Initial Management of the Burn Patient PART2

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.