What is the characteristic healing process of deep partial thickness dermal burns?

Deep Partial Thickness Dermal Burns Heal with Granulation Tissue and Fibrosis

Deep partial thickness dermal burns heal through a combination of granulation tissue formation and fibrosis, making option A the correct answer.

Burn Classification and Characteristics

Deep partial thickness burns (also known as deep second-degree burns) have distinct characteristics that differentiate them from other burn types:

• Healing Process: Deep partial thickness burns heal through granulation tissue formation and fibrosis 1, 2
• Pain Sensation: These burns are painful to both light touch AND pressure (not just pressure alone) 3
• Tissue Damage: They involve destruction of the epidermis and injury to deeper dermal layers 3
• Appearance: They do not blanch on pressure (unlike superficial partial thickness burns) 3
• Hair Follicles: While some hair follicles may be damaged, they are not completely intact as in superficial first-degree burns 3

Why Option A is Correct

Deep partial thickness burns damage both the epidermis and deeper layers of the dermis. The healing process involves:

1. Formation of granulation tissue (new connective tissue)
2. Fibrosis (scar tissue formation)
3. Limited epithelialization from remaining skin appendages 1, 2

This healing process is distinct from other burn types and often results in hypertrophic scarring without appropriate treatment 1.

Why Other Options are Incorrect

• Option B (Painful to pressure only): Incorrect - Deep partial thickness burns are painful to both light touch and pressure. Full thickness (third-degree) burns are painless due to destruction of nerve endings 3.

• Option C (Intact hair follicle): Incorrect - Intact hair follicles are characteristic of superficial (first-degree) burns. Deep partial thickness burns involve damage to many hair follicles 3.

• Option D (Blanch on pressure): Incorrect - Blanching on pressure is characteristic of superficial partial thickness burns. Deep partial thickness burns typically do not blanch on pressure 3.

Clinical Management Considerations

Deep partial thickness burns require careful management:

• Immediate Care: Cool burns immediately with clean running water for 5-20 minutes 3

• Treatment Options:

  • Early tangential excision and grafting is practiced by many surgeons 1
  • Abrasion of burn wounds unhealed at two weeks after injury can be effective 1, 2
  • Novel biomaterials like hydrogels may help reduce contraction and inflammation 4
  • Single dressing with appropriate materials can reduce healing time and inhibit scar proliferation 5

• Referral Indications: Deep partial thickness burns involving face, hands, feet, genitalia, or >10% body surface area (>5% in children) should be treated at a specialized burn center 3

Pitfalls to Avoid

• Misdiagnosis: Distinguishing between superficial and deep partial thickness burns can be challenging but is crucial for proper treatment planning
• Delayed Treatment: Deep partial thickness burns often require treatment beyond first aid to speed healing, prevent infection, and reduce scarring 3
• Inadequate Pain Management: These burns are painful and require appropriate analgesia; over-the-counter pain medications like acetaminophen or NSAIDs are generally recommended 3

Understanding the healing process of deep partial thickness burns is essential for determining appropriate treatment strategies and predicting outcomes for patients with thermal injuries.