Burn depth: A review

Abstract

Despite the plethora of technologic advances, the most common technique for diagnosing burn depth remains the clinical assessment of an experienced burn surgeon. It is clear that this assessment is accurate for very deep and very shallow burns. But since clinical judgment is not precise in telling whether a dermal burn will heal in 3 weeks, efforts to develop a burn depth indicator are certainly warranted to accurately determine which dermal burns to excise and graft. This review summarizes the considerable literature in which a variety of techniques to determine burn depth have been used.

Assessment of burn depth and burn wound healing potential

“…Clinical evaluation of the burn wound is the most widely used and the least expensive method of assessing burn wound depth [6]. This method relies on a subjective evaluation of the external features of the wound such as wound appearance, capillary refill, and burn wound sensibility to touch and pin prick [1,2,7,8].…”

“…With clinical judgment it is possible to diagnose very deep and very shallow burns with adequate reliability, but clinical evaluation is markedly less accurate for burns of intermediate depth which unfortunately are very common [6]. Overall estimates report that clinical depth assessment is accurate in only about 2/3 of the cases [8] with the most frequent cause of error attributed to depth overestimation [11].…”

“…Punch biopsy of burn tissue with subsequent histological analysis is frequently considered as the 'gold standard' of burn depth assessment, serving as the basis for comparison of other diagnostic modalities [6,9]. Assessment is performed by a pathologist on thin sections of the tissue following hematoxilin and eosin staining [20].…”

“…Although these vital dyes can identify surface necrosis, they have generally been proven not to distinguish between partial and full thickness burns [29]. Given the limited amount of diagnostic information these vital dyes provide, they are regarded as having low clinical utility [6]. Fluorescent dye was first evaluated by Dingwall [36] using sodium fluorescein.…”

Application of infrared thermography for early assessment of burn wound depth in children - a preliminary study

“…Certainly, the physical thickness of the necrotic tissue cannot serve as a useful wound classification parameter because the skin of a person has different depth at various places. Now, the commonly accepted classification of burn wounds, originally proposed by Jackson in early seventies [3], takes into account the time of wound healing physiology and relates the depth of a wound to the necrosis of particular skin layers [4]- [5].…”