Between 3,000 to 4,000 people die of severe burns each year in the United States, reports The Merck Manual. Heat, electricity, radiation and chemicals can all cause third-degree burns, the most severe type of burn. The very young and elderly are most susceptible to severe burns. Treatments for third-degree burns can take many months.
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Burns are classified as first, second and third degree. Third-degree burns destroy the top layer of skin, the epidermis, and the middle layer, the dermis. Bone, muscle, fat and nerve endings may be damaged or destroyed, the University of Chicago reports. Skin appears white or charred and no pain is felt in the burned area because nerve endings are destroyed.
People with third-degree burns who have airway involvement need immediate intubation, which involves placement of a tube that delivers oxygen into the lungs. Burnsurgery.org states that severe swelling makes tube placement difficult. Third-degree burns that involve the face, hands, feet or genitals or that cover more than 5 percent of the total body surface area should be treated at specialized burn centers, the University of Chicago advises. Many people with third-degree burns develop dehydration from fluid loss and need large amounts of intravenous fluids to avoid shock.
Third-degree burns are at high risk for infection, Burnsurgery.org states, because of dead tissue and lack of blood flow to the area. Antibiotics given via intravenous infusion and in creams help prevent infection.
Healing the Skin
Keeping the skin clean and free from infection requires application of medications containing silver or other ingredients to help the skin heal. Burns require dressings with sterile bandages that are often changed several times a day. Dead skin must be removed in a process called debridement. The healing skin in third-degree burns often forms a thick scabbed area, called eschar, which restricts blood flow to the damaged skin, and may need to be cut away, the University of Chicago explains.
Temporary skin grafts using donor skin, called an allograft, or animal skin, called a xenograft, or permanent skin grafting with unburned skin from another area, called an autograft, protect the burned area while it heals. Skin substitutes may also be used to cover healing wounds.
Some scarring inevitably occurs after a third-degree burn. Hypertropic scarring, which is thickened, reddened, itchy, tight and painful scarring, occurs in 50 percent of third-degree burns, Burnsurgery.org states. Scarring can result in contractures, which is a tightening of the skin around the joints, making them inflexible and difficult to move. Early wound closure, use of pressure garments and medications such as corticosteroids, antihistamines and interferons help reduce scar formation.