A third-degree burn is a severe injury penetrating all skin layers, extending into underlying fat, muscle, or even bone, causing extensive tissue destruction, disrupting nerve endings, blood vessels, and hair follicles. Paradoxically, due to complete nerve tissue destruction, these burns may result in little to no pain at the deepest injury site, though surrounding areas can be very painful. Such burns are a medical emergency, requiring immediate professional intervention to mitigate further damage and preserve life.
Immediate Actions to Take
First, ensure safety from the burn source and call emergency services (e.g., 911). While waiting for help, keep the individual calm and prevent hypothermia to prevent shock. Cover the person with a clean, dry blanket to maintain body temperature and provide comfort.
Do not attempt to remove any clothing adhered to the burn wound, to avoid further tissue damage. Instead, carefully cut around any stuck fabric. Apply a clean, non-stick dressing (e.g., sterile gauze or a clean cloth) loosely over the burn to protect from contamination. This shields exposed tissues from pathogens and avoids pressure.
Avoid applying ice, butter, ointments, or other home remedies to the burn. These substances can exacerbate the injury, introduce infection, or hinder proper medical assessment. Maintain a calm environment and reassure the injured person to manage anxiety and prevent shock before medical professionals take over.
Professional Medical Treatment
Upon arrival at a medical facility, initial focus is assessment and stabilization. Professionals prioritize establishing an airway, ensuring breathing, and supporting circulation to address burn shock. IV fluids replace significant fluid losses from damaged capillaries, preventing dehydration and maintaining organ function. Fluid volume is calculated based on patient weight and total body surface area affected.
Pain management is an immediate concern, with strong analgesics often given intravenously for rapid relief. Wound care begins with cleaning the burn to remove debris and dead tissue, known as debridement. Debridement prevents infection and promotes healing, as dead tissue provides a breeding ground for bacteria. Depending on the burn’s extent and depth, debridement may occur in stages over several days.
Infection prevention is a key treatment component due to compromised skin barrier. Broad-spectrum antibiotics may be administered prophylactically or to treat existing infections. Skin grafting is often necessary to close defects, especially for large or deep burns that cannot heal naturally. Autografts, using the patient’s own healthy skin, are the preferred method for permanent wound closure. Temporary grafts from donors or synthetic materials may be used initially to protect the wound and prepare it for autografting.
Recovery and Aftercare
Recovery from a third-degree burn extends beyond acute hospitalization, often requiring extensive rehabilitation. Physical therapy is important, focusing on maintaining joint mobility, muscle strength, and functional independence. Therapists guide patients through exercises to stretch new scar tissue, preventing contractures that limit movement. Occupational therapy helps patients relearn and adapt daily tasks, such as eating, dressing, and personal hygiene, often using adaptive equipment.
Psychological support is also important, addressing emotional trauma from severe injury, pain, and changes in body image. Patients may benefit from counseling or support groups to cope with post-traumatic stress, anxiety, or depression.
Scar management is an ongoing process aimed at minimizing appearance and functional limitations of burn scars. Pressure garments, worn consistently for many months, apply continuous pressure to the healing skin to flatten and soften scars. Massage therapy also improves scar elasticity and reduces discomfort. For some, laser therapy or reconstructive surgeries may be considered later to improve scar appearance and function. Regular follow-up appointments with the burn care team are important to monitor healing, manage complications, and adjust rehabilitation plans.