Many burn injuries will heal without the need for surgery. When a burn is very deep, sometimes surgery is needed to help the wound heal faster and to prevent worsening scarring.

Assessing Burn Wounds

During daily dressing changes, our burn team assesses the wound for signs of how “deep” the burn is and any signs of infection. This includes looking at the color of the wound, giving it a light press to see if it turns white and then fills back in with pink (this is called “blanching”).

Superficial Second-Degree Burns

If burns involve only the upper layers of the skin (superficial second degree), they will likely heal well with minimal to no change in skin texture. It can take a few months for skin color to return (it may stay pale/ pink for a while), and this may be apparent depending on your child’s normal skin tone. Superficial second-degree burns are usually moist and light pink in appearance. They also blanch quickly and can be very painful because of damage to the nerve endings in the skin.

Deep Second-Degree and Third-Degree Burns

If burns go very deep in the skin (deep second-degree) or all the way through the skin (third-degree), they can show as very pale with red speckles, or even white in appearance. You can sometimes see that the skin is thinner than the surrounding normal skin. 

Deep second-degree and third-degree burns are typically less painful than superficial burns because the nerve endings are more damaged. These burns, depending on the size and location, may need skin grafting to help them heal faster, reduce the risk of infection, improve function and mobility, and in some cases, improve the final cosmetic appearance of the wound. Depending on the size and location of your child’s burns, the burn team may use a staged technique involving several procedures. Our team will talk about your child’s plan in detail and answer any questions you may have. 

Skin Grafting

A skin graft is taking a very thin strip of skin from a non-burned area and applying it to an area that was injured.

• First, a burn surgeon will remove the injured skin and make sure the wound bed is ready to receive its new covering.
• Then, a burn surgeon will use a device to take a very thin area of skin from another area. Depending on the size and location of the area to be grafted, they may “mesh” the skin graft to help it stretch and cover a larger surface area. This helps to keep the “donor” site as small as possible.
• Dressings are then applied to both the donor and graft sites.

Because the skin taken from the donor site is so thin, the area usually heals in about a week and typically has a good cosmetic appearance.