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Complications of Third Degree Burns (Part II)

Compartment Syndrome:

A compartment is defined as a closed space of nerves, muscle tissue and blood vessels. This space is surrounded by fascia (thick layer of tissue) that doesn’t stretch. When the pressure inside the compartment increases from any cause and if the pressure increases substantially, this may lead to the compression of the nerves, blood vessels and muscles inside the compartment. The result may be impaired blood flow and reduced oxygenation that may result in muscle and nerve damage. Compartment syndrome most commonly involves the forearm and lower leg although it can occur in other places.

In third degree burns the pressure increases due to fluid retention and edema (swelling) causing compression of muscles, nerves and blood vessels which will lead to ischemia (reduction in blood flow) and necrosis (death) of tissue if not managed quickly.

Clinical features include:

  1. Pain: it is usually severe pain and out of proportion with the injury. The pain doesn’t respond to pain medication and is increased by stretching the muscle group within the compartment.
  2. Alteration or decrease sensation of the skin.
  3. Paleness of the skin.
  4. Weakness and in later stages paralysis of the limb may occur if not treated.
  5. Capillary refill time (the rate at which blood refills empty capillaries) of the digits is prolonged.
  6. Congestion of the digits.

Compartment syndrome is considered a medical emergency that requires immediate surgical treatment. The surgical procedure is called a fasciotomy which is simply done by making a long incision in the fascia to release the pressure building inside.


Seizures can happen following third degree burns specially in the first few days following the injury. Seizures may happen due to electrolyte imbalance, low oxygen level in the blood (hyp0xemia) or low level of oxygen in the tissues (hypoxia), infections leading to septicemia and septic shock, the toxic effect of certain medications administrated in burned patients or the accumulation of toxins in the body as a result of poor or malfunction of the kidneys.

Psychological complications:

Burn injuries can be devastating and can affect the patient both physically and emotionally. Children with severe burn injuries may suffer for psychological trauma for a long time such as post traumatic stress disorder (PTSD); they may also suffer bed wetting, nightmares and sleep disturbance. Anxiety, attacks of agitation, panic disorder and depression are also common. Patients may suffer personality issues such as low self esteem and disturbed self image as a result of the scarring and disfigurement caused by the burn injury; this often result in social withdrawn, feeling of worthlessness and loneliness. Psychological therapy play an important role in the healing of patients following burn injuries.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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