Full Thickness Burns

3rd Degree Burns (Generalisation)

Full 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.

Full 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.

The following section describes my particular burns

Full Thickness Burns in the Facial Area.
The face 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.

Unlike 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, careful spot grafting is performed.using Full Thickness, or Thicker Split-skin (approx .38mm) Autograft to prevent scar contractures.

In 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.

neck grafts

Most 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.

Full 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

In full thickness burns of the back of the hand, early skin 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.

Since 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.

I 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 application.

Other Areas (I include this section after research, for the completeness of this report) Burns 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.

In 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.

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