VI.
Third Degree (Full Thickness Burn)
Definition.- A full
thickness or third degree burn occurs with
destruction of the entire epidermis and dermis,
leaving no residual epidermal cells to repopulate.
This wound will therefore not re epithelialize and
whatever area of the wound is not closed by wound
contraction will require skin grafting.
Appearance: A
characteristic initial appearance of the avascular
burn tissue is a waxy white color. If the burn
produces char or extends into the fat as with
prolonged contact with a flame source, a leathery
brown or black appearance can be seen along with
surface coagulation veins. Direct exposure with a
flame is the usual cause of a third degree burn.
However, contact with hot liquids such as hot
grease, tar or caustic chemicals will also produce a
full thickness burn. The burn wound is also painless
and has a coarse non pliable texture to touch. A
major difficulty is distinguishing a deep dermal
from a full thickness (third degree) burn that
extends just through the dermis. This burn is termed
an indeterminate burn.
Outcome: Except for a very
small wound e.g., 2 x 2 inches, the burn wound will
require excision and a skin graft.
Treatment
1. Gentle wash, removing loose tissue, char.
2. Eschar penetrating antibodies, SSD first choice,
preferably changed twice a day, using closed
dressing.
3. Early surgical excision and grafting.
4. Prophylactic parenteral antibiotics are not
indicated.
