What is a sixth-degree burn?

A burn injury can range from very minor to extremely severe, depending on factors like how much of the body was burned, how deep the burn went, and where on the body the burn occurred. First-degree burns only affect the outer layer of skin, while second-degree burns go deeper into the dermis layer. Third-degree burns penetrate the entire thickness of skin and cause damage to tissues below. Fourth-degree burns extend past the skin and into muscle or bone. Fifth-degree burns destroy deeper tissues like tendons or major nerves.

What is a sixth-degree burn?

A sixth-degree burn is a burn that damages all layers of the skin and underlying connective tissue, fat, muscle, and even bone. This is an extremely severe burn that penetrates through the full thickness of the body. Sixth-degree burns are very rare because they require such extensive damage that most victims would not survive.

How are burns classified?

Burns are classified by severity based on how deeply and extensively they damage tissues:

First-degree burns

A first-degree burn only affects the outer layer of skin, called the epidermis. These burns cause redness, swelling, and pain, but do not blister. Sunburn is a common first-degree burn. They usually heal within a week and rarely scar.

Second-degree burns

Second-degree burns go deeper into the dermis, the thick layer of living skin below the epidermis. These cause redness, pain, swelling, and blistering as fluid accumulates between damaged layers of skin. Second-degree burns take longer to heal, often 2-3 weeks, and may scar.

Third-degree burns

A third-degree burn destroys the full thickness of skin, causing significant damage to nerves and blood vessels. Fat, muscle, and bone underneath may also be affected. These burns appear white or charred. They require skin grafting to heal and result in severe scarring.

Fourth-degree burns

Fourth-degree burns extend past the skin and damage underlying muscle or bone tissue. They result in the same charring and scarring as third-degree burns, but with involvement of fat, muscles, tendons or bones. Treatment is challenging and recovery can take months.

Fifth-degree burns

The most severe burn category before sixth-degree, fifth-degree burns destroy skin along with deeper tissues like tendons or major nerves. They can cause paralysis or loss of function in body parts. Healing these burns is extremely difficult.

What makes a sixth-degree burn different?

While most classification systems stop at fourth or fifth-degree, sixth-degree burns are so severe they go beyond even these categories. A sixth-degree burn is defined by:

  • Full thickness destruction of skin, fat, muscle and connective tissues
  • Exposure and charring of underlying bones
  • Damage extends through the full depth of the body

Essentially, a sixth-degree burn destroys all soft tissues and penetrates completely through to bone. This requires an extraordinarily powerful thermal source like molten metal, high voltage electricity, or prolonged direct flame exposure.

How are sixth-degree burns treated?

Treatment for sixth-degree burns focuses on stabilization and preventing complications:

  • Airway management if smoke inhalation occurred
  • IV fluids and medication for shock
  • Infection control with antibiotics
  • Swift escharotomy to relieve tissue pressure
  • Rigorous wound care and frequent debridement
  • Reconstruction of damaged bones or joints
  • Multiple staged skin grafts and flaps
  • Long term rehabilitation of paralysis or limb loss

Full recovery is extremely rare. Disability or loss of function is common even after treatment due to the severity of tissue damage.

What are the chances of surviving a sixth-degree burn?

Survival rates for sixth-degree burns are very low, estimated between 5-20%. This reflects the severity and depth of damage they cause. Critical factors determining survivability include:

  • Size of total body surface area burned – higher % means higher risk of mortality
  • Whether airway or lungs were burned, causing respiratory failure
  • Level of other traumatic injuries beyond the burn itself
  • Pre-existing medical conditions that complicate recovery
  • How rapidly the burn victim receives expert emergency care

Small sixth-degree burns have better chances if the rest of the body remains intact. But full-body deep burns cause multiple organ failure and are often fatal.

What are common causes of sixth-degree burns?

Most sixth-degree burns result from:

  • High voltage electrical injuries – from power lines or lightning
  • Severe scalds from hot liquids like molten metal or boiling water
  • Prolonged direct flame exposure in a fire or explosion
  • Chemical burns from strong acids or alkali

The powerful energy sources required mean these burns are more likely in industrial or utility accidents. Victims may be tradespeople, construction workers, or first responders.

Electrical burns

Electrical injuries can cause deep burns by direct tissue damage along the pathcurrent flows through the body. Nerves, blood vessels, and musclemay be severely damaged.

Thermal burns

Extended contact with flames or superheated liquids like molten metal can fully penetrate the body’s soft tissues. This causes charring around burned bones.

Chemical burns

Concentrated strong acids or bases can cause partial or full-thickness burns by chemical reaction with proteins in skin, fat and muscle.

What are the long term impacts?

Patients who survive sixth-degree burns face major long-term impacts:

  • Permanent disability or loss of function
  • Disfigurement from extensive skin grafting and scarring
  • Chronic wounds vulnerable to infection
  • Joint contractures causing reduced mobility
  • Need for reconstructive and plastic surgeries
  • Loss of digits, limbs, or extremities
  • Pain, numbness and sensitivity loss
  • PTSD, depression, and trauma

Rehabilitation needs are extensive including physical, occupational, and psychological therapy. Family and social support systems are critical for managing ongoing challenges.

Notable examples of sixth-degree burns

Some notable cases help illustrate the traumatic severity of sixth-degree burns:

Jacqueline Saburido

In 1999, Jacqueline Saburido suffered extensive burns over 60% of her body after a car crash where another driver was impaired by marijuana and alcohol. She experienced deep burns to her head, back and arms with charred bones requiring reconstruction.

Michael Haddad

In 2017, Michigan man Michael Haddad received a severe sixth-degree electrical burn to his face and skull while repairing a live power line. His bones were visible on over 35% of his head.

Zeeshan Mallhi

Pakistani celebrity Zeeshan Mallhi experienced a sixth-degree burn covering nearly half his face and shoulder in 2020 from an on-set pyrotechnic accident.


A sixth-degree burn is an extremely severe, life-threatening burn penetrating through all soft tissues to damage underlying bone. While most burns are classified as first to fourth degree, sixth-degree burns extend to the full depth of the body. Survival chances are low due to the level of tissue damage. Those who do recover face major long-term impacts to physical function, appearance, and quality of life. Preventing these traumatic injuries requires stringent safety measures when working with hazardous thermal, electrical, and chemical sources.

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