[libribook.com] Traumatic Scar Tissue Management 1st Edition

Figure 6.1
Depth of burn trauma and structures impacted.
Dermal water plays an important role in maintaining the physical properties of
the skin (e.g. moisturizing and elasticity) (Nakagawa et al. 2010). Specialized
cells in the dermis assist with regulating temperature and fighting infection. The
dermis also houses vessels that supply blood and nutrients to the skin. Damage
to the sweat glands, sebaceous glands, hair follicles, nerve receptors, blood
vessels, lymph nodes/vessels, muscle and connective tissue may occur.
Partial-thickness burn injuries can be extremely painful, are often accompanied
by blistering and edema/swelling, and may require debridement (removal of
lacerated, weaken, debilitated or contaminated tissue) or skin grafting
(transplanted tissue). Depending on the type of skin graft needed, the donor site
may lose the epidermis and part or all of the dermis.
Third Degree
Third degree trauma involves destruction of all epidermal and dermal layers and
is commonly referred to as a ‘full-thickness’ injury. Damage extends below hair
follicles and sweat glands, into the subcutaneous tissue (i.e. connective tissue
(CT) layer that is seeded with adipocytes).
With full-thickness trauma, there may be extensive edema and skin
characteristics can change dramatically (e.g. charred, leathery appearance). Third
degree injuries are usually not painful because of the destruction of nerve
endings. Skin grafting or other replacement options are often required.
Fourth Degree
Fourth degree trauma involves destruction of epidermis, dermis, subcutaneous
tissue, ligaments, tendons, nerves, blood vessels, possibly down to the level of
bone. Fourth degree trauma often leads to amputation and significant functional
impairment. Skin grafting and multistage reconstructive procedures are
necessary.