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Full Thickness Burns

- See:
      - Burn Management:
      - Chemical Burns:
      - Electrical Burns:
      - Frost Bite:

- Discussion:
    - full thickness injury which extends thru the entire dermis, and therefore spontaneous re-epithelialization will not occur;
    - clinical features: wound is insensate, waxy or dry, inelastic, has white appearance, and venous thrombosis may be present:
          - the insensate nature of the full thickness wound allows them to be distinguised from partial thickness wounds, and facilitates the 
                 debridement (since anesthesia is not required);
    - debridement:
          - escharotomy:
                 - indicated for circumferential full thickness burns in order to prevent tourniquet effect;
          - one problem is that it may not always be obious which tissues have a deep partial thickness injury and which tissues have received a 
                 full thickness injury (noting that deep partial thickness injuries will have a better result if they are allowed to re-epithelialize 
                 - remember that full thickness burns will leave the tissue insensate, and therefore tangential debridement can be carried out until 
                         sensate or bleeding tissue is encountered;
                 - often the palm and soles of the feet will sustain deep partial rather than full thickness burns, and these specialized skin surfaces 
                          have abetter result when they are allowed to regenerate;
          - treat w/ early excision (3-7 days) w/ STSG meshed 1.5-1.0 and non-expanded;
                 - full thickness or deep partial thickness burns of the hand can benefit from prompt excision and grafting to reduce edema formation 
                        and permit early joint motion;
                 - use of thick STSG or FTSG will help to minmize joint contracture;
    - 4th degree burns:
           - dermis + deep tissue (muscle, tendon, bone, nerve)
           - treatment amputation or flap coverage and lateral reconstruction;
           - consider external fixation

Year Book: Thermal-Crush Injuries of the Hands and Forearms: An Analysis of 60 Cases.

Primary surgical management of the deeply burned hand in children.

Early free-flap coverage of electrical and thermal burns.

Surgical correction of postburn flexion contractures of the fingers in children.

Results of early excision and grafting in hand burns.

Tangential excision of eschar for deep burns of the hand: Analysis of 156 patients collected over 10 years.

A comparison of full-thickness versus split-thickness autografts for the coverage of deep palm burns in the very young pediatric patient.

Burn sydactyly.

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