Burn, Partial and Full Thickness to Foot
Debora Sanches-Pinto, MD
, Elof Eriksson, MD
History:
17 year old woman who came to the ER with a scald burn to her left foot that had occurred 11 days earlier.
Eleven days after scald burn to left foot
Findings:
Scald burn to a 12 X 14 cm over the dorsum of the left foot. The central part of the wound is of full thickness and the rest deep partial thickness. There are no other injuries to the foot. Except for the acute burn, the patient is completely healthy.
Diagnosis:
Acute scald burn to dorsum of left foot less than 1% of Body Surface Area in a healthy 17 year old woman.
Differential Diagnoses:
It is either a deep partial thickness or full thickness burn.
Workup Required:
Vital signs and CBC and Basic Chemistry.
Plan:
1. Outpatient workup.
2. Schedule for debridement and split thickness mesh grafting or micro grafting under local anesthesia as an outpatient.
3. Dress grafted wound with: a, synthetic contact layer, moist foam and compression
4. Plan return visits 3, 7, 14 and 21 days after grafting
5. Admit, debride superficially and treat with Silvadene cream in an approximately 2mm thick layer + gauze dressing which is to be changed twice daily. If the burn turns out to be full thickness, schedule patient for mesh grafting or micro grafting.
Expertise Needed:
Burn surgeon.
Treatment:
At 11 days after injury, it was clear that the central wound, 11 X 8 cm was of full thickness and the patient was taken to the OR for debridement and micro grafting under local anesthesia. The micro grafts were covered with a synthetic contact layer, then a thin layer of hydrogel, then a moisture preserving foam and then a compressive wrap covering the foot and the ankle. She was scheduled for return appointments 3, 7, 14 and 21 days after surgery. She was completely healed 5 weeks after grafting.
Grafted wound – 10 days after micro grafting
Follow Up:
One year after grafting of dorsal foot burn the wound remains healed but with pigment changes.
References
Brownson,E,G, Gibran,N,S: Evaluation of the Burn Wound: Management Decisions. In Herndon,D,N: Total Burn Care, 10:87, 2018
Gillenwater,J, Garner, W: Thermal, Chemical and Electrical Injuries. In Grabb and Smith's Plastic Surgery. Ed by Chung, K,C, 21:177, 2020
Hamnerius, N, Wallin, E, Svensson, A, Stenstrom, P, Svensjo, T: Fast and Standardized Skin Grafting of Leg Wounds with a New Technique. Eplasty, 16:14, 2016
https://www.semanticscholar.org/paper/Evaluation-of-the-Burn-Wound%3A-Management-Decisions-Brownson-Gibran/ebcf636c16531a3c7ddccf1bb38dbb8e57710559
https://www.google.com/search?q=Gillenwater%2CJ%2C+Garner%
https://www.google.com/search?q=Hamnerius%2C+N%2C+Wallin%2C+E%2C+Svensson%2C+A%2C+Stenstrom%2C+P%2C+Svensjo%2C+T%3A+Fast+and+Standardized+Skin+Grafting+of+Leg+Wounds+with+a+New+Technique.+Eplasty%2C+16%3A14%2C+2016&rlz=1C1CHBF_enUS930US930&oq=Hamnerius%2C+N%2C+Wallin%2C+E%2C+Svensson%2C+A%2C+Stenstrom%2C+P%2C+Svensjo%2C+T%3A+Fast+and+Standardized+Skin+Grafting+of+Leg+Wounds+with+a+New+Technique.+Eplasty%2C+16%3A14%2C+2016&aqs=chrome..69i57.114658j0j9&sourceid=chrome&ie=UTF-8
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