Burns are a common injury. The most common causes of injuries in daily life are hot liquids (boiling water, hot oil, hot porridge), steam, flames, etc. In addition, certain chemical substances (acid, Alkali, phosphorus, magnesium, benzene), electric current, radiation and nuclear energy can also cause damage to the skin or other tissues.

The severity of burns depends on the area and depth of the burn. The larger the area and the deeper the depth, the more serious the impact will be on the local and systemic parts.

Estimation of burn area: The new nine-point method is based on the old nine-point method and is obtained based on actual measurements of a large number of human bodies in my country. The area of ??the head and neck is 9%, the area of ??the upper limbs is 18% (2*9%), the area of ??the trunk including the perineum is 27% (3*9%), and the area of ??the lower limbs including the buttocks is 46% (5*9%+1%). See table.

Table

New rule of nine points

Parts

Area (%)

Head and neck

Both upper limbs

Torno

Both lower limbs and buttocks

Total of whole body

9 (1*9)

18 (2*9)

27 (3*9) including perineum 1

46 (5*9+1)

100 (11 *9+1)

The palm method can be used when burning a small area. That is, the palm area of ??the patient's own side with five fingers together is 1%. The area can be estimated quickly. It can also be used when burning a very large area. This method calculates the area of ??unburned skin to indirectly estimate the burn area. In clinical practice, the above two methods are often used together. When estimating the burn area in children, attention should be paid to the anatomical characteristics of children, that is, the proportion of the head and lower limbs of children is different from that of adults. The younger the child, the larger the proportion of the head and the smaller the proportion of the lower limbs. As age increases, the ratio of head to lower limbs gradually approaches that of adults. Therefore, when applying the nine-point rule to calculate the burn area in children, the following corrections must be made:

The area of ????the head and neck of children is 9+ (12-age)

The area of ??both lower limbs in children is 9*5+1- (12-age)

Burn depth classification generally uses the three-degree and four-point method, normal human skin It is composed of epidermis and dermis. The depth of burns is divided according to the degree of burn, namely first-degree burns (Ⅰ degree), second-degree burns (Ⅱ degree), and third-degree burns (Ⅲ degree). I-degree burns are epidermal burns. Due to local capillary congestion, symptoms The injury is red, swollen, hot and painful, also known as erythema and burn. Generally, no treatment is required and it will heal in 3 to 5 days without leaving scars. Since first-degree burns have little impact on treatment and aftermath, they are not included when calculating the burn area. Second-degree burns are divided into two categories: superficial second-degree burns and deep second-degree burns according to the degree of damage: superficial second-degree burns damage the entire thickness of the epidermis and the superficial dermis, which is characterized by the separation of the epidermis and the dermis and the accumulation of exudate in them. Subcutaneous blisters, so they are also called vesicular burns. The clinical manifestations are local redness, swelling, and severe pain. When the blisters are removed, a light pink base with uniform bright red spots and a congested vascular plexus in the superficial dermis can be seen. There is often fluid oozing from the wound surface. If there is no infection, it will heal within 10 to 14 days without leaving scars, but there will be pigmentation. Deep second-degree burns damage the deep dermis, but there are residual skin attachments such as sweat glands, hair follicles, and sebaceous glands. The clinical manifestations are local swelling, dullness of sensation, and may or may not have blisters. After removing the necrotic epidermis, you will see a pale base with scarlet dots of uneven density (caused by dilation and congestion of capillaries around sweat glands and hair follicles). Wound healing requires local necrotic tissue to fall off or be phagocytosed and absorbed by the nearby deep epidermis. Regeneration or epithelial proliferation from residual skin attachments, so the healing time is longer, taking 3 to 4 weeks, and there are scars. Deep second-degree wounds are easily infected and become third-degree wounds due to the presence of necrotic tissue. Third-degree burn injuries involve the full thickness of the skin or reach as deep as subcutaneous fat, muscles, and bones. Because the peripheral nerves are damaged, the pain sensation disappears. The clinical manifestations are that the area is pale, tan or burnt black, the skin has lost its elasticity, is hard to the touch like leather, and the surface is dry, but there is a large amount of fluid exuding in the subcutaneous tissue space, and necrotic tissue 1 to 2 days after the injury ( After eschar) dries, embolized dendritic vessels may be seen.

The eschar usually separates gradually in 3 to 5 weeks, and granulation wounds appear. Autologous skin grafting surgery is necessary to eliminate the wounds