What is the treatment for partial thickness but deep burns?

Treatment for Deep Partial Thickness Burns

For deep partial thickness burns, immediate cooling with clean running water for 5-20 minutes followed by application of petrolatum-based products and non-adherent dressings is the recommended treatment, with referral to specialized burn care for burns involving face, hands, feet, genitals, or covering >10% body surface area (>5% in children). 1, 2

Initial Management

• Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular ischemia 1, 2
• Monitor children closely for signs of hypothermia during cooling, especially with larger burns 1
• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain control 1

Wound Care After Cooling

• After cooling, clean the wound with tap water or isotonic saline 2
• Apply a thin layer of petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 2
• Cover with a clean, non-adherent dressing such as Xeroform, Mepitel, or Allevyn 2, 3
• For burns awaiting professional evaluation, loosely cover with a clean cloth or non-adherent dry dressing 1

Treatment Based on Location and Severity

Deep Partial Thickness Burns Requiring Specialized Care:

• Burns involving the face, hands, feet, or genitals require immediate referral to a specialized burn center due to risk of functional disability 1, 2, 4
• Burns covering >10% body surface area in adults or >5% in children require specialized care 1, 2
• All burns with signs of inhalation injury (facial burns, difficulty breathing, singed nasal hairs, soot around nose/mouth) require immediate emergency medical services 1, 4

Deep Partial Thickness Burns Managed at Home:

• Small deep partial thickness burns without the above criteria may be managed at home with proper wound care 2
• Dressings should be changed daily and the wound should be monitored for signs of infection 2

Advanced Treatment Options

• For burns requiring professional care, silver sulfadiazine cream may be applied under sterile conditions to a thickness of approximately 1/16 inch once to twice daily 5
• Hydrocolloid dressings have shown faster epithelialization of hand burn wounds (15.7 days) compared to other treatments 6
• Silver-containing foam dressings may offer reduced pain during early treatment phase compared to traditional silver sulfadiazine dressings, though wound healing outcomes are similar 7

Common Pitfalls to Avoid

• Do not apply ice directly to burns as this can cause further tissue damage 1, 2
• Do not apply butter, oil, or other home remedies to burns 2, 4
• Do not break blisters, as this increases infection risk 2
• Do not delay referral for burns involving critical areas (face, hands, feet, genitals) 1, 2
• Be aware that silver sulfadiazine may cause transient leukopenia, particularly decreased neutrophil count, with maximal depression occurring within 2-4 days of treatment initiation 5

Monitoring and Follow-up

• Monitor for signs of infection including increasing pain, redness, swelling, or purulent discharge 2
• Continue treatment until satisfactory healing has occurred or until the burn site is ready for grafting 5
• For burns treated with silver sulfadiazine, be alert for potential side effects including skin necrosis, erythema multiforme, skin discoloration, and burning sensation 5

Deep partial thickness burns represent a significant injury that often requires specialized care to ensure optimal healing and minimize scarring. Proper initial management with cooling, appropriate dressings, and timely referral to specialized care when indicated are essential for optimal outcomes.