hot steam, chemical substances, electricity etc.

According to the depth of the burn injury, there are:

• superficial burns (1,2 and 3a degrees);
• deep burns (3b and 4 degrees).

A thermal burn of the 3rd degree is an injury received after contact with any heat carrier - both liquid or dense, and vaporous. The most commonly diagnosed burns are those resulting from contact with open sources fire; less common are burns with boiling water and electric current.

Burns with boiling water of the 3rd degree are less common than the first two degrees, since in most cases boiling water has time to cool on the body even before the lesion reaches deep tissues. However, cases of combined tissue damage are not uncommon, when the burn is a combination of several degrees. In such a situation, the doctor determines the condition of the victim, depending on what area the wound surface has in the deepest affected areas.

A third-degree chemical burn always heals much harder than similar burns resulting from thermal or electrical exposure. Rejection of dead tissues (scab, crust) begins only by the fourth week, and the wound itself heals extremely slowly, with the formation of dense deforming scars. Sensitivity is usually lost after a 3rd degree chemical burn.

A 3rd degree eye burn is not diagnosed so often: such an injury is possible in case of fires or if it hits the face chemical liquid or aerosol with aggressive filler. A burn can lead to a pronounced decrease in visual acuity (up to its complete loss). Also, cases of development of corneal leukoma, cicatricial deformity of the eyelids, increased intraocular pressure, atrophy of the affected organ of vision.

Complications and consequences

Possible complications after a 3rd degree burn can be divided into several groups:

• The development of a burn disease, which consists of several stages, namely:

1. a period of shock (lasts about 48 hours, sometimes up to 72 hours);
2. the period of toxemia (the entry of toxins into the bloodstream as a result of the decomposition of damaged tissues);
3. period of septicotoxemia (development of a purulent process);
4. recovery period(wound healing).

• Development endogenous intoxication associated with the accumulation of toxic substances as a result of disruption of the liver and kidneys.
• The development of sepsis and the infectious process, due to infection from outside and the formation of secondary immunodeficiency.

How long does a 3rd degree burn heal?

The healing period for a 3rd degree burn usually lasts from 6 weeks to 6 months, and for a 3b degree burn - up to 12 months. In most cases, the wound surface does not heal completely, since there are tissues that have undergone necrosis - such areas cannot heal on their own. In order to ensure complete healing, you should contact a surgeon who will transplant the skin from healthy areas to the burn surface.

Diagnosis of a 3rd degree burn

The diagnosis of a 3rd degree burn is usually not difficult: the doctor determines the area of ​​damage and depth (by assessing pain sensitivity). Usually than deeper burn the less pain sensitivity.

Sometimes, to clarify the diagnosis and appointment proper treatment, the doctor suggests the victim to take the following tests:

• blood on the degree of coagulation;
• blood for anemia;
• blood on the quality of electrolytic metabolism;
• urine for general analysis.

According to the data obtained as a result of examinations, one can judge the degree of intoxication, blood loss, as well as the work of the liver and kidneys.

Instrumental diagnostics is carried out only in the presence of internal damage. For example, with a burn of the esophagus, endoscopy may be prescribed.

Differential Diagnosis

Differential Diagnosis carried out between burn injuries of degrees 3a and 3b. By the way, such differentiation presents certain difficulties and is finally possible only after the process of rejection of dead tissues.

3rd degree burn treatment

Therapeutic measures for a 3rd degree burn should consist of a whole range of methods, the main goals of which will be:

• elimination of pain;
• anemia prevention;
• prevention of hypoxia;
• normalization of metabolic and equilibrium processes in the body;
• elimination of intoxication;
• prevention of violations by of cardio-vascular system;
• prevention of disorders of the liver and kidneys;
• stabilization of the energy potential of the body.

Treatment of 3rd degree burns in a hospital is mandatory - it can be a burn department or a center. The doctor, using anesthesia, treats the burn and evaluates its condition, while deciding how the treatment will be carried out - closed or open method.

Medicines for dressings are, in the vast majority of cases, antiseptics:

• Ethacridine lactate - used in the form of solutions of 1:2000, and if irritation occurs on the skin, you can use a solution of 1:1000. Sometimes it is allowed to use Etacridine in the form of powder on the wound.
• Furacilin - used for irrigation and wet dressings, in the form of an aqueous 0.02% solution. In some cases, the drug may cause allergies.
• Silver nitrate 0.5% is used for a short time, as the drug can cause a change in skin color (as a result of the accumulation of metallic silver).

In addition, treatment of the wound surface with infrared and UV rays is prescribed - this helps to prevent the development of wet necrosis, stop the course of a purulent infection and accelerate epithelization.

Ointments for burns of the 3rd degree begin to be used only after the exudation in the wound is completed. Usually prescribe such external drugs:

• Synthomycin 10% is applied directly to the wound, or under a bandage. Synthomycin is avoided infants as the drug may cause an allergic reaction.
• Furacilin ointment 10% is used under the bandage. Rarely, this ointment can provoke the development allergic dermatitis, but most often well accepted by the body.
• Gentamicin ointment - it is applied directly to the area of ​​the skin affected by the burn, 3-4 times a day. Continue treatment with ointment for 1-2 weeks, if there is no allergy to the drug.
• Levomekol - used to treat burns in adults and children, starting from 3 years of age. The ointment is not recommended for long-term use. It is advisable to change this drug to another after 5-7 days, in order to avoid the development of osmotic shock in healthy tissues.

In addition to ointments, for a 3rd degree burn, an aerosol with an antibiotic is used. Olazol is a drug based on sea ​​buckthorn oil, boric acid, benzocaine and chloramphenicol, which promotes wound healing. Olazol is applied daily or once every two days, depending on the degree of tissue damage and the stage of their recovery.

Ointments and other means for the treatment of burns should not irritate the wound surface - on the contrary, they should have a softening and analgesic action. Ointment dressings are replaced daily or every other day.

Systemic antibiotics for 3rd degree burns are prescribed only individually, and only in cases where the area of ​​damage is more than 10% of the total surface of the skin. Sometimes antibiotics are administered intramuscularly, and only in very severe cases- intravenously. Typically prescribed medication a wide range antibacterial activity:

• drugs of the cephalosporin group;
• penicillin preparations;
• sulbactam with cefoperazone;
• fluoroquinolone drugs.

When joining fungal infection prescribe levorin or diflucan, and with anaerobic infection - metronidazole.

Help with 3rd degree burns

The first aid rules for a probable 3rd degree burn are the following recommendations:

• The first step is to eliminate the source that provoked the burn: put out the fire, pour water over the affected area of ​​the body, remove burning items of clothing, etc.
• Clothes that have become attached to the body must not be forcibly removed!
• If the victim is unconscious, witnesses should be questioned about exactly how the injury occurred, and an ambulance should be called as soon as possible.
• It is recommended to substitute the affected limb under the flow cold water for 15 minutes.
• The surface of the burn should be covered with gauze or a bandage to avoid infection.
• Severely affected limbs are fixed with splints.
• With a large burn area, the victim should be given as much water as possible (tea, juice, etc.).
• In the presence of severe pain, you can give a person an analgesic (baralgin, ibuprofen, etc.).
• If the victim is unconscious, the need for artificial respiration should be assessed and indirect massage hearts.

vitamins

• Tocopherol is taken to prevent the formation of rough scars on the skin. Children are prescribed from 100 to 300 IU, and for adult patients - from 200 to 800 IU. The drug is taken throughout the entire period of treatment of the burn.
• Retinol is taken in order to facilitate the absorption of tocopherol, 25 thousand IU daily.
• Ascorbic acid will help prevent excessive nervousness and anxiety, increase immune defense and stimulates the healing process. The dose of ascorbic acid for a 3rd degree burn is 500-1000 mg daily.

Additionally, doctors advise taking multivitamin preparations with high content B vitamins (for example, Undevit). Regular use of brewer's yeast has a good stimulating and strengthening effect.

Physiotherapy treatment

Physiotherapy procedures for 3rd degree burns help relieve pain and stop development inflammatory process and also speed up skin regeneration.

• After the end of the acute period - approximately 3-4 days - to relieve pain, you can use the devices Lenar, Transair, El Esculap Medteco, which work according to the method of transcranial electrical stimulation.
• During the formation of the scab, the treatment of the wound surface with the Geska apparatus is used - 2 sessions per day, 25 minutes each, for 14-20 days in a row.
• During the period of active recovery and formation of granulations, use:

1. electrical stimulation (14-15 sessions);
2. franklinization (daily for a month);
3. ultraviolet therapy with the use of suberythemal doses (10-12 sessions, every other day);
4. low-frequency magnetotherapy (35 minutes daily, for 15 days);
5. permanent magnetotherapy with the use of elastomagnet sheets (15 five-hour procedures);
6. laser therapy(helium-neon, 20 daily sessions of 20 minutes).

• At the stage of formation of cicatricial changes appoint:

1. electrophoresis with lidase;
2. paraffin applications (temperature regime 50°C);
3. hydrocortisone by ultraphonophoresis (12 sessions).

Treatment of 3rd degree burns at home

A 3rd degree burn is a fairly serious injury that cannot be properly treated at home. Alternative treatment may be useful only as additional method along with traditional medical care.

In case of a burn, especially of the 3rd degree, special attention should be paid to the presence of vitamins E and C in the diet - they help stop the inflammatory reaction and restore injured tissue structures. In addition, ascorbic acid is actively involved in the formation of collagen fibers, which are the main components of scar tissue. Essential Vitamins are situated in fresh vegetables, berries, fruits and unrefined vegetable oils.

At the stage of healing of the wound surface, the juice of the aloe plant can help - it usually speeds up the regeneration processes and supports primary tension fabrics. The simplest recipe for using aloe is to drop a few drops from the thick part of the leaf onto the affected area of ​​the skin.

Some time after the burn, when acute period injuries will be left behind, you can apply compresses from freshly grated potatoes - for about 1-1.5 hours daily.

Accelerate the healing lotion of green tea - and it is known to be an excellent antioxidant. Lotions are moistened in a strong tea leaves and applied to the wound.

At the healing stage, you can use an ointment based on calendula. To prepare it, mix the pharmacy tincture of calendula and petroleum jelly in a ratio of 1 to 2.

Herbal treatment can only be used if it is approved by the attending physician. For example, often patients use such popular recipes:

• The leaves of black elderberry are poured over with boiling water and, after cooling, are applied to the affected area.
• 100 g of St. John's wort is boiled in 0.5 l vegetable oil(within half an hour), after which it is filtered and cooled. Used for application to burn wounds.
• A decoction is prepared from the rhizome of the galangal (for 1 tablespoon of the root - 250 ml of water). Used for lotions on the wound.
• Plantain leaves are doused with boiling water, cooled and applied to the burn injury site.

Homeopathy

Usually, when receiving lighter burns - for example, 2 degrees, but with the formation of bubbles with liquid - it is recommended to use Arnica 30, Aconite 30 and Cantharis 30, with an individually selected dosage.

With a 3rd degree burn, with severe tissue necrosis, stronger homeopathic remedies may be required:

if the victim is in a state of shock and does not complain of pain, then Opium 1m should be used;

for chemical burns with acid or alkali concentrates, Sulfuricum acidum 30 is recommended for use.

If the homeopathic doctor does not prescribe a different dosage, then you should take 2 tablets of the listed drugs every half hour, but not more than three times. Already within 2 hours the condition of the victim should improve. If the drugs have a greater dilution than 30 (for example, 6 or 12), then they are given every 15 minutes.

Surgical treatment

The most common operation after a 3rd degree burn is skin grafting, which consists of three consecutive procedures:

• removal of transplanted material (as a rule, skin from healthy areas of the patient is suitable);
• preparation of the wound surface (cleansing, washing isotonic saline, drying);
• direct transfer of material to the wound.

The transplant operation is carried out using general anesthesia. Skin grafts are fixed with a bandage or sutures, pre-perforated to improve survival. The average period of time for engraftment of transplanted skin is one week.

In addition to skin grafting, 3rd degree burns are sometimes used surgical interventions about the elimination of scars and skin deformation. Scars after a burn of the 3rd degree are excised, and skin deformities are replaced with a healthy material - a transplant.

Rehabilitation after 3rd degree burns

Rehabilitation measures after a burn injury of the 3rd degree are carried out after the relief of acute symptoms and prevention possible complications. The rehabilitation period implies the use of procedures and methods that contribute to the final healing of the wound and the restoration of the victim’s ability to fully move around and lead a normal life (or, according to at least, self-serve your needs).

Nonetheless, given period still accompanied by:

• metabolic disorders (eg, anemia and dysproteinemia);
• disorders of the heart and blood vessels (for example, low blood pressure);
• dysfunction respiratory system(difficulty breathing, shortness of breath);
• work disorder digestive system(lack of appetite, constipation);
• impaired renal function.

In addition to measures to prevent possible adverse effects and to accelerate the recovery of the body, procedures are carried out to prevent cicatricial changes in the skin.

Nutrition for 3rd degree burns

Immediately after receiving a 3rd degree burn, the patient is advised to follow a sparing diet, with the predominant use of dairy products, broths, freshly squeezed juices, and vegetable oil. After a few days, you should gradually increase the calorie content due to the regular use of carbohydrate foods - cereals, fruit purees, berry jellies. In case of violation of the water and electrolyte balance, as well as to accelerate the elimination of toxic substances from the body, it is recommended to drink enough liquids - mineral water, compotes, herbal teas, kissels, fruit drinks.

Forecast

With timely medical care, the prognosis of 3rd degree burns can be relatively favorable, but this depends on how deep and extensive the tissue damage was. A 3rd degree burn may be accompanied by a positive prognosis if the following measures were applied to the victim:

• quality first aid;
• surgery;
• physiotherapy procedures;
• rehabilitation methods and recommendations for further care of the damaged area.

If a 3rd degree burn had a relatively small size and was shallow, then the prognosis for it complete cure can be considered favorable.

After receiving a thermal injury, many are wondering how quickly and how the burn heals. The time it takes to fully restore the skin is individual. It depends on factors such as age, degree and area of ​​damage, the nature of the traumatic agent, the state of health of the victim. Thermal injuries are the most difficult to treat and lead to irreversible complications in children, elderly and debilitated patients. A child can die even with a small area of ​​\u200b\u200bdamage.

The burn heals in several stages. Their sequence is determined by the degree of thermal injury, the presence of purulent complications in the wound, the nature of the traumatic agent.

Burn degrees

In total, 4 degrees of burns are distinguished, which differ in the depth of the lesion:

Types of burns

The speed and sequence of stages of recovery depends on the type of traumatic impact.

Depending on this, burns are divided into the following types:

• thermal;
• chemical;
• radiation;
• electrical.

Solar and thermal burns from exposure to boiling water are usually superficial; heal pretty quickly. Chemical injuries often occur as a result of contact with animal poisons (jellyfish), plants (hogweed, nettle), household products. With short-term exposure, they are superficial, recovery is fast.

Healing thermal burns from hot objects (heated iron, battery, heater) will depend on the duration of contact and the affected area. Short-term exposure does not cause serious consequences and the burn goes away fairly quickly. Prolonged contact may lead to thermal injury fourth degree.

The most dangerous injuries are from exposure to open flames. Most often, these are burns of 3B and 4 degrees.

Without the help of qualified specialists, recovery will not come on its own. Healing occurs after surgical treatment.

Influence of burn area

The affected area plays a significant role in wound healing. The larger the wound surface, the higher the risk of developing a burn disease.. With her, except local manifestations on the skin, there is a lack of organ functions, a violation of the heart. Recovery is longer, more difficult, and in some cases, the injury is fatal.

The affected area is measured in several ways. One method is to use the victim's own palm. In adults, one palm corresponds to 1% of the body area. In children, special tables are used, which are also suitable for adults, depending on age.

How healing happens

First-degree burns heal fairly quickly. It may take 1 to 3 days. Redness, swelling subside. Peeling, pigmentation appears at the site of the burn wound, which after a while disappears on its own without a trace.

Burns of the 2nd degree can heal from 2 to 3 weeks, with small areas and without complications - up to 1 week. Under the bubble, if an autopsy has not occurred, a young pink skin. If the blister bursts, an infection is possible, then it will take more time.

With 3A degree burns, at the initial stage, a dark-colored scab or blister with hemorrhagic contents often forms on the skin. After some time (2-4 weeks), the scab exfoliates, and the bubble bursts, exposing the underlying layers of the epidermis. Islands of young skin appear in these areas, which gradually close the entire wound. Full recovery may take three weeks to two months.

3B and 4th degree burns do not heal on their own. On the initial stages a dense black scab appears in the wound area. After its rejection on the underlying tissues, if suppuration has not occurred, pink granulations begin to appear. This stage of healing will require a very long period, which can be up to several months..

After the appearance of juicy granulations, a person's own skin can be transplanted. At the next stage, either its engraftment or rejection is possible. In the latter case, you need reoperation. After restoration, rough scars form on the skin, disfiguring scars.

Very hard and take a long time to heal thermal damage severe degree in the joints. After all stages of recovery, they develop contractures that limit the mobility of the limbs.

When an infection is attached, the healing of any stage slows down. Therefore, treatment is carried out in specialized conditions. medical institutions with the use of antibacterial drugs.

As you know, any physical contact with high temperatures leads to burns varying degrees. It all depends on how long the contact was and in which particular area of ​​​​the body suffered as a result of an accident. Any burns (especially of the face) are accompanied by severe pain that spreads to adjacent areas from the affected area.

Chemically capable of damaging the skin and subsequent tissue balls active substances, incandescent solid materials, liquids or steam, as well as sunlight.

AT medical practice there is a special division of burns, this classification takes into account their severity, approximate dates treatment and rehabilitation. More about the type division:

• First degree - only the upper layer of the epithelium is broken, the scale of the injury is insignificant. Sometimes there is swelling and redness. The average full recovery period takes 3 to 7 days.
• The second degree - the occurrence of bubbles filled with liquid is permissible (it is strictly forbidden to pierce them). Pain sensation and general symptoms more pronounced than in the previous case. The recovery period varies from 2 to 3 weeks.
• Third degree - the integrity of all layers of the epithelium is violated, the entire area is covered with bubble formations of various sizes. Bruising and mucous masses are noticeable inside the swellings. Requires surgery and a carefully selected course of rehabilitation. This degree has an additional division into 3a degree burns and 3b degree burns. In the first case, the body is able to recover on its own, but in the second, it requires surgical intervention, a huge complex of local and internal preparations.
• Fourth degree - especially dangerous view thermal and chemical burns, is accompanied by complete destruction of the skin at the cellular level, while muscles and tendons are affected, as well as the joints of nerve fibers.

Characteristics of thermal damage of the third degree

A 3rd degree burn differs from previous types in the presence of subcutaneous hemorrhages and severe pain. In some cases, there are shock states, loss of consciousness and similar manifestations. Treatment of 3rd degree burns is quite lengthy and requires constant control by qualified professionals. The need to visit the hospital, due to the fact that the patient must receive professional assistance in the shift dressing material and consumption instructions oral medications(painkillers, anti-inflammatory and similar in clinical effects).

More detailed information on how to treat a 3rd degree burn is given below. It is very important to follow all first aid instructions (this will allow you to mitigate backfire and speed up the healing process.

If a person ignores any manifestations and does not seek help in time, intoxication of the body, extensive inflammation and other pathologies await him. In addition, deep cicatricial lesions, large scars and similar cosmetic defects are possible (the affected area will not look aesthetically pleasing - crumpled, flaky, erased).

First aid

Such injuries can be cured much faster with high-quality first aid. The first step is to stop the patient's contact with the focus of irritation. Burnt clothing can be removed only when it has not melted to the upper layers of the skin. A person should be given water (preferably warm) and several painkillers (ketanov, analgin and in extreme cases diphenhydramine).

In the presence of chemical damage wash the area cold water using soapy water. It is recommended to apply a dry dressing made of sterile tissue or a disinfected medical bandage.

When the sun's rays are the cause of the burn, try to take the patient to a living area (sheltered ultraviolet radiation). After that, apply on the injured area special local funds(panthenol, lifeguard, others).

After following all the above instructions, call an ambulance (especially if we are talking about 3 degrees of burns - type a or b). An appointment with a doctor will greatly increase your chances of a speedy recovery, so try to make an appointment as soon as possible.

Treatment

After delivering the victim medical institution he was given painkillers intramuscularly. After that, intravenous administration of antibacterial drugs is performed. If blood poisoning has begun, a transfusion is prescribed (full - all blood or separate - plasma and other elements). To restore the body, droppers with saline, glucose and other nutrients are placed.

At further stages of treatment, the patient is regularly changed dressings, treat the area of ​​damage and select a course of physiotherapy. In medical practice, cases were often recorded when the body was on the mend, and then inflammation began. In such situations, the doctor attributes surgery aimed at removing dead tissue and foci of infection.

Prevention

To avoid this kind of injury, try not to overheat in the sun. In addition, take special care in terms of physical contact with unknown liquids and substances. Follow all safety rules when working with hot objects. Be careful even at home, do not allow the possibility of contact with hot liquids or steam.

A third degree burn is deep damage tissue surfaces from thermal, chemical, electrical or radiation exposure, which affects not only the epidermis, but also the inner layers of the skin.

The degree, severity of the burn is assessed by doctors according to the area of ​​​​damage to the skin and the depth of the wound. Damage to the first and second stages have a small area of ​​damage and do not affect the deep layers of the skin. In the treatment of such injuries, the prognosis is positive, the wounds heal quickly, without surgical intervention.

More complex injuries (3-4 degrees) affect not only the layers of the dermis, but also the tissues under it. If the area of ​​such damage is more than 15% of the skin, the body begins to be poisoned by the decay products of its own burned tissues. The victim develops a burn disease.

The appearance of suppuration in the injured area aggravates the patient's condition - the body temperature rises, general weakness, appetite disappears, the victim suffers from insomnia, becomes irritable, excitable. It is more difficult to heal such an injury.

Depth is determined by the color of the burned tissue: unlike superficial, deep is characterized by a darker shade of skin or blisters. Damage area: 1 palm makes up 1% of the surface of the human body. characterized by severe redness and swelling.

Signs 2 - blisters appear, filled with a light yellow liquid. In areas with stage 3 lesions, the skin looks thickened, the blisters on it are light brown, pain syndrome weakly expressed or absent altogether. A 3rd degree burn heals longer, requires serious, step by step treatment. Stage 4 injuries are accompanied by deep tissue necrosis - dark color skin, up to black with charring, there is no pain syndrome. Burns according to ICD-10 refers to codes T20 - T32.

Grade 3 injuries due to the difference in the depth of tissue damage have a variety: 3A and 3B. They look the same, visually it is impossible to determine. The examination takes place in a hospital setting with the help of instruments. For the treatment protocol, this difference will be of fundamental importance. Grade 3A is characterized by damage to the epidermis and upper dermis. Grade 3B affects, among other things, subcutaneous adipose tissue.

First aid for 3rd degree burns

It consists in alleviating the condition of the victim and preventing further contact with the cause of the injury. The source of injury can be: boiling water, steam, aggressive chemicals, electric shock, fire. For the first emergency care Before the arrival of the doctor, you need to act according to the instructions:

• cut off clothing with scissors around the affected tissue;
• cover the area with a sterile napkin;
• provide fresh air;
• give the pain reliever paracetamol or ibuprofen;
• do not touch the damaged surface: an infection can get into the wound.

• wash or smear the area with antiseptics;
• cool the wound with ice or other improvised means;
• use cotton wool or a bandage to cover the burned area of ​​the body: the fleecy particles of the material will stick to the wound, preventing recovery;
• remove cauterized to the injured skin parts of clothing - this will provoke additional bouts of pain;
• lubricate the burnt layer with fats, oils, or use other traditional medicine.

Treatment of a 3rd degree burn is possible only in a hospital setting, and first aid should be provided as soon as possible. This will help to avoid complications in the treatment.

Further treatment in children and adults

The third degree involves surgical intervention - skin grafting from healthy areas to affected tissues. Operations can also be aimed at preventing further spread of the infection. The patient is shown treatment with hormonal, antihistamine, painkillers, sedatives. If visible areas of the body, such as the face, were injured during the injury, the patient is subsequently shown surgical interventions to eliminate cosmetic defects.

If necessary, under anesthesia, the blisters are opened, dead tissues are removed. Self-replacement of medicines prescribed by doctors can cause undesirable consequences.

Such popular ointments as Rescuer or Panthenol are not used for 3B.

Hospitalization of children should be carried out with suspicion already at the 2nd degree, since defensive forces the baby's skin is much softer and thinner. Parents cannot always assess the severity of the damage. The provision of medical care for babies is mandatory, and parental negligence can become fatal.

Possible consequences

The consequences of third-degree burns depend on which part of the body the person suffered, the area, and the depth of tissue damage. If the germ layer of the epidermis is preserved under the blisters at grade 3A, skin grafting may not be necessary, since its regeneration is possible. Non-healing and long-healing wounds of the 3B degree require special attention doctors. Keloid scars appear at the site of the lesion.

They tighten healthy parts of the body, causing pain and inconvenience. If such a defect occurs, their excision is indicated. After treatment, the most common consequence of skin lesions is the formation of scar tissue or scars.

Disability after 2-3 degrees is unlikely.

Is it possible to treat at home

When receiving a burn injury to the skin, a person is in an excited state of shock, cannot objectively determine the severity of the injury. Nearby people are not able to assess the condition of the victim. After providing first aid, best solution will go to the emergency room or burn center. The specialist will characterize the lesion and diagnose the victim, a decision will be made - to be treated at home if the burn is 1-2 degrees, or in the hospital if a more serious wound is received.

It is impossible to make a diagnosis from a photo on the Internet.

How long does recovery take

The duration of rehabilitation depends on psychological state health of the patient at the time of injury. The third degree A or B burn, if first aid is provided in a timely manner, with an uncomplicated course, will heal in 1-1.5 months. More severe damage will take longer. Hands, fingers, toes, elbows, knees have thinner skin, so it will have to be treated comprehensively. The doctor will prescribe ointments to restore the dermis, joint mobility. The patient will need physiotherapy, massage, a lot of strength, patience.

It's hard to say how long it will take to recover. Under the influence medical preparations it will take not days, but weeks, until the healing process takes place. There is always a risk of burns, so you need to know the rules for first aid and the use of hazardous substances.