Third degree burns, also known as full-thickness burns, are the most severe type of burns. They extend through the entire layers of the skin and cause damage to the tissues underneath. Here is an overview of what 3rd degree burns look like:
Appearance
The appearance of a 3rd degree burn can vary depending on how long it has been since the initial injury. Here are some of the common characteristics:
- White, blackened, or charred skin – The skin will often take on a leathery or waxy texture.
- No blisters – Since the entire thickness of skin is destroyed, fluid cannot collect underneath to form blisters.
- Dry with no bleeding – The blood vessels underneath the skin are damaged so there is no blood circulation or fluid weeping.
- Cracking or peeling – Dead skin may begin peeling off the area in sheets.
- Exposed fat, muscle, or bone – If the burn is severe enough, it may penetrate down to the fat, muscles, or bones underneath.
- Nerve damage – The area may feel numb due to destruction of the nerve endings in the skin.
The burn will also be clearly demarcated from the surrounding healthy skin, with an obvious border between damaged and undamaged tissue.
Color
The color of a 3rd degree burn depends on several factors:
- Pale white or tan – This is the typical color right after the initial burn when the skin is necrotic (dead).
- Red or pink – As healing begins, new capillaries and granulation tissue start to grow into the area.
- Black – Very severe burns may appear black when the skin and tissues are charred or significantly damaged.
- Yellow – Some burns can take on a yellow, jaundiced color as they heal due to changes in pigmentation.
The color can help determine how deep and severe the burn is. Black, white and tan burns indicate full thickness injury reaching down past the skin into fat, muscle, or bone.
Pain and Sensation
Since the nerve endings in the skin are destroyed, 3rd degree burn areas are often painless or numb. However, the tissues around the burn site may still have intact nerves and feel pain. As the burn heals, some sensation may return but it is often diminished.
Here are some typical pain and sensation characteristics of 3rd degree burns:
- Numbness or no pain over the main damaged area.
- Exposure of nerve endings can cause hypersensitivity.
- Pain at the edges or surrounding areas of the burn.
- Tingling, pins and needles sensation as nerve regeneration occurs.
- Itchiness as the burn heals.
- Tightness or difficulty moving due to scar tissue contraction.
Location on the Body
3rd degree burns can occur anywhere on the body but certain locations are more susceptible due to thinner skin or proximity to bone. Common locations include:
- Face – eyelids, nose, lips, ears, cheeks
- Neck and throat
- Shoulders
- Arms, especially the inner aspects
- Hands, including palms and fingers
- Torso or trunk
- Genital area
- Joints like the knees, elbows, or ankles
- Feet, especially the soles
Circumferential burns that go all the way around a limb or the torso are especially concerning due to potential restriction of breathing and circulation.
Size of the Burn
Larger total body surface area (TBSA) burns have higher risks of complications and mortality. The size of a 3rd degree burn is measured as a percentage of the person’s total body surface area affected. For example:
- Less than 10% TBSA – Usually survivable if treated promptly
- 10-20% TBSA – Risk of shock and infection, may require hospitalization
- 20-30% TBSA – Life threatening, will require IV fluids and wound care
- Over 30% TBSA – Extremely high risk of death due to complications
In general, the larger the size of the 3rd degree burn, the more serious the prognosis. However, the location of the burn also matters, with burns to the face, hands, feet and genitalia carrying higher risks due to function and appearance.
Depth and Severity
3rd degree burns can range in severity depending on how deep they penetrate:
- Superficial-partial thickness – Destruction of the entire epidermis and part of the dermis.
- Deep-partial thickness – Destruction of the epidermis and most of the dermis.
- Full thickness – Destruction of the entire epidermis and dermis.
- Subdermal – Penetrates below the skin into fat, muscle, or bone.
The deeper the burn extends into tissues, the higher the risk of scarring and loss of function. Muscle, nerve, bone, and blood vessel damage will also increase healing time and complications.
Healing and Scarring
Unlike first or second degree burns, third degree burns do not heal naturally because the skin’s regenerative layer and blood supply are destroyed. Over time the burn will heal by:
- Forming scar tissue to cover and protect the area.
- Granulation tissue slowly filling in the damaged skin and tissues.
- Contraction and tightening of the scar.
Without surgery, this will lead to extensive, thick, tight scarring that may restrict movement. Skin grafts are usually required for deep 3rd degree burns to improve function and appearance.
Infection Risk
Due to the loss of protective skin layers and immune functions, 3rd degree burns are at very high risk of bacterial infection. Signs of infection include:
- Increasing redness, swelling and pain
- Pus or foul-smelling drainage
- Fever
- Raised body temperature around the burn
Burn victims are treated with IV antibiotics and frequent dressing changes to prevent dangerous wound infections, especially of antibiotic-resistant bacteria like MRSA.
Treatment and Recovery
Third degree burns require emergency medical treatment and months of wound care for proper healing. Treatment involves:
- Emergency care and rehydration with IV fluids
- Pain medication and tetanus immunization
- Frequent dressing changes
- Physical therapy to maintain range of motion
- Nutritional support
- Antibiotics for infection prevention
- Skin grafts for deep burns once granulation tissue forms
- Multiple surgeries and scar care
- Psychological treatment for trauma
With comprehensive treatment, many 3rd degree burn victims can ultimately regain function and improve their appearance. However, the recovery process is long, painful and labor intensive.
Mortality
The risk of dying from a 3rd degree burn depends on several factors:
- Age of patient – very young and very old are highest risk
- Size of burn – higher % TBSA means higher mortality
- Location – face, hands, genitals increase risk
- Other injuries or health conditions
- Delay in treatment – infection risk increases mortality
Modern medical care has greatly improved burn survival rates. However, severe and extensive 3rd degree burns still carry significant mortality risk. The long-term prognosis also depends on the extent of scarring and disability.
Conclusion
Third degree burns are a severe form of injury penetrating through all layers of the skin. They require emergency medical care and months of treatment to prevent complications like infections and loss of function. The extent of tissue damage and characteristics like color, sensation, location, size, and depth help determine prognosis. With proper wound care and skin grafts, many 3rd degree burns can heal over time. However, the healing process results in extensive scarring that may limit function and appearance.