1.3.1 Thermal Injury

Grading & Level of Importance: A


 Site specific codes only.


Burns; Combustio & Ambustio.


Most frequent accidents in household and leisure. 


Physical damage to the skin with tissue destruction of varying degrees caused by thermal energy.

Aetiology & Pathogenesis

Direct tissue damage from exogenous thermal energy of different origin.

Signs & Symptoms

Cascade of erythema, blistering and necrosis depending on severity of exposure.


Area of exposure with strongest damage related to the site of highest exposure.


Burns are divided into three degrees:

  1. 1st degree characterised by: erythema and pain.
  2. 2nd degree characterised by: grade 2 a: superficial with epidermal and dermal blistering and 2 b: deep dermal blistering and destruction of hair.
  3. 3rd degree characterised by: involvement of all layers and all adnexae, with extension to the subcutis and muscles.

Laboratory & other workups

If grade 2b and grade 3, monitoring of electrolyte and protein balance.


Depending on the degree of tissue damage, varying from little papillary edema with initial subepidermal blistering and dilatation of blood vessels, vacuolated or necrotic keratinocytes without inflammatory infiltrate to complete tissue necrosis. 


Varies with degree of severity and extent. More extensive burns treated in specialized burn centres. Burns involving >40% of skin surface area are often fatal.


Shock in severe cases and super-infections. Children with > 5% and adults with > 10% surface involvement have to be admitted to the hospital.


History and clinical features.

Differential diagnosis

Scalds, chemical burns.

Prevention & Therapy

Must be adjusted to extent and severity. Minor burns should be cooled, local corticoid emulsions; prevention of superinfection. With more severe burns, temperature control is a problem. Management involves wound care, electrolyte and protein replacement, pain control and systemic antibiotics and referral to regional burn centre. Skin transplantation can be considered at a later stage. Preservation of normal skin for in vitro growth / cell culture.


Critical body surface involvement >10% children and >20% adults. 

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