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Treatment
of Burns and their Outcome (continued)
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DEEP
PARTIAL THICKNESS (DEEP 2nd DEGREE) BURN
Definition:
A deep partial thickness or deep second degree burn
extends well into the dermal layer and fewer viable
epidermal cells remain.
Therefore re-epithelialization is extremely
slow, sometimes requiring months.
Grafting is often the preferred treatment for
long term function.
Appearance: In
these patients, blister formation does not
characteristically occur because the dead tissue layer
is sufficiently thick and adherent to underlying
viable dermis that it does not readily lift off the
surface. The
wound surface may be red and dry in appearance with white
areas in deeper parts (dry since fewer blood vessels
are patent). There
is a marked decrease in blood flow making the wound
very prone to conversion to a deeper injury and to
infection. It
is often not possible to distinguish a deep partial
from a full thickness burn by initial appearance.
Frequently the wound is a mixed second and
third degree. Direct
contact with flames is a common cause. Most chemical
burn are also deep.
The appearance of the deep dermal burn changes
dramatically over the next several days as the area of
dermal necrosis along with surface coagulated protein
turns the wound a white to yellow color.
The amount of surface coagulum is accentuated
with the use of a topical antibiotic, making the deep
second degree burn difficult to differentiate from a
third degree burn.
The presence of some pain can assist in the
diagnosis because pain is usually absent in a
full-thickness injury.
Fluid losses and the metabolic effects of deep dermal burns are basically
the same as that seen with the third degree burn.
Outcome: A
deep dermal burn will require 4-8 weeks or longer to
heal.
Since the epidermis is very thin and not
adhered well to dermis (no rete pegs), wound breakdown
is common.
Excision and grafting is the preferred
treatment.
Dense scarring is usually seen if the wound is
allowed to heal primarily.
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Figure
8: Deep
Dermal Burn |
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| Deep
dermal burn: too deep to use wound matrix
until debrided to a viable bed, as matrix will
not adhere to dead tissue. |
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Figure
9:
Deep Arm |
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Figure
10:
Patchy Flank |
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