Burns: Degrees and Treatment
Burns are among the most destructive forms of injury, both in terms of the immediate tissue damage they cause and the long-term challenges of recovery.
They are classified according to the depth of tissue involvement. First-degree burns affect only the epidermis. Second-degree burns extend into the dermis and may be superficial or deep, while third-degree burns destroy the full thickness of the skin and may extend into the subcutaneous tissue or deeper structures.
In addition to the immediate tissue destruction, severe burns trigger an extensive systemic response, including a major inflammatory reaction, increased vascular permeability with fluid loss, secondary ischaemia caused by oedema and a high risk of infection.
The treatment of second- and third-degree burns requires multidisciplinary management in a specialist centre, followed by prolonged rehabilitation.
Characteristics of Burns
A critical feature of deep burns is the zone of stasis. Surrounding the central area of necrotic tissue is a region that has not yet undergone necrosis but remains under severe ischaemic stress.
Unless this zone is treated promptly and the ischaemia is reversed, the affected tissue may become necrotic, increasing both the depth and the extent of the burn. By contrast, if adequate oxygenation is restored early, the tissue within the zone of stasis may recover.
At the same time, the healing of burns, particularly deep second-degree burns, depends on the ability of the remaining epidermal appendages, including hair follicles and sebaceous glands, to restore the epithelial surface.
This process requires adequate oxygenation and favorable biological conditions within the underlying tissue.
Scientific Evidence Supporting the Use of Hyperbaric Oxygen Therapy in Burns
The use of hyperbaric oxygen therapy in burn management has been studied extensively and is recognised by specialist burn centres internationally.
Clinical studies have reported faster healing, a reduced need for surgical excision and skin grafting, lower infection rates and improved outcomes in deep second-degree burns that subsequently did not require grafting. In particular, preserving the zone of stasis and preventing the burn from progressing in depth represents one of the most clinically important mechanisms of the treatment.
Reduced intravascular oedema, improved white blood cell function and bactericidal activity against anaerobic pathogens, which are often involved in burn wound infections, are additional documented mechanisms supporting its use.
The Role of Hyperbaric Oxygen Therapy
In burn care, hyperbaric oxygen therapy is used as an adjunct to specialist treatment provided by the burn centre, never as an alternative.
For severe burns, early treatment within the first 24 to 48 hours offers the greatest potential to preserve the zone of stasis.
Each session supplies the ischaemic tissue surrounding the burn with the oxygen required for survival. The increased oxygen tension in the plasma helps overcome the effects of microvascular oedema that restrict normal blood flow. At the same time, the anti-inflammatory effects of hyperbaric oxygen therapy may reduce the destructive inflammatory cascade associated with severe burns.
The number of sessions depends on the severity and extent of the burn and typically ranges from 20 to 30, in coordination with the specialist burn care team.