THIRD-DEGREE BURNS: STABILIZATION PROTOCOLS AND ADVANCED SUPPORT

Abstract

Third-degree, or full-thickness, burns are critical thermal injuries that extend through the epidermis, dermis, and often into the subcutaneous tissue (hypodermis), characterized by complete necrosis, absence of immediate local pain, and a high risk of sepsis, the leading cause of mortality. This article, a narrative review of recent literature, critically analyzes contemporary protocols for stabilization and advanced support. The emphasis is on the pathophysiology of the injury and evidence-based therapeutic strategies. Initial stabilization focuses on early and rigorous fluid replacement, guided by individualized hemodynamic monitoring, and the management of microbial colonization. In topical treatment, 1% silver sulfadiazine (SSD) is the gold standard, but its association with biological amniotic membrane dressings has demonstrated significant improvement in clinical outcomes, such as reduced recovery time to graft readiness. In metabolic support, the RE-ENERGIZE clinical trial revealed that enteral glutamine supplementation did not result in a benefit in mortality or length of hospital stay. It is concluded that effective management requires early intervention, individualization of fluid resuscitation, and a continuous, multidimensional, and multidisciplinary approach that integrates antimicrobial therapies, advanced biomaterials, and early functional rehabilitation.