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Areas of partial- and full-thickness injuries should be recorded on an
anatomic chart and then a percentage of TBSA computed. First-degree
burns are not included. BSA calculations are inexact, and some burns may
progress over time, so BSA estimates should be reassessed.
Description of Burn. The language used to describe burn severity has
evolved over time, from a nomenclature of degrees to a description of the
anatomic depth of the burn ( Fig. 104.2 ).
A superficial burn (formerly called first degree) occurs when the
epidermis is injured but the dermis is intact. These burns are characterized
by redness and a mild inflammatory response confined to the epidermis,
without significant edema or bulla formation ( Fig. 104.3A ). Superficial
burns are not included in the calculation of burn surface area used for
therapeutic decisions. These minor burns may be painful and usually
resolve in 3 to 5 days without scarring.
In a partial-thickness burn (formerly called second degree), the dermis is
partially injured. Partial-thickness burns can be characterized as either
superficial or deep. Superficial partial-thickness burns expose the rich
capillary network in the dermis resulting in a pink-red color and moist
appearance. Blistering is often present ( Fig. 104.3B ). Increased capillary
permeability, resulting from direct thermal injury and local mediator
release, results in edema. These injuries are usually painful because intact
sensory nerve receptors are exposed. Healing occurs in about 2 weeks, and
scarring is usually minimal.