Terminology for Burns and Wound Care

1. Introduction

In this lesson, you will learn about burns and wounds, including their treatment and care.

Burns are injuries (skin damage) caused by exposure to heat, flame, radiation, electricity, or chemicals. Burns cause damage to the skin layers, so deeper burns can seriously affect the integrity of the skin.

The term wound can be interpreted in several ways, but typically refers to an open wound caused when the skin is damaged due to some sort of external force, like an injury (Merriam-Webster, n.d.). Wounds can also reduce the effectiveness of skin as a protective barrier.

Burns and wounds are both included in this lesson because both involve some similar risks, such as infection.

2. Burns

Regardless of their cause, burns can lead to a massive fluid loss due to the loss of protection against dehydration by the skin. Burned skin is also extremely susceptible to infection due to the loss of protection against pathogens by the skin.

key concept

Burns were traditionally classified by their degree of severity as first-degree, second-degree, third-degree, and fourth-degree burns. This historic classification of burns has been replaced by a system reflecting the need for surgical intervention. They are referred to as superficial, superficial partial-thickness, deep partial-thickness, and full-thickness burns.

Full-thickness burns require debridement, surgical removal of dead tissue, followed by grafting skin from an unaffected part of the body or from skin grown in tissue culture. The general term for skin repair is dermatoplasty.

Severe burns are quickly measured in emergency departments using a tool called the “Rule of Nines,” which associates specific anatomical locations with a percentage of the body that is a factor of nine. This is used to calculate the total body surface area (TBSA) affected by burns. A rapid estimate of the burned surface area is used to estimate the amount of intravenous fluids needed to replace fluid loss. Using the Rule of Nines, the head is calculated as 9%, the upper limbs are 9% (4.5% on each side), the lower limbs are 18% (9% on each side), and the trunk is 36% (18% on each side), and the perineum/genitalia is 1%. The figure below illustrates the Rule of Nines. Note that there are specialized versions of this calculation for infants and children, as their body proportions are different.

Burns can occur in several ways:

• Thermal burns are caused by fire, hot liquids, or steam.
• Chemical burns are caused by acids and alkalis, including industrial chemicals.
• Electrical burns are caused by contact with electrical currents.
• Radiation burns are caused by radiation exposure, including UV exposure (sunburn), and radiation therapy.
• Friction burns include road rash and carpet burn.

The local effects of burns include tissue destruction, inflammation, and fluid loss. The systemic effects include shock, electrolyte imbalances, and infection risk. Shock, which is potentially life-threatening, occurs when there is insufficient blood supply to body tissues. For example, hypovolemic shock occurs when there is significant blood or fluid loss (e.g., through diarrhea), and anaphylactic shock occurs during anaphylaxis, a severe, potentially life-threatening allergic reaction. Burn shock specifically occurs when there is hypovolemia (low blood volume) due to fluid loss from skin damage.

3. Wounds

There are many types of wounds. Some are simple abrasions and lacerations that may heal easily even without stitches. Others may require considerable care and management.

Acute wounds are wounds such as scratches and abrasions that occur quickly and then heal over a relatively short period of time. Examples of acute wounds include abrasions and lacerations, which you have already learned about. Puncture wounds are small but deep penetration wounds (e.g., the type of wound someone would get by stepping on a nail). Avulsion injuries can occur within the body, but skin avulsion injuries occur specifically when skin is torn away from its normal location. A skin avulsion injury can be relatively minor, or something more substantial like degloving, which occurs when skin and subcutaneous tissue are torn away, as shown in the figure below (which shows degloving and amputation).

Chronic wounds do not heal quickly. The exact amount of time required to classify a wound as chronic can vary, but these are wounds that can persist for very long times.

Examples of chronic wounds include:

• Pressure injuries (formerly called pressure ulcers): Include decubitus ulcers and bedsores; caused by prolonged pressure on bony areas.
• Diabetic ulcers: Neuropathy-related non-healing wounds in diabetes.
• Venous ulcers: Leg ulcers that develop due to poor circulation.
• Arterial ulcers: Ulcers that result from reduced blood flow to the extremities.

step by step

Wound healing follows a predictable series of phases:

1. Inflammatory Phase (0–6 days): White blood cell response to clear bacteria and debris.
2. Proliferation Phase (4–24 days): Granulation tissue (defined below) forms, new blood vessels grow.
3. Maturation (Remodeling) Phase (21 days–1 year): Collagen remodeling, wound contracts.

Wound healing can be affected by many factors, including age, diabetes, infection, and malnutrition.

As wounds heal, they produce exudate (drainage). Exudate can take several forms:

• Serous: Clear, watery fluid.
• Sanguineous: Bright red, fresh blood.
• Serosanguineous: Pale pink, watery mix of blood and serous fluid.
• Purulent: Pus-containing; yellow, green, thick pus (sign of infection).

Sometimes, wounds become infected. Signs that an infection has developed include:

• Erythema: Redness around wound.
• Edema: Swelling and fluid buildup.
• Foul odor: Indicates bacterial overgrowth

Additional terms used in this context are suppuration (producing pus) and pyogenic (related to pus formation). A wound with purulent drainage produces pus-filled exudate.

4. Treatments, and Procedures

When a burn first occurs, it needs rapid treatment. For minor burns, it may be sufficient to run cool water on the burn. Do not use ice.

Fluid resuscitation can be used for severe burns. IV fluids may be given to prevent hypovolemic shock.

During burn and wound care, debridement can be necessary. This can be accomplished in several ways. There are several different types of debridement available. Mechanical debridement includes scrubbing and irrigation. Autolytic debridement uses dressings to allow the body to break down tissue naturally (“auto” means “self” and “-lysis” means breakdown or separation). As the name suggests, enzymatic debridement involves the application of special enzymes that break down necrotic tissue. In some cases, surgical debridement is needed. In surgical debridement, the dead tissue is surgically removed using a scalpel.

When monitoring burns and wounds, some descriptive terms can be helpful:

• Eschar: Dead, blackened tissue after burns.
• Slough: Yellow, moist dead tissue.
• Granulation tissue: Red, bumpy new tissue forming during the healing process.
• Maceration: Skin softening due to excess moisture.

Dressings are commonly used on wounds, including burns. Examples of dressing types include:

• Occlusive dressings: Maintain moist environment (e.g., hydrocolloid).
• Gauze dressings: Used for absorption and wound coverage.
• Antimicrobial dressings: Silver-containing dressings to prevent infection.

Sometimes, the damage is so severe that skin grafting is needed. Skin grafting is used for severe burns and large wounds. The skin can be obtained from the patient who needs a graft (autograft), from another person (allograft), or from another species, such as a pig (xenograft).

In some cases, hyperbaric oxygen therapy (HBOT) is used to increase the oxygenation of wounds to promote healing. HBOT is performed by having patients enter a pressurized chamber with a pure oxygen atmosphere. HBOT is especially helpful in treating chronic wounds, crush injuries, and burns that are not healing properly.

REFERENCES

Merriam-Webster. (n.d.). Wound. In Merriam-Webster.com dictionary. Retrieved 6 April 2025, from www.merriam-webster.com/dictionary/wound