Definition & Overview
The dressing and/or debridement of partial thickness burns (less than 5% of total body surface area) is part of the management of second-degree burns, which affect the top two layers of skin, namely the epidermis and hypodermis. As such burns have the tendency to become a full-thickness or a third-degree burn, proper management, including proper dressing and debridement, is crucial.
The specific method of dressing and debridement to use is determined based on the results of burn wound evaluation. In this evaluation, the extent of the burn is determined by calculating how much of the total body surface area is affected.
Who Should Undergo and Expected Results
Patients who should undergo the procedure are those who suffer from burns that have reached the second layer of the skin known as the hypodermis and whose wounds make up less than 5% of their total body surface area.
Second-degree burns can be caused by heat, electricity, radiation, chemical, and friction, but are commonly the result of direct contact with fire or flame as well as scalds. Thus, people who work around heat or flame, electrical equipment, chemicals, combustibles, and radioactive materials are considered at a higher risk.
Partial thickness burns are also classified into two different categories, namely superficial and deep partial thickness depending on their depth. Superficial burns, which affect the epidermis and the papillary layer of the dermis, may cause the following symptoms:
- Red skin that turns white when pressed
- Clear open or closed blisters
- Moist and painful skin
On the other hand, deep partial thickness burns that affect the epidermis and extend all the way into the reticular layer of the dermis, may cause:
- Red and white skin that does not blanch
- Bloody blisters
- Moist and painful skin
Superficial partial thickness burns can be left to heal on their own as long as the wound is properly cleansed, debrided, and dressed, whereas deep burns usually require more comprehensive treatment, such as surgery.
Proper dressing and debridement can encourage proper wound healing by protecting the wound from foreign debris and bacteria. It can also prevent complications and reduce scarring.
The type of dressing used influences the results of the procedure. The use of biologic dressings is known to result in faster healing, less pain, and less scarring, whereas non-biologic dressings are known to allow rapid epithelialisation while also costing less than biologic alternatives.
How is the Procedure Performed?
Dressing and/or debridement of partial thickness burns focuses on cleaning the wound during which all dirt, dead tissue, and foreign objects are removed. The procedure may also involve escharotomy, wherein a cut is made along the dead tissue to help decrease swelling. The wound is then treated, usually with topical ointments or antibiotics, before it is covered with a sterile dressing for protection. The bandage or dressing is placed over the burn loosely, especially if there are blisters, as the friction may cause more pain to the patient. Doctors also make sure that the adhesive holding the dressing in place does not touch the burn itself.
However, it is also possible to simply perform a debridement procedure without dressing the wound. This mostly depends on the size of the injured area as well as its location.
Partial thickness burns that are less than 5 percent of the total body surface area may take up to 2 weeks to heal, while larger burns may take up to a month.
Possible Risks and Complications
The dressing and/or debridement of partial thickness burns that affect less than 5% of total body surface area, when done properly, can help reduce potential risks and complications, such as scarring, that may otherwise arise from a burn injury. However, since partial thickness burns affect the deeper layer of skin, there is an inherently greater risk of infection than that associated with first-degree burns.
The procedure is generally safe, but may be painful as the debris and dirt are removed from the injured skin.
Fortunately, for burns that affect less than 5% of the total body surface area, the potential complications are fewer. There is little to no risk of going into shock, which is associated with burns that affect more than 10% of the total body surface area due to the amount of fluid that can be lost due to the burn injury. Nevertheless, burn patients are generally advised to drink more while recovering to help replace lost fluids.
Johnson, R. Michael; Richard, Reg. “Partial-Thickness Burns: Identification and Management.” Advances in Skin & Wound Care: July/August 2003: 16(4): 178-187. http://journals.lww.com/aswcjournal/Fulltext/2003/07000/PartialThicknessBurns_Identificationand.10.aspx
Lloyd EC, Rodgers BC, Michener M, Williams M. “Outpatient burns: Prevention and care.” Am Fam Physician. 2012 Jan 1;85(1): 25-32. http://www.aafp.org/afp/2012/0101/p25.html