Center for Severe Burn Injuries | Specialists and Information

The severity of a burn can be determined based on the percentage of the body’s surface area affected and the depth of the burn.

The percentage of the body’s surface area burned can be roughly estimated using the Rule of Nines:

• the upper extremities and the head and neck each account for 9%,
• the lower extremities each account for 18%,
• the entire trunk accounts for 36%, and
• the genital area or the palm of the hand accounts for 1% of the body surface area

In addition to this rough estimate, doctors can determine the burned body surface area more precisely using special tables.

These tables further subdivide the body parts and also take into account age-related changes in body proportions.

In adults, doctors diagnose a severe burn injury when 15% or more of the skin is burned.

According to the Rule of Nines, this would include, for example, both arms, one leg, or the entire back. If internal injuries are present in addition to external injuries—such as those caused by inhaling very hot air (inhalation trauma)—even minor skin burns are sufficient for specialists to classify the injury as a severe burn.

Burns are particularly dangerous in children, as they have a higher ratio of body surface area to body mass. Thus, a burn covering just 10% of the skin is already considered a severe burn.

The depth of the burn is defined by the burn degree:

In first-degree burns, only the outer layer of skin (epidermis) is burned; the skin is slightly reddened (as with a sunburn), swollen, and painful. These burns usually heal completely and do not require special treatment at a specialized center.

Second-degree burns result in blisters and cause severe pain.

In third- and fourth-degree burns, the patient no longer feels pain because the nerve endings have also been burned.

In a third-degree burn, the entire skin is affected; in a fourth-degree burn, the subcutaneous fatty tissue, muscles, and bones are charred. Pathogens can penetrate through the severely damaged skin, which can lead to further complications.

Severe burn centers have intensive care units for burn patients, where severely burned patients are placed on a ventilator and induced into an artificial coma @ Vadim /AdobeStock

Whether a burn injury is treated on an outpatient basis, as an inpatient in a hospital, or at a severe burn center depends primarily on the severity of the burn.

The current guidelines from 2018 recommend transfer to a severe burn center for the following injuries or patients:

• Second-degree and higher-degree burns covering 10% or more of the body surface area
• Third- and fourth-degree burns
• Burns to the hands, face, or genitals
• Electrical burns, including lightning strikes
• Chemical burns
• Inhalation injury

For burn patients with additional medical conditions or injuries that complicate treatment

For burn patients who require special psychological, psychiatric, or physical care

In general, all patients with burns should have the opportunity to receive treatment at a specialized center.

A severe burn center treats more than just burns caused by heat or fire.

While these are the most common causes of severe burns, they can also result, for example, from the skin coming into contact with certain chemicals, electric current, or a lightning strike.

A center for severe burn injuries typically holds a certification that designates the center as a high-quality facility.

To receive such a quality certification, certain structural, equipment, and staffing requirements must be met, and a minimum number of annual treatments for patients with severe burns must be performed.

Since centers for severe burn patients are specifically designed to care for patients with severe burns, they offer them the best possible chances of recovery.

These centers are characterized, for example, by the following features:

• Heated admission and shock room
• Capability for maximum intensive care
• Dedicated surgical wing where, for example, the surgical removal of severely damaged tissue or skin grafts can be performed
• Access to hydrotherapy
• Capability for continuous bacteriological diagnostics
• Capability for continuous renal replacement therapy

Initial care for severely injured patients is provided in the trauma room @ ronnachaipark /AdobeStock

Even after the initial acute treatment, burn patients can continue to benefit from the services of a severe burn center. 

Procedures such as microneedling or dermabrasion (the sanding down of raised scars) can be used even years after the burn injury to minimize long-term damage and alleviate psychological distress.

Other services include conservative therapies such as:

• scar massage 
• Camouflage or 
• Permanent makeup

Centers for severe burn injuries cover the entire spectrum of treatment needs, from acute care to rehabilitation and follow-up care.