Burn Injury in the USA

Between 2011 and 2015, approximately 486,000 fire or burn injuries were seen at Emergency Departments.1,2 Approximately 40,000 of these required hospitalization. Thanks to advances made in treatment over the past several decades, ~97% of those treated in burn centers will survive. Unfortunately, many of those survivors will sustain serious scarring, life-long physical disabilities, and adjustment difficulties.

There are three primary types of burns: first-, second-, and third-degree. Each degree is based on the depth of damage to the skin, with first-degree being the most shallow (minor) and third-degree being the deepest (most severe). There is a fourth, rare class (fourth degree) in which the injury extends beyond the skin into underlying tissue like muscle or bone. In first and second degree burns the deeper uninjured skin usually contains enough stem cells and helper cells to allow the skin to heal very well by itself. However, for third degree burns, the injury destroys so many of these cells that the skin cannot heal itself or can only do with serious scarring. In such cases the standard practice is to perform a skin graft in which a thin layer of healthy skin from an uninjured area on the patient is removed and transplanted to the injury site. This skin graft brings with it new stem cells that can form new, healthy skin. Sometimes the skin graft is prepared in a way that allows a relatively small amount of healthy skin to be used to treat a much larger area of burn. This process is called “meshing”. In meshing a large number of tiny slits are made in the skin graft so that it can be spread or expanded to cover a large area. Skin stem cells within the graft then heal the tiny expanded slits to create healthy skin.

Burn and the US Military

Burns are a frequent source of injury in military operations, typically comprising 5% to 20% of wounds incurred during conventional conflicts1. Burns comprised ~5% of casualties evacuated from Operations Iraqi and Enduring Freedom (OIF and OEF). From April 2003 to May 2005, 273 military patients with significant burns were treated at the United States Army Institute of Surgical Research at Fort Sam Houston in Texas. Sixty-three percent of these injuries occurred in combat with detonation of improvised explosive devices (IEDs) responsible for ~70% of combat wounds. On average, combat-related burn injury covered 15% of the patient’s body surface area.

Additionally, military trauma (i.e. blast injury) creates not only large wounds but also large areas of fibrosis and scar formation. These scars are often very visible and can often draw unwanted attention to the Wounded Warrior. In some instances the scars become so extensive and thick that they can limit movement of joints and greatly restrict the patient’s ability to move. Overall, only 36% of military personnel with burn injuries from Operations Iraqi and Enduring Freedom returned to full military duty.2

There is also a substantial burden from burn to the civilian population in war. A recent study from the Syrian Civil War reported that from 2011 to 2015 a total of 2,462 patients were hospitalized with burn injuries3. Most of these patients had burns covering more than 15% of their body with an average of 57% of body surface area burned.

  1. Kauvar et al J Surg Res. 2006 132(2):195-200
  2. Kauvar et al Burns. 2006 Nov;32(7):853-7
  3. Yuce et al Saudi Med J. 2017 Jan; 38(1): 93–96