Deep dermal (deep partial-thickness) burn
Depth of injury · Into reticular dermis Over 3 weeks Hypertrophic scar
Extends into the reticular dermis and destroys most but not all of the adnexal epithelium. The few surviving deep follicles and sweat gland coils can still resurface the wound, but slowly and with heavy scarring.
Traced from the start
Detail
- Depth destroyed
- Epidermis and most of the dermis, sparing only the deepest follicles and sweat gland coils
- Clinical signs
- Sluggish or absent capillary refill and blunted pinprick sensation, because dermal vessels and nerve endings are largely destroyed
- Healing
- More than three weeks if left alone; wound contraction and dense collagen deposition follow
- Three-week rule
- Any burn taking longer than three weeks to heal carries a high risk of hypertrophic scarring and contracture, which is the argument for early tangential excision and split-thickness grafting
- Assessment
- Clinical estimation of depth is only around 70% accurate, so burns are reassessed at 48-72 hours before a grafting decision
When it goes wrong
Deep dermal burn allowed to heal by secondary intention across a joint
Hypertrophic scar and contracture with permanent loss of range of movement; prevented by early excision and grafting plus pressure garments and splinting
Deep dermal burn of the hand, face, perineum, or a circumferential or inhalational injury
Criteria for referral to a specialist burns unit regardless of total body surface area
Practise this structure
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