From the Guidelines
Third-degree burns require immediate emergency medical attention and should not be treated at home, with treatment typically involving removing dead tissue (debridement), intravenous fluids to prevent shock, antibiotics, and pain management, as well as nutritional support and physical therapy to maintain joint mobility and prevent contractures. The management of severe thermal burns in the acute phase involves a multidisciplinary approach, with burn wound dressings playing a crucial role in reducing pain, protecting the wound from external contamination, and limiting heat loss 1. However, wound care should be performed only after a well-conducted resuscitation, and ideally, a burns specialist should be consulted to define the most appropriate dressing for the clinical situation.
Some key considerations in the treatment of third-degree burns include:
- Removing dead tissue (debridement) to promote healing and prevent infection
- Administering intravenous fluids to prevent shock and maintain fluid balance
- Using antibiotics, such as silver sulfadiazine, to prevent infection
- Providing pain management with medications, such as morphine
- Performing skin grafting surgery to cover the burned area
- Implementing nutritional support to meet the increased metabolic demands of severe burns, with a focus on providing adequate protein (1.5-2 g/kg/d) and avoiding excess carbohydrate provision, which can propagate hyperglycemia and exacerbate inflammation 1
- Conducting physical therapy to maintain joint mobility and prevent contractures
It is essential to note that third-degree burns are particularly dangerous because they destroy all layers of skin, including nerve endings, blood vessels, and sweat glands, leaving the body vulnerable to fluid loss, infection, and temperature regulation problems. Therefore, professional medical management is necessary to prevent life-threatening complications, including sepsis, hypovolemic shock, and permanent disability.
From the FDA Drug Label
Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. The treatment for a third-degree (full-thickness) burn injury includes the use of silver sulfadiazine cream, USP 1% as an adjunct for the prevention and treatment of wound sepsis 2.
- It is used as a topical antimicrobial drug.
- The use of silver sulfadiazine cream is indicated for second and third degree burns.
From the Research
Treatment for Third-Degree Burn Injuries
- The treatment for third-degree (full-thickness) burn injuries typically involves early excising of the eschar and covering of the wound to prevent infection 3.
- Non-viable tissue is removed by initial aggressive surgical debridement, and split-thickness skin grafts are often used for the rapid and permanent closure of full-thickness burns 3.
- Accurate evaluation of the severity of the burn and initiation of appropriate treatment are necessary to prevent adverse effects on the subsequent treatment and course 4.
- Early surgical evaluation for possible excision and grafting is necessary for third-degree burns 5.
- Topical antimicrobial agents, such as bacitracin, neomycin, silver sulfadiazine, and mafenide, can be used to control microbial colonization and prevent invasive infections 6.
Surgical Options
- Split-thickness skin grafts remain the standard for the rapid and permanent closure of full-thickness burns 3.
- Other surgical options for covering the wound bed have been described, but the choice of procedure depends on the individual case 3.
- Early surgical evaluation is necessary to determine the best course of treatment for third-degree burns 5.
Wound Care
- Proper wound cleaning, unroofing, and debriding of most blisters are essential for treating third-degree burns 5.
- Topical chemoprophylaxis is necessary for all second- and third-degree burns to prevent infection 5.
- The use of exogenous enzymes, such as collagenase, may accelerate wound cleaning and healing 7.