|
SECTION
FOUR:
ANATOMIC
ASSESSMENT OF THE BURN WOUND
Burn depth is
defined based on the depth of coagulation necrosis into
epidermis and dermis (recognizing that the anatomical depth
may change with wound conversion).
| CAUSE |
DEPTH
DEGREE |
APPEARANCE |
PAIN
|
Hot
Liquids
- Short exposure
- Long exposure |
Superficial
dermal
Deep dermal |
web,
pink, blisters
wet, dark red |
severe
minimal |
Flames
- Flash exposure
- Direct contact |
partial
thickness
full thickness |
severe
minimal |
wet,
pink blisters
dry, white, waxy or
brown, black leathery |
| Chemicals |
usually
full thickness |
severe |
light
brown to light gray |
A.
PARTIAL THICKNESS BURN
There are four
categories of second degree burn typically used to
characterize the depth of injury. Each corresponds with
healing time, treatment modalities and outcome.
Click
to Enlarge the Image
Click
to Enlarge the Image
Burn due to Flash
Exposure
MID-DERMAL
BURN
Characteristics:
1. Necrosis to mid-dermis
2. Large zone of injury (potential conversion)
3. Eschar separated from viable tissue by edema layer
|
Click To Enlarge
(SEE MID-DERMAL BURN)
|
The schema of a mid
dermal burn is shown. There is not only a larger zone of
necrosis but also a larger zone of injury as dermal elements
are more readily injured by heat or mediators once below the
high flow upper dermis. The edema layer is still quite
prominent and often provides a natural interface for
mechanical debridement leaving a viable wound bed.
Deep
Dermal Burn
Characteristics
1, Necrosis involving majority of skin layers
2. Zone of necrosis adherent to zone
3. Smaller edema layer
Click
to Enlarge the Image
The
zone of coagulation involves the majority of the dermal
layer. The remaining dermis can be considered the zone of
injury with a high risk of conversion. Edema is more diffuse
throughout the burn and the necrotic tissue remains adherent
requiring either necrolysis or preferably surgical
debridement for removal.
Indeterminate
Dermal Burn
A deep burn that
cannot be clinically distinguished as a deep dermal or
full thickness
After a mixed deep
dermal and full thickness compound
Click
the Image to Enlarge
(Waxy
white in middle is full thickness)
Appearance:
white, waxy, but some bleeding from escharotomy. Is it deep
dermal or full thickness?
Full Thickness Burn
Necrosis of
entire dermis including all epidermal elements edema diffuse
beneath eschar
Full
thickness burns: dry waxy appearance. Note: thrombosed
vessels
Burn
Depth and Outcome
|
Second
Degree
|
Cause
|
Appearance
|
Pain
|
Healing
|
Scar
|
|
Superficial
|
hot liquid
short exposure
|
wet, pink,
blisters
|
severe
|
10-14 days
|
minimal
|
|
Mid-Dermal
|
hot liquid
longer exposure, flash flame
|
less wet,
red ± blisters
|
moderate
|
2-4 weeks
|
moderate
|
|
Deep-Dermal
|
chemicals,
flames
|
dry, white
|
minimal
|
3-8 weeks
|
severe
(needs graft)
|
|
Indeterminate
(2nd or 3rd)
|
chemicals,
flames
|
dry, white
|
none
|
_
|
_
|
|
Third
Degree
(full
thickness)
|
chemicals,
flames, explosion, with very high temperature
|
dry, white
or char
|
none
|
need graft
|
mild to
severe, depending on timing and type of graft
|
TABLE
continued below
|
Second
Degree
|
Risk
|
|
Superficial
|
low risk
|
|
Mid-Dermal
|
moderate,
higher in children, elderly
|
|
Deep-Dermal
|
high risk
|
|
Indeterminate
(2nd or 3rd)
|
_
|
|
Third
Degree
(full
thickness)
|
_
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