7 Thermal Injuries
Burns
As a general principle, it is useful to remember that burns are often distributed asymmetrically or are localised, whereas a condition such toxic epidermal necrolysis has a symmetrical pattern and wide distribution. The shape of lesions may also be helpful in deciding on whether the lesions are burns. According to Gross et al (p 96)1 ‘Biologically abnormal patterns such as straight or angular borders, drip configurations or unusual symmetry’ may increase the index of suspicion of a burn.
Burns tend not to progress after about 5 days (unless there is repetitive injury) and this may be a useful feature in the differentiation from other skin lesions. The differential diagnosis of these types of lesion is addressed in standard dermatology texts.1,2
Traditionally, burns to domestic animals are divided into three categories.1
Full thickness: third degree
As the name suggests, the injury involves the full thickness of the skin. Coagulative necrosis develops in the connective tissue, blood vessels and skin adnexae. Microscopically, the epidermis and dermis may have a swollen amorphous appearance before neutrophilic inflammation becomes established. Granulomatous panniculitis is more suggestive of thermal injury than chemical burns (see Chapter 10).
Burns caused by flame
Flames singe hair and feathers before more serious damage (charring) develops in the skin, nails, beaks and deeper tissues. Careful examination of the pattern of hair or feather damage can help establish the position adopted by the victim at the time of being burnt or engulfed in flame (Case studies 7.1–7.3, Figs 7.1–7.6).
Case study 7.1
Charring affected feathers, beaks, wing tips, hocks and feet, and in one chick the sternum was burnt. Particles of burnt material were present on the body surfaces and, in one chick, deep within the air passages of the lungs. Some parts of the surface of each chick were unaffected. Using this pattern of exposed, burned areas and unburned parts (which were protected either by the wall of the nest or as a result of being pressed tightly against siblings), it was possible to reconstruct the situation in the nest at the time of the fire. A simple diagrammatic representation of the nest and chicks allowed the Court to visualise and understand why certain parts were burned and others spared (Fig. 7.1).
Case study 7.2
A report was received of two men dousing a young pigeon in cigarette lighter fuel, or similar inflammable liquid, before setting the bird on fire. When questioned, the accused admitted setting the bird alight but claimed that the bird was dead, lying on her back. Burnt feathers showed that flames had extended over the back from the tail, the head, and along the under surface around the vent and posterior abdomen (but not the breast), and undersurface of the right wing. Extending the left wing (Fig. 7.2) revealed that the feathers at the wing tip, and over part of the back of the bird, were undamaged. These areas of burning indicate that the pigeon was resting on her chest with her right wing extended but the left wing held tightly against the body.
The marked hyperaemia of the right side of the head (Fig. 7.3) and of the left foot (Fig. 7.2) is a vital reaction and confirms that the bird survived the attack for a limited period. Internally there was no evidence of natural disease or other trauma that might account for disability or death of this bird.
Case study 7.3
The blood in the frontal sinuses suggested that the skull fractures had occurred before death.
The splitting of the skin in burnt cadavers must be viewed with some caution. Splits are known to arise in the heated skin of burnt human corpses,3 particularly over extensor surfaces and joints; the same may be true for domestic animals. Such splits can mimic ante-mortem wounds and need to be differentiated from true wounds. This may be difficult if heat damage is considerable, but examination of deeper tissues may provide convincing evidence of ante-mortem wounding.