# Thermal burns

Thermal burns, comprising of 5 to 10% of all injuries peacetime, arise from exposure to high temperature. The severity of burns depends ceteris paribus from the area and the depth of tissue damage, especially from Piazza deep lesions. The most common are the following methods of determining the size of the burn.
Measurement by hand (the area of the palm is 1,0-1,2% of the entire surface of the skin) is way more simple and convenient, but is used only with limited damage. Measurement of the rule of nines" Wallace: the surface of the head and neck is 9% of the body surface, the area of the upper limb - 9%, lower 9X2=18%, the front and back of the torso is also on 18%, perineum and genital organs - 1 %. The method is applicable mainly in total defeat of the various parts of the body. Measurement method D. Valavina more difficult. On the front side of the card Valavina inflicted on the background of a millimeter grid two silhouette of a man (front and back). Silhouettes shade colored pencils, respectively affected areas. Each color represents the depth of tissue damage. Then count the number of shaded square millimeters, which corresponds to the burn area, expressed in square centimeters. With the defeat of the lateral parts of the body to the amount shaded square millimeters add the product of 5 mm2 (conditional width of the side surface of the body) by the number of square millimeters, expressing the length of the affected area on the diagram. Determination of the area of the burn, expressed in percentage to the entire skin surface, is made according to the table printed on the back of the card.
Classification of burns. Depending on the depth of tissue damage are distinguished extent Acting On Sopalovic - Boyer, burns first degree is characterized by redness of the skin; II degree - education bubbles, III degree - scab. According to Ziegler, there are still Acting IV degree, characterized by charring tissues. Krabi (C. Kreibich) shared everything burns on five levels: (I and II degree, as in other classifications, III degree - necrosis of the epidermis, IV degree - skin necrosis in the entire thickness; V degree - skin necrosis and lower fabrics. In 1960, the 27-th all-Union Congress of surgeons adopted (at the suggestion of A. A. Vishnevsky and M. I. Schreiber) chetyrehstennoy classification, which About. I and II degree usually characterized; O. II [ degrees are divided into two: III degree And border necrosis held at the level of maleyeva (germ) layer of the skin, affecting all or a portion of, and level III B - necrosis of the entire thickness of the skin; O. IV degree - skin necrosis and lower fabrics (printing. Fig. 4-6).

Fig. 4. Burns I and II degrees. Fig. 5. Burns II and III extent. Fig. 6. Deep burn (III and IV).

Burns first degree expand skin capillaries and plasma probative in tissue. These O. accompanied by redness, swelling of the affected area and burning sensation. All phenomena disappear during 2-4 days. The surface layers of the epidermis in the area of O. slushayutsya. When Acting II degree prepodavala plasma rasslaivath epidermis, forming bubbles. The bottom of the bubble is usually malpighian layer. Bubbles appear in the first hours and days after O. Contents of small bubbles may gradually be absorbed. Sometimes bubbles nagnaivajutsja. When significant exudate produces large drain bubbles bursting even with minimal trauma. Burns of II degree in uncomplicated heal without leaving scars.
In the first Dean after O. often impossible to distinguish clinically degree III a and III B. In both cases, the affected areas and to form a scab brown or gray. At a deeper O. flame scab often has parchment view with a grid of phlebitis. The principal difference between Acting degree III a and III B is in the nature of regeneration. In the first case comes islet epithelization due to the remnants germ layers of the skin and epithelium of the skin appendages. The defects heal without scarring, only in some areas, where have time to develop granulation tissue, formed scars. In the second case, the healing occurs by granulation and scarring. Spontaneous epithelization possible to a limited extent due to the rise of the epithelium from the edges of the defect. O. IV degree are often localized on the scalp, hands, feet, front surface of the tibia.
On Sovittu (S. Sevitt), with burns, there are two types of necrosis: primary arising at the moment of impact of high temperatures on the fabric, and secondary, developing for several days due to malnutrition; the true depth of tissue damage cannot be determined with certainty during the first 48 to 72 hours. When Acting meets and tertiary necrosis (M. I. Schreiber), developing after the rejection of burn scab due neurotrophic disorders. This kind of necrosis occur at burn depletion.