Scientific facts

There are two main categories of burns – deep burns and superficial burns. Superficial burns only damage the top layer of skin and are typically very painful. However, they can heal without intervention within approximately 14 days. First-degree and second-degree “A” (superficial) burns fall into this category.

First-degree burns only affect epidermis, the top layer of the skin. A typical example are sunburns. They cause a temporary skin redness. The second-degree “A” (superficial partial-thickness) burns typically cause blistering. The wound is pink as there is enough blood supply.

Deep burns affect deeper skin layers. We distinguish between second-degree “B” burns, causing partial damage of deep skin layers, and third-degree burns that damage all skin layers. These are always serious injuries that take more than three weeks to heal. A surgery is often needed and they almost always leave scars. The colour of the wound is a determining factor. A deep burn is typically white, red, brown, black or a combination thereof.

The three critical body areas:

Face and neck – the main concerns include swelling, burn of respiratory tract and permanent effects.

Hands and feet – from wrists and ankles down. These parts are a concern for functional reasons, because they are key for our normal functioning in life.

The third area is genitals and gluteus, where the healing process is often complicated by infections.

We estimate the size of a burn in percentage of the body surface affected by the burn. One way to estimate the size is the so-called rule of palm. The palm of the patient with fingers stretched out and the thumb held tightly with the other fingers correspond to approximately 1 % of the body surface. IMPORTANT – you need to use the hand of the victim not of the attending person!

The other method is the so called “rule of nines”. The different parts of the body correspond to approximately 9 % of the body surface, i.e. head and neck; chest; abdomen; upper half of the back; lower part of the back; arm; thigh; shank and foot. IMPORTANT – the rule of nines cannot be used on children! Another way is to use special diagrams into which you can draw the affected areas and calculate the size of the burn. In future, artificial intelligence will be used to calculate the size based on photographic scan.

Patients with burns are treated in specialised burn centres. In Czechia, we have three such centres in Prague and in Brno and Ostrava, the regional capitals. Burns are complex injuries requiring interdisciplinary approach which means that specialists from different disciplines participate in the treatment. The reason is that burns have adverse effects on the whole patient and his or her organ systems.

Therefore, each patient needs a complex and intensive therapy. Surgical treatment is demanding, long and may lead to complications. Another important part of the treatment is nutrition, a prerequisite for successful healing, for instance. Serious burns may require long, sometime life-long physical therapy and re-education.

Superficial burns, i.e. first-degree and second-degree “A” burns heal by regeneration, which means without forming of scar tissue, usually within 14 days after the injury. Deep burns always heal through cicatrisation, which means scar tissue forming. Every skin scar is a very dynamic tissue, which can be worked with to achieve optimal functional and aesthetic results.

Scar treatment (rehabilitation) is done by specialists in burn centres. You can learn more about scars (in Czech language) in the book Jizva nejen v popáleninové medicine published in 2019.

In the case of the so called “contact burns”, we talk about pain threshold, which is the temperature of the material that causes intense pain when in contact with human skin. Many experiments and studies indicate that the threshold is 43°C. However, materials differ in terms of the temperature required for the material to become hot enough to cause burns. For instance, stainless steel plates used for children’s slides or around swimming pools can reach up to 60-80°C in hot summer months and can cause serious burns if touched. A hot-plate of a standard cast-iron stove can reach up to 250°C.