Consensus on the treatment of second-degree burn wounds (2024 edition)

Funds:

Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences 2019-I2M-5-076

Shanghai Top Priority Research Center Project 2023ZZ02013

Key Program of National Natural Science Foundation of China 81930057

General Program of National Natural Science Foundation of China 81971836

Program of Shanghai Academic Research Leader 23XD1425000

More Information

Corresponding author: Shizhao Ji, Email: shizhaoji2022@163.com; Shichu Xiao, Email: huangzhuoxiao4@hotmail.com; Zhaofan Xia, Email: xiazhaofan@163.com

摘要

Abstract: Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
- Burns /
- First aid /
- Infection /
- Wound management /
- Consensus /
- Surgical procedures /
- Operative /
- Debridement

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参考文献(306)

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Figure 1. Treatment processs for second-degree burn wounds. TBSA total body surface area

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Table 1. Rating of the quality of evidence based on the GRADE system

Quality of evidence	Definition
High quality	Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality	Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality	Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Downgrading factors: risk of bias, inconsistency of results, publication bias. Upgrading factors: the presence of a large effect size or evidence of a dose–response relationship.

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Table 2. Diagnostic classification of depth of second-degree burn wounds

Burn depth	Damaged tissue level	Wound appearance	Tactile feature	Healing time	Scar
Superficial second-degree burn wounds	Epidermis and upper dermis	Erythema, blisters, moist wound base, exudation.	Significant pain and whitening of the wound base on pressure.	< 2 weeks	Generally no scar.
Shallow deep second-degree burn wounds	Epidermis and middle dermis	Deep pink, blisters, wet or dry wound base.	Pain or nociception absent, no whitening of the wound base on pressure.	2–3 weeks	The incidence of scars is about 30%.
Profound deep second-degree burn wounds	Epidermis and deep dermis	Red and white alternating, blisters may be present, and the wound base may be wet or dry.	Pain or pain sensation disappears, and the wound base does not turn white on pressure.	Mostly > 3 weeks	The incidence of scars ranges from 70% to 80%.

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Table 3. Diagnostic criteria for grading the degree of infection of burn wounds

Degree of infection	Local manifestation	Systemic manifestation	Invaded tissue level
No infection	There are no local signs of infection such as redness, swelling, heat and pain.	No obvious signs	Microorganisms only contaminate or colonize the wound surface or necrotic tissue but not normal dermis.
Mild infection	Local redness, swelling, elevated skin temperature and local pain, as well as increased or purulent secretion (viscous, turbid, and opaque or bloody secretion) at the wound surface or around the wound edge are present. Meanwhile, other causes of skin inflammation should be ruled out (such as skin allergy, distal limb fracture and venous thrombosis).	No obvious signs	Microorganisms invade the superficial residual dermis in the wound.
Moderate infection	A marked increase in purulent secretion with odour and foul smell, aggravation of inflammation around the wound surface, obvious expansion of redness and swelling, increase in local pain, possible tissue edema, andthe surrounding tissues swell significantly.	The symptoms may be accompanied by fever, elevated body temperature and other systemic symptoms of infection.	Microorganisms invade the deep dermis or the entire residual dermis in the wound.
Severe infection	Poor wound vitality, dark colour, basal dryness, gradual blackening and necrosis at the centre of the wound, progressive deterioration of blood supply with increased exudation, accompanied by peculiar smell, progressive wound deepening, or expansion to normal tissues around the wound or even to the whole skin.	There are obvious systemic symptoms of infection. Sepsis or septic shock may occur in severe cases.	Microorganisms break through the dermis or invade the surrounding normal tissues.