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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Second Degree Burns



- See:
      - Burn Management:
      - Chemical Burns:
      - Electrical Burns:
      - Frost Bite:

    - 2nd degree / superficial:
           - partial thickness which involves the dermis and a portion of the dermis;
           - w/ superficial partial thickness injuries there will be preservation of sebaceous and sweat glands as well as hair follicles;
           - clinical features: wounds are sensate and painful, erythematous, moist, and may blister;
           - prognosis: expect healing in 3 weeks, as the skin re-epithelializes from deeply seated epithelial cells which line the hair follicles, and sweat glands;
           - management:
                   - cold irrigation:
                          - injured extremity should be submerged or irrigated with cold water for 30 min or longer;
                                 - there is at least one anecdotal case in which a patient sustained a partial thickness burn to the hand and forearm;
                                 - the patient placed the hand in ice chilled water for about 30 min;
                                 - the portion of the hand and forearm that was submerged demonstrated minimal burn injury where as the portion of the forearm that
                                         was not sumerge sustained a serious deep thickness injury;
                   - topical antibiotics
                          - silver sulfadiazine
                          - mafenide acetate
                   - frequent debridement of the overlying eschar / coagulum reduces bacterial count;
                   - splint: thumb abducted, wrist 30 deg, MPs at 80 deg;
                   - compression garment after epithelialization;
    - 2nd degree - deep:
           - clinical features:
                   - wounds are sensate and painful, moist, and may blister;
                   - wounds may appear erythematous but deeper wounds may appear white;
           - prognosis: deep partial thickness may take over 6 weeks to heal, as the skin re-epithelializes from deeply seated epithelial cells which line the hair follicles, and sweat glands;
           - management:
                   - topical antibiotics
                           - silver sulfadiazine
                           - mafenide acetate
                   - elevation
                   - splint: thumb abducted, wrist 30 deg, MPs at 80 deg;
                   - compression garment after epithelialization;
           - debridement:
                   - early tangential excision and graft does not give better long term results than spontaneous healing;
                   - the problem is that it may not always be obious which tissues have a deep partial thickness injury and which tissues have received a full thickness injury (noting
                           that deep partial thickness injuries will have a better result if they are allowed to spontaneously re-epithelialize);
                           - remember that full thickness burns will leave the tissue insensate, and therefore tangential debridement can be carried out until sensate or bleeding tissue is encountered;
                           - often the palm and soles of the feet will sustain deep partial rather than full thickness burns, and these specialized skin surfaces have a better result when they are allowed to regenerate;
                   - frequent debridement of the overlying eschar / coagulum reduces bacterial count



Failure of topical prostaglandin inhibitors to improve wound healing following deep partial-thickness burns.

A comparison of full-thickness versus split-thickness autografts for the coverage of deep palm burns in the very young pediatric patient.

Year Book: Thermal-Crush Injuries of the Hands and Forearms: An Analysis of 60 Cases.

Primary surgical management of the deeply burned hand in children.

Early free-flap coverage of electrical and thermal burns.

Surgical correction of postburn flexion contractures of the fingers in children.

Results of early excision and grafting in hand burns.

Tangential excision of eschar for deep burns of the hand: Analysis of 156 patients collected over 10 years.
  
Burn sydactyly.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 22, 2012 11:36 am