Superficial partial-thickness burn

Depth of injury · Epidermis + papillary dermis Heals under 3 weeks No graft

Destroys the epidermis and papillary dermis but leaves the deeper dermis and the whole adnexal reservoir intact, so the surface is resurfaced from surviving follicular, sebaceous and sweat gland epithelium as well as from the wound margin.

Traced from the start

  1. Stratum basale (germinativum)
  2. Lamina densa (type IV collagen basement membrane)Sublamina densa anchoring fibrils (type VII collagen)
  3. Papillary dermis
  4. Reticular dermis
  5. Hair follicle and the bulge stem cell nicheSebaceous glandEccrine sweat gland
  6. Superficial partial-thickness burn

Detail

Depth destroyed
Epidermis and papillary dermis; the reticular dermis and all appendages survive
Clinical signs
Blisters, brisk capillary refill and severe pain, because the dermal nerve endings are intact
Healing
Re-epithelialises in about 7-14 days from adnexal epithelium and wound edges, with no scarring and at most pigment change
Epidermal (superficial) burn
A sunburn-type injury involving epidermis only: painful, no blister, heals in 3-7 days, and is excluded from the percentage total body surface area used for fluid calculation
Fluids
Partial and full-thickness burns above 20% TBSA in an adult (10% in a child) need formal resuscitation: 3-4 mL/kg per %TBSA of Hartmann's over 24 hours from the time of the burn, half in the first 8 hours, titrated to a urine output of 0.5-1 mL/kg/h

When it goes wrong

Scald or brief flash burn reaching the papillary dermis

Cool with running water for 20 minutes (effective up to 3 hours after injury), avoid ice, cover with cling film; the wound heals without grafting

Wound infection or hypoperfusion in the first 48 hours

The zone of stasis converts, and a superficial partial-thickness burn deepens to a deep dermal burn that will now scar

Practise this structure

16 questions in the bank tagged Skin.

All 16 Skin questions →