Emergency Care of the Burn Patient

Burns by Degree

SUPERFICIAL SECOND DEGREE BURNS

The other type of second degree burns is the deep second degree burn which can be much more difficult to treat because they don't heal as well. They can scar significantly because of the extended healing time. These burns need to be treated like third degree burns which means the will require surgery for skin grafting for optimal functional and cosmetic results.

Deep partial thickness burns have a waxy, white appearance which looks much like a third degree burn. The surface appears to be more dry and is much less painful than a superficial partial thickness burn.

Most of this diagram is taken up by the dermis which is much thicker than the epidermis and contains several structures that are very important physiologically. Notice the large blood vessels within the deep part of the dermis. These supply the skin with blood. These remain intact with second degree burns and that is why the injury may take on a bright red appearance. The nerve endings are also located deeply within the dermis, which explains why second degree burns tend to hurt as much as they do.

Notice on the diagram, the skin appendage lining the hair follicle or a sweat gland. This tubular structure is made up of epidermis. The epidermis penetrates deeply into the dermis. It is from these skin appendages that healing takes place. The superficial tissues which have been destroyed by the burn will fall off and intact epidermis will well up over the surface of this tissue and recover it with new skin. Because of these skin appendages this burn may heal in about 30 days, but very deep partial thickness burns shouldn't be permitted to heal because of their tendency to scar.

This is a picture of an elderly women with deep second degree hand burns on post burn day number 24. Eventually the left hand was grafted, where as the right hand was allowed to heal on its own.

These are the same hands after all wounds have healed. Notice the significant scar formation on the right hand; the hand wound that was allowed to heal on it's own.

This is how a deep partial thickness burn may look if allowed to heal without surgical intervention. The scars take on a very thick and rubbery texture and the function of the hands and arms will be poor due to the loss of range of motion. Scar tissue is quite unstable. The epidermis which covers a scar is not a good quality. Even months after this hand has healed, when the person starts using their hand areas of epidermis may tear off. Then they'll have to go back into dressings. This will compromise the potential of doing any kind of heavy work. Skin grafting a wound like this will achieve a better end result, both functionally and cosmetically.

Deep Second Degree Burns

*DISCLAIMER This site is designed as an introduction to thermal injury for emergency medical technicians, medical students and physicians in training. It is not a comprehensive guide to thermal injury. As such the information may not be sufficient to address specific patient problems and these should be handled by physicians familiar with the specific clinical details pertinent to the individual patient. We invite comments from all users of this site.