thickness burns penetrate completely through the epidermal and dermal
layer. All epidermal and dermal functions are lost at the burn area.
These burns enter the subcutaneous fat layer and occasionally the
muscle or bone.
thickness burns appear waxy and dry. They will be white, brown or
black and appear charred. The patient will not experience pain at the
site of the full thickness but will likely feel intense pain in the
partial thickness burn areas around the full thickness site.
section describes my particular burns
Thickness Burns in the Facial Area.
houses all 5 senses, and can produce a complex array of emotional
signals. More than any other feature, the face is responsible for how
the world views each of us and, in turn, how we interpret our world.
Because of these distinctions, care and management of the burned face
is important both psychologically, and cosmetically.
deep burns elsewhere, facial burns are mostly handled conservatively,
and when possible, are treated open, with ointments. The infection of
facial wounds is uncommon, allowing treatment to be concentrated on
conservation of vital tissue. If some areas do need resurfacing,
spot grafting is performed.using Full Thickness, or Thicker
Split-skin (approx .38mm) Autograft
to prevent scar contractures.
my case, one cheek, and an area under my bottom lip needed full
thickness skin grafting, the Donor Site being my other cheek, which
was closed by sutures. It took a long time for me to learn to smile
again as most of the nerves were destroyed, and even now, it's only a
grimace, but Kids and Dogs do recognise it!
My front neck area had 2 thick Split Skin grafts, to
prevent contractures, the skin taken from my thigh.
ear burns will respond well to conservative treatment. My burns were
mostly to my left side, but my right ear lost the top helical rim and
most of the earlobe. No grafting was done, and it healed up quite well.
Any how, no-one can really see BOTH of your ears at the same time.
Thickness Burns of the Hand
The care and
management of hand burns is almost as important as it is for facial
burns. The palm is usually spared due to involuntary fist clenching
at the time of burning, but when the palm suffers deep burns, the
wounds have a poor prognosis
full thickness burns of the back
of the hand,
grafting is desirable as long as aggressive physiotherapy is started
early. My left hand was completely 'De-Gloved', but apart from the
inside finger areas, the thicker than usual skin of my palm saved my
palm from 3rd
degree burns. The entire back of the hand was covered with split skin
graft sheet, as was my arm right up to the elbow. Physiotherapy on my
fingers was started very early and seemed to last a couple of hours a
day for several days, it was so easy to doze off while Physio Marilyn
worked on each finger. It was highly successful and it wasn't long
after that I
could 'make a fist' by clenching my fingers.
then I have had full use of that hand, excepting for the over-all
loss of feeling, mainly in my fingertips which precluded me from
carrying on with any manually demanding pursuits.
was very lucky in that a visiting surgeon did this job, and that he
had the expertise to spare my dorsal hand veins and tendons, and to
position all finger joints in full flexion prior to graft
include this section after research, for the completeness of this
of the perineum are unusual with major burn injuries. Many perineal
burns will heal by contraction if kept clean, Colostomy is not
necessary. Burns of the penis may cause more problems secondary to
contracture. Penile full-thickness burn may be conservatively
debrided and grafted to minimize contractures. Revisions following
grafting for penile burns are frequent.
women, burns involving the breasts have important psychological and
cosmetic implications. Sheet grafts are preferred for coverage.
Nipple burns will often repair naturally from the lactiferous ducts,
and conservative management is indicated. Full thickness burns
debriding and resurfacing involving the trunk in young females most
often spare the breast bud, which should not be included in the
excision specimen. Scars constrict growth and hinder development.