![]() The zone of coagulation is where all cells are no longer viable and is at the central portion of the burn. The extent of the burn can divide into multiple regions. Surgical management and possible reconstruction are necessary for these burns. Subdermal burns affect the layers beneath the cutaneous layer to include adipose tissue (fourth-degree), muscle (fifth-degree), or bone (sixth-degree). These burns are usually painless as the nerves that run in the subdermal plane are singed and destroyed along with the skin's blood supply. This layer is slow to heal and should be excised, which creates extensive scar formation that often requires reconstruction. Healing time will be over three weeks, and lead to noticeable hypertrophic scarring.įull-thickness (third-degree) burns penetrate completely through the dermis and hypodermis, leaving a leathery and dry appearance to the skin. Deep partial-thickness burns present similarly to superficial partial-thickness burns but have little to no blanching and have diminished sensation. Deep partial-thickness burns reach the reticular dermis and may affect the hair follicles, nails, sweat, and sebaceous glands. It can take 10-14 days to heal completely with little to no scar formation. The superficial partial-thickness burn extends to the papillary dermis and is more painful than a superficial burn, produces exudative fluid, and easily blanches. Once this layer has been burned and structurally damaged, the skin can only repair itself when the basal layer of keratinocytes regenerates the skin layers. These burns penetrate the dermo-epidermal junction and create blisters that cause more apparent damage. The affected epidermis sloughs off in 3 to 4 days as keratinocytes regenerate.īurns that penetrate the dermis are partial-thickness burns (second-degree), and depending on the depth of penetration, partial-thickness burns further characterize as superficial partial-thickness or deep partial-thickness. Erythema and pain are characteristic of superficial burns and include injuries such as sunburns or small flash burns. Superficial (first-degree) burns are defined as burns to the epidermis and usually cause minimal damage and no blisters. The total body surface area (TBSA) of the burn and burn depth are the best predictors of morbidity and mortality and determines the treatment steps. All layers of the skin contain immune-competent cells that assist in the protective barrier created by the skin. The hypodermis is composed of a layer of fatty connective and areolar tissue as well as nerves and larger blood vessels that help supply the more superficial layers of the skin. Sweat glands and hair follicles are present in this layer. The dermis is found beneath the epidermis and is the mechanical strength layer that also functions as the main metabolic and nutrient-dense layer due to the blood vessels that penetrate this layer from below. The epidermis can be 10 to 100 cells thick, depending on the location on the body. This section is made up of keratinocytes, which create a protective barrier against the outside environment. The epidermis is the outermost layer of the skin and is avascular. It protects against trauma, radiation, microorganisms, and provides regulation of temperature and tactile sensation. The largest organ of the human body is the skin.
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