Assessment of Burn Severity and Extent

First Degree

First Degree burns affect the superficial epidermis, but basal layer remains viable. Clinically this burn presents as painful erythema that tans within 48 hours; however, this is not considered in estimating burn percentages.

Second Degree

Second Degree burns affect part of the dermis. Typically this burn is divided into superficial and deep second degree burns. Re-epithelialization occurs from the preserved epithelial appendages.

• Superficial - involves only the most superficial dermis. It presents with blistering or sloughing of overlying skin, causing a red, painful wound. Typically, the burn blanches but shows good capillary refill. Hairs cannot be pulled out easily.
  • Healing occurs within 14 days, typically without scarring and without requiring surgical intervention.

• Deep - involves more of the epidermis with fewer epidermal appendages spared. It may present as blisters, or a wound with white or deep red base. Sensation is usually decreased.
  • Healing takes more than 14 days. Incidence of hypertrophic scarring correlates with the length of healing phase greater than two weeks. Therefore debriding and grafting is recommended by 2-3 weeks.

Third Degree

Third Degree burns affect all epidermis, dermis and epidermal appendages. It presents as a white, black or mottled hard, dry wound, from which hairs are easily pulled out. No pain is present.

• If left without surgical intervention the eschar will eventually separate by the formation of a layer of granulation tissue. Potential risks of not debriding and grafting include:
  • sepsis
  • hypertrophic scarring
  • increased pain

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