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2nd degree burn
Specific location of the burn will guide management plan, areas of thin skin, flexion and extension creases and fine joints of the fingers are severely affected by persistent inflammation. When poor quality healing or hypertrophic scar anticipated early resurfacing with better quality skin must be considered
3rd degree burns
Full thickness burns = destroys the entire dermis and the potential for reepithelialisation and healing
Thick inelastic eschar will be present and defines the depth of the injury
Initially the burn surface is not painful
Skin graft resurafcing is indicated because no spontaneous epitheliaisation is possible
Early grafting reduces morbidity, small joints of hand extremely sensitive to any degree of skin restriction
4th degree burn
results from prolonged thermal contact and invloves soft tissues and underlying tendon, joimt and bones. Injured tissue is charredProlonged hot immersion, exyended flame contact and electrical burn injury may show this level of tissue destructionExtensive reconstruction procedures and often amputation result
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