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0.4 Integumentary system module 5: diseases, disorders, and  (Page 4/21)

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Burns are sometimes measured in terms of the size of the total surface area affected. This is referred to as the “rule of nines” , which associates specific anatomical areas with a percentage that is a factor of nine ( [link] ). This allows first responders to quickly estimate the percentage of the BSA (body surface area) that is damaged. This calculation allows a quick decision to be made about the level of care a patient needs. A patient with extensive burns needs to be sent to a burn center quickly for life saving treatment unavailable at regular hospitals.. Burns are also classified by the degree of their severity.

Calculating the size of a burn

This diagram depicts the percentage of the total body area burned when a victim suffers complete burns to regions of the body. Complete burning of the face, head and neck account for 19% of the total body area. Burning of the chest, abdomen and entire back above the waist accounts for 36% of the total body area. Anterior and posterior surfaces of the arms and hands account for 18% of the total body area (9% for each arm). The anterior and posterior surface of both legs, along with the buttocks, accounts for 36% of the total body area (18% for each leg). Finally, the anterior and posterior surfaces of the genitalia account for 1% of the total body area.
The size of a burn will guide decisions made about the need for specialized treatment. Specific parts of the body are associated with a percentage of body area.

Classification of burns

A first-degree burn    is a superficial burn that affects only the epidermis. Although the skin may be painful and swollen, these burns typically heal on their own within a few days. The skin will usually appear red. A sunburn fits into the category of a first-degree burn. A second-degree burn    goes deeper and affects both the epidermis and the upper portion of the dermis. These burns result in swelling and a painful blistering of the skin. It is important to keep the burn site clean and sterile to prevent infection. If this is done, the burn will heal within several weeks. A third-degree burn    fully extends into the epidermis and dermis, destroying the tissue and affecting the nerve endings and sensory function. These are serious burns that may appear white, red, or black; they require medical attention and will heal slowly without it. Oddly, third-degree burns are usually not as painful because the nerve endings themselves are damaged. Third-degree or full-thickness burns cannot be repaired by the body, because the local tissues used for repair are damaged and require debridement (removal of damaged skin tissues), or even amputation in severe cases. Usually this procedure is followed by grafting of the skin from an unaffected part of the body, or from skin grown in tissue culture for grafting purposes. Damaged skin may also be replaced by synthetic skin, animal skin or the skin of a cadaver.

Scars and keloids

Most cuts or wounds, with the exception of ones that only scratch the surface (the epidermis), lead to scar formation. A scar    is collagen-rich skin formed after the process of wound healing that differs from normal skin. Scarring occurs in cases in which there is repair of skin damage, but the skin fails to regenerate the original skin structure. Fibroblasts generate scar tissue in the form of collagen, and the bulk of repair is due to the basket-weave pattern generated by collagen fibers and does not result in regeneration of the typical cellular structure of skin. Instead, the tissue is fibrous in nature and does not allow for the regeneration of accessory structures, such as hair follicles, sweat glands, or sebaceous glands.

Sometimes, there is an overproduction of scar tissue, because the process of collagen formation does not stop when the wound is healed; this results in the formation of a raised or hypertrophic scar called a keloid    . In contrast, scars that result from acne and chickenpox have a sunken appearance and are called atrophic scars.
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Source:  OpenStax, Integumentary system. OpenStax CNX. Mar 19, 2015 Download for free at http://legacy.cnx.org/content/col11770/1.1
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