Any adult burn more than 15% and pediatric burn more than 10% will land up in hypovolaemic shock if not adequately resuscitated. Body surface area burns is usually calculated by Wallace's rule of ‘9’ in adults and Lund and Browder's chart in adults and children. The amount of fluid loss will depend on extent of burns. This plasma loss is the cause of hypovolaemic shock in burns. By 48 hours either capillary permeability returns back to normal or they are thrombosed and are no more the part of circulation. Increased capillary permeability and resultant plasma leak persists till 48 hours and is maximum in first 8 hours. This causes plasma to leak out from capillaries to interstitial spaces. There is generalized increase in capillary permeability due to heat effect and damage. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds. It may take years for scar maturation in burns.

Even after complete epithelisation of burn wound, remodelling phase is prolonged. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn injury has always been the domain of burn specialists.

2nd degree chemical burn healing stages