Exam 3 Study Guide
Week 9: Burn Rehabilitation
Definitions of thermal, chemical, electrical, and radiation burn
Thermal: Flame, scalding, thermal contact
o Temperature causes direct damage to the skin and sometimes the underlying
tissue
o Thermal common with children & elderly (watch patterns for abuse)
o Flame patterns vary and may involve inhalation in enclosed areas
Chemical: Caused by an acid, alkali, or organic compound
o Severity depends on the agent, concentration volume and duration of
exposure
o Sporadic pattern
o Know the chemical to neutralize burning process
Electrical: Caused by contact with high voltage or low voltage electricity or lightning
strike
o High voltage (power lines) causes underlying injury as well as obvious tissue
damage
o Low voltage (household) causes minimal cutaneous damage plus pain and
neurologic sequelae
o Lightning may cause cardiac arrest and other injuries
o “Tip of iceberg” entrance small, exit is blowout
Radiation: Damage due to radiant energy such as nuclear explosions or contact with
radioactive materials
o Sunburn (ultraviolet)
Definitions of 1st, 2nd, 3rd, and 4th degree burn
First degree
o Superficial
o Appearance - dry, erythema (red), no blister
o Tactile perception - sensitive, painful regardless of stimulation
o Blanching – blanches with pressure
o Spontaneous healing
Second degree
o Superficial partial thickness
o Appearance – moist, red, blistering, edema
o Tactile perception – painful regardless of stimulation
o Blanching – blanches with pressure
o re-epithelializes in 14-20 days
Deep partial thickness
o Appearance – Wet/waxy, patchy/white/red, blistering
o Tactile perception – Pressure only
o Blanching – No blanching
o Can convert to 3rd degree burn
, Third degree
o Full thickness,
o Appearance – Waxy, white/grayish/charred, leather appearance, NO blisters
o Tactile perception - None, insensate
o Blanching – No blanching
o Affected areas depressed, can heal in months/ years but increased chance of infection
Fourth degree
o Similar to full thickness except that charred tissue may slough away, exposing burned muscle,
bones or other deeper structures
o Will often require local or distant tissue flaps for reconstruction – skin grafts must have a good
bed for survival
o Often requires amputation of involved extremity or digit
What are the different types of skin grafts? What is the difference between a donor site vs
graft site?
Types:
Autograft – skin from self
Homograft/allograft - skin from cadaver
Xenograft – skin from an animal
CEA (cultured epithelial autograft) - biopsied skin grown in lab
Integra – dermal replacement (required a graft following integra intake
Donor vs graft:
Donor site is location from where skin is excised to then be relocated to cover the
burn
Donor site because of the depth of excision essentially becomes a partial
thickness wound
Donors heal in approximately 7-10 days
Donor are more painful than the graft site
Donor sites can be reharvested up to 3-5 times
Graft site is the location of the burn that will be covered by homograft or
autograft
Position of deformity for the neck, shoulder, elbow, wrist, and hand
Goals:
Prevent deformity/contractures
Prevent decubitus ulcers
Reduce/control edema
DEFORMITY CORRECT Technique
NECK Flexion Extension No pillow
Towel roll
Week 9: Burn Rehabilitation
Definitions of thermal, chemical, electrical, and radiation burn
Thermal: Flame, scalding, thermal contact
o Temperature causes direct damage to the skin and sometimes the underlying
tissue
o Thermal common with children & elderly (watch patterns for abuse)
o Flame patterns vary and may involve inhalation in enclosed areas
Chemical: Caused by an acid, alkali, or organic compound
o Severity depends on the agent, concentration volume and duration of
exposure
o Sporadic pattern
o Know the chemical to neutralize burning process
Electrical: Caused by contact with high voltage or low voltage electricity or lightning
strike
o High voltage (power lines) causes underlying injury as well as obvious tissue
damage
o Low voltage (household) causes minimal cutaneous damage plus pain and
neurologic sequelae
o Lightning may cause cardiac arrest and other injuries
o “Tip of iceberg” entrance small, exit is blowout
Radiation: Damage due to radiant energy such as nuclear explosions or contact with
radioactive materials
o Sunburn (ultraviolet)
Definitions of 1st, 2nd, 3rd, and 4th degree burn
First degree
o Superficial
o Appearance - dry, erythema (red), no blister
o Tactile perception - sensitive, painful regardless of stimulation
o Blanching – blanches with pressure
o Spontaneous healing
Second degree
o Superficial partial thickness
o Appearance – moist, red, blistering, edema
o Tactile perception – painful regardless of stimulation
o Blanching – blanches with pressure
o re-epithelializes in 14-20 days
Deep partial thickness
o Appearance – Wet/waxy, patchy/white/red, blistering
o Tactile perception – Pressure only
o Blanching – No blanching
o Can convert to 3rd degree burn
, Third degree
o Full thickness,
o Appearance – Waxy, white/grayish/charred, leather appearance, NO blisters
o Tactile perception - None, insensate
o Blanching – No blanching
o Affected areas depressed, can heal in months/ years but increased chance of infection
Fourth degree
o Similar to full thickness except that charred tissue may slough away, exposing burned muscle,
bones or other deeper structures
o Will often require local or distant tissue flaps for reconstruction – skin grafts must have a good
bed for survival
o Often requires amputation of involved extremity or digit
What are the different types of skin grafts? What is the difference between a donor site vs
graft site?
Types:
Autograft – skin from self
Homograft/allograft - skin from cadaver
Xenograft – skin from an animal
CEA (cultured epithelial autograft) - biopsied skin grown in lab
Integra – dermal replacement (required a graft following integra intake
Donor vs graft:
Donor site is location from where skin is excised to then be relocated to cover the
burn
Donor site because of the depth of excision essentially becomes a partial
thickness wound
Donors heal in approximately 7-10 days
Donor are more painful than the graft site
Donor sites can be reharvested up to 3-5 times
Graft site is the location of the burn that will be covered by homograft or
autograft
Position of deformity for the neck, shoulder, elbow, wrist, and hand
Goals:
Prevent deformity/contractures
Prevent decubitus ulcers
Reduce/control edema
DEFORMITY CORRECT Technique
NECK Flexion Extension No pillow
Towel roll
