The degree of tissue damage is related to the agent causing the burn and to the

The degree of tissue damage is related to the agent

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• The degree of tissue damage is related to the agent causing the burn and to the temperature of the heat source as well as length of exposure. • Differences in skin thickness of various parts of the body also affect burn depth.
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• Burn wounds are classified as superficial-thickness wounds, partial-thickness wounds, full-thickness wounds, and deep full-thickness wounds. 1) Superficial thickness wounds • Of all burn types, superficial-thickness wounds result in the least damage because the epidermis is the only part of the skin that is injured. Caused = sunburn, short (flash) exposure to high intensity heat. Redness with mild edema. Desquamation (peeling of dead skin) occurs 2-3 days after the burn. Heals in 3-6 days without scar. 2) Partial thickness wounds • A partial-thickness wound involves the entire epidermis and varying depths of the dermis. • Depending on the amount of dermal tissue damaged, partial-thickness wounds are further subdivided into superficial partial-thickness and deep partial-thickness injuries. Superficial partial thickness = injury to upper third of the dermis, leaving a good blood supply Pink and moist and blanch (lighten) when pressure is applied. Might have blistering. Nerve endings are exposed and any stimulation causes pain. Depp partial thickness = extend deeper into the skin dermis, and fewer healthy cells remain. Blisters do not form. Wound surface is red and dry with white areas in deeper parts. Blanches slowly or not at all. Moderate edema and less pain than superficial burns. Blood flow to the area is reduced and progression to deeper injury can occur from from hypoxia and ischmiea. Heal in 2-6 weeks. 3) Full thickness wounds • A full-thickness wound involves destruction of the entire epidermis and dermis, leaving no true skin cells to repopulate; therefore, skin will not regrow. Has hard, dry leather eschar that forms from coagulated particles of destroyed skin. The eschar is dead tissue; it must slough off or be removed from the wound before healing can occur. When injury is circumferential (completely surrounds an extremity or the chest) = blood flow and chest movement for breathing may be reduced by tight eschar. Escharotomies (incision through the eschar) or fasciotomies (incision through eschar and fascia) may be needed to relieve pressure and allow normal blood flow and breathing. Sensation is redcued or absent because of nerve ending destruction. Can heal from weeks to months. 4) Deep full thickness wounds Extend beyond the skin and damage muscle, bone and tendons. Occur with flame, electrical or chemical injuries. Wound is blackened and depressed, and sensation is completely absent. Needs early excision and grafting. Amputation may be needed when an extremity is involved.
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