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Therapeutic Approach

Thermal insult can result in burn injury to:

  1. The epidermis only, classified as a first-degree burn, which appears erythematous without skin breakdown

  2. Injury encroaching into the dermis, classified as superficial or deep partial thickness or second-degree burns, with a blistered appearance

  3. Injury to the entire dermis, classified as full thickness or third-degree burns, with a pale, leathery, and ashen appearance

  4. Injury to the underlying fat, fascia, or bone, or fourth-degree burns

First-degree burns can be managed with soothing ointments, vaseline, or cocoa butter. Antimicrobial agents are not indicated. Second-degree burns can be managed with topical therapies. Wounds should be cleansed and nonviable skin debrided prior to the application of a topical antimicrobial agent. Deep second-degree burns often require surgical excision and grafting. Third-degree burns require surgical excision and grafting. Surgical donor sites are managed with topical therapies. Scars can be managed with fractional CO2 laser and Kenalog injections, as well as reconstructive surgery. See Table 94-1.

Table 94-1Burns Treatment Table

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