An acute burn is the recent one, that of the first hours and days. What is done in that period largely determines the lasting damage that will remain afterwards.
First of all, the urgent part: for a burn, cool running water for twenty minutes — not iced, no ice — remove any clothing that is not stuck and any rings or bracelets before the area swells, cover with a clean cloth and go to the emergency department. Nothing else. And what must not be done, because in Peru it is still done and it makes the injury worse: no toothpaste, no oil, no egg white, no potato, no lard, no herbs. All of that traps the heat in the skin, contaminates the wound and makes later assessment harder.
A burn has one particular feature: it deepens over the first forty-eight hours. What looks superficial on the first day can turn out to be deeper on the third, which is why the assessment is repeated. Everything else depends on the real depth: a superficial burn heals on its own in a week or two with no lasting damage, while a deep one never will by itself and needs debridement and grafting. Grafting in time what is not going to close on its own is the decision that most reduces the final scarring.
It usually helps when there is
- A recent burn needing its depth assessed.
- A deep burn that will not heal on its own and needs grafting.
- A burn on the face, hands, feet, genitals or skin creases, always.
- An extensive, electrical or chemical burn.
- A burn wound that has gone more than two weeks without closing.
Worth discussing first if
- Immediate emergency if it is extensive, involves the airway or affects a small child.
- A high-voltage electrical burn, which requires hospital assessment.
- Suspected smoke inhalation: absolute priority and urgent transfer.
- Underlying conditions that delay healing.
- An area already treated with home remedies, which needs cleaning first.
None of these rules the procedure out on its own; all of them change the conversation.
What degree it is
Depth, not extent, decides whether a burn will close on its own or need surgery.
Superficial
Red, painful skin with no blisters. It heals on its own in three to five days with no scarring. It is the typical sunburn.
Partial thickness
Blisters and a great deal of pain. If it is superficial it closes in two weeks; if it is deep, it takes longer and usually needs grafting.
Full thickness
White, brown or leathery skin, and strikingly painless because the nerve endings were destroyed. It always needs grafting.
Closing early means less lasting damage
The rule that orders the treatment is one of time: a burn that stays open for more than two or three weeks heals with contracture and with keloid in a much higher proportion of cases. So once it is established that an area is not going to heal on its own, it is debrided and grafted without waiting further. Prolonged waiting "to see if it closes" is the most frequent cause of the lasting damage that later needs long operations.
Functional areas take priority: face, hands, neck, armpits, joint creases and genitals. A contracture in a crease limits movement permanently, and there the decision to operate is taken sooner and with less room for doubt.
Preventing contracture starts in the acute phase, not afterwards: correct positioning of the joints, splints where appropriate and early movement. A burned hand that spends two weeks closed in a fist is a hand with lasting damage.
What the process is like
From the first treatment to closure of the wound.
First aid
Cool running water for twenty minutes, remove clothing that is not stuck and anything constricting, cover with a clean cloth and go to the emergency department. Nothing applied to the skin.
Assessment
The extent and depth are estimated, and repeated at forty-eight hours because a burn deepens. Which areas will close on their own is established.
Dressings or surgery
Directed wound care in the superficial areas. Debridement and grafting in the deep ones, without waiting more than two or three weeks.
Preventing lasting damage
From the start: positioning, splints, movement, and afterwards compression garments, moisturising and sun protection for months.
What to expect
A burn scar takes between one and two years to mature fully.
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Days 1 to 3
Pain, swelling and frequent dressings. The burn finishes declaring its real depth.
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Weeks 1 to 3
The superficial areas heal over. The deep ones are debrided and grafted. Movement and splints to prevent contractures.
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Months 1 to 6
The active phase of the scar: red, firm and itchy. Compression garment, daily moisturising and strict sun protection.
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Months 6 to 24
The scar matures and lightens. This is the point after which surgery for any remaining damage is considered.
Risks, and what is not promised
From the burn itself: wound infection, deepening of the injury, contracture of creases with limitation of movement, hypertrophic or keloid scarring — very frequent after burns — changes in skin colour and permanently altered sensation.
From the treatment: partial or total loss of the graft, a scar at the donor site and the need for more than one operation. In extensive burns there are serious general risks as well, and their management belongs in a hospital burns unit.
It is not promised that a deep burn will leave no scar: it always does. What does change the result considerably is the time to closure and the care over the following months. These risks are reduced by correct first aid, early closure, compression and sun protection. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about burns
Cool running water over the area for twenty minutes — not ice, which makes the injury worse — remove clothing that is not stuck and any rings or bracelets before it swells, cover with a clean cloth and go to the emergency department.
Do not apply anything else: no toothpaste, no oil, no egg white, no potato, no lard, no herbs. All of that traps the heat, contaminates the wound and makes it harder to assess.
Not at home. An intact blister protects the wound and reduces pain and the risk of infection.
In the consultation it is decided which ones should be removed — the very large ones, or those over a crease — and that is done under sterile conditions.
Usually between the third and fifth day, because a burn deepens over the first forty-eight hours and the initial depth is misleading.
The practical rule: what is not going to close on its own within two or three weeks is grafted. Waiting beyond that greatly increases contracture and keloid.
A superficial burn leaves no scar. A deep one does, always, and it is best to know that from the start.
What changes the result is closing early and looking after the scar over the following months: compression, daily moisturising and strict sun protection. That part depends largely on the patient.
Question not answered here? There are more answers in the frequently asked questions.
