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CLASSIFICATION OF BURNS BY DEPTH AND SURFACE TREATMENT AREAS

The classification of burns by the depth of tissue damage.

Different countries have adopted different classifications. We use the classification developed under the guidance of A. A. Vishnevsky, Academician of the Academy of Medical Sciences of the USSR, and adopted at the 27th Congress of Surgeons, which provides for the division of burns into 4 degrees.

1 degree of burn, representing superficial damage only to the epidermis, is characterized by redness and swelling of the skin.

Grade 2 burn - damage to the epidermis and partially the underlying dermis. This degree is expressed by redness, swelling, the formation of bubbles filled with clear yellowish liquid.

Clinical signs of burns of 3A and 3B degrees do not have bright distinctive features, however, their differentiation is important because at 3A degrees the papillary layer of the dermis with epidermal particles partially maintains vitality, allowing later burn injury to self-epithelialize, while at 3B degree self-healing wounds occur very slowly and only due to epithelialization from its edges.

In case of a fourth degree burn, there is a brown or black scab, the density and thickness of which may be different. It is clear that the possibilities for self-reparation in such burns are very limited.

The ability to self-epithelize a burn wound served as the basis for developing a simpler classification suitable for the purpose of military medical triage of victims. According to her, burns of the 1st, 2nd, 3A degrees are referred to superficial, and 3B and 4th to deep, requiring specialized medical care.

However, the practical determination of the area and depth of a burn is often quite complex and requires sufficient experience.
Most burns are mosaic, i.e. when burns of different depth are localized in different areas of the skin, in addition, the depth of necrosis can also increase due to the stasis zone.

The classification of burns by lesion area

The methods of approximate determination of the burn area according to the rule of “nines”, the rule of the palm, with the help of special tables (Table. Postnikov) are sufficiently fully described in the textbook. When determining the area of ​​a lesion, it is necessary to take into account Frank's rule, which established that 1% of the area of ​​a deep burn should be equated by gravity to 3% of the surface. The Frank index is obtained from the addition of the surface burn area in (%) and the tripled area of ​​a deep burn. If it is less than 30, then the forecast is considered favorable, if it is 30-60, then it is relatively favorable; 61-90 - doubtful, with 91 and above - unfavorable.

Another simple predictive tool is the so-called rule.

"hundreds": by the age of the patient it is necessary to add the burn area as a percentage (taking into account the Frank rule). With the result of summation up to 60, the forecast is favorable; 61 –80 - relatively favorable; 81 - 100 - doubtful; more than 100 - unfavorable.
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CLASSIFICATION OF BURNS BY DEPTH AND SURFACE TREATMENT AREAS

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