Characteristics of Deep Partial Thickness Dermal Burns
Deep partial thickness dermal burns heal with granulation tissue and fibrosis, which is the correct answer (A). 1
Burn Depth Classification and Characteristics
Deep partial thickness burns have distinct characteristics that differentiate them from other burn types:
Healing Process: Deep partial thickness burns heal through a combination of epithelialization and granulation tissue formation, often resulting in fibrosis 2. This healing process typically takes longer than superficial burns and may lead to hypertrophic scarring without appropriate intervention.
Pain Sensation: Deep partial thickness burns are painful to both light touch and pressure, not just pressure alone 1. This differs from full-thickness burns which are often painless due to destruction of nerve endings.
Hair Follicles: In deep partial thickness burns, hair follicles may be damaged but some deep portions remain viable. This contrasts with superficial burns (first-degree) where hair follicles remain completely intact 1.
Blanching Response: Deep partial thickness burns typically do not blanch on pressure, unlike superficial partial thickness burns which do blanch when pressure is applied 1.
Clinical Implications
Understanding the characteristics of deep partial thickness burns is crucial for proper management:
Healing Time: Without intervention, deep partial thickness burns typically heal in approximately 3-4 weeks, compared to superficial partial thickness burns which heal in 7-14 days 1, 3.
Scarring Risk: The granulation tissue and fibrosis formation in deep partial thickness burns creates a higher risk of hypertrophic scarring and contracture 2.
Treatment Approach: Deep partial thickness burns often benefit from early debridement and may require grafting to minimize scarring and contracture 4, 5.
Special Considerations: Burns involving the face, hands, feet, and genitals require specialized care even if they are deep partial thickness, as functional and cosmetic outcomes are particularly important in these areas 6, 1.
Management Pearls
Early cooling of burns with clean running water (15-25°C) for 5-20 minutes can help limit burn progression 1.
Assessment of burn depth can be challenging initially, and some burns may convert from partial to full thickness in the first 48 hours.
Deep partial thickness burns unhealed after 14 days may benefit from abrasion techniques to enhance epithelialization 5.
Novel approaches using hydrogels and dermal matrices have shown promise in reducing inflammation and preventing contraction in deep partial thickness burns 4, 7.
Remember that deep partial thickness burns involve damage through the epidermis and into the dermis, but some dermal elements remain viable, allowing for eventual healing through the combination of granulation tissue formation and fibrosis.