The Third Degree

Here is a copy of my most recent assignment for my Anatomy and Physiology class. The text is entirely mine. If anyone wishes to quote from it or use the information for their own assignment, or to use the entire essay for teaching purposes, feel free.

COMPLICATIONS AND TREATMENT OF THIRD DEGREE BURNS
The severity of the potential complications posed by third degree burns depends on which part of the body was burned and on the amount of tissue that was damaged. The percentage of damage is calculated using the Rule of Nines. The following is the Rule of Nines measures for an adult: each arm has 9% of the body’s total skin, the head 9%, each leg 18% (two 9’s), the front of the torso 18%, the back of the torso 18%, and the neck 1%. Generally speaking, as the percent of the surface burned increases, morbidity and the probability of mortality increases sharply. Burns which cover 20% or more of the body surface can be fatal without treatment.
The most urgent complication posed by third degree burns is death due to loss of blood plasma, leading to circulatory shock and cardiac arrest. This happens because of fluid being transferred from the bloodstream to replace the fluid lost from the damaged tissue. The result is a decrease in the volume of circulating bloodstream. Another pressing complication comes from the potential for infection in the burned, dead tissue known as eschar. A secondary concern is contracture, or abnormal connective tissue fibrosis as the result of a third degree burn being left to heal on its own without medical intervention. Severe deformities can result from this.
Treatment for third degree burn victims starts with administering intravenous fluid to replace that which has been lost from the damaged tissue. The burn victim must also consume a very high number of calories to make up for protein loss and assist in tissue repair. They will receive supplemental nutrition intravenously or through a gastric tube. They will also receive powerful antibiotics.
The patient is kept in a sterile environment and will receive debridement treatments. The most commonly used method for many years has been mechanical debridement, in which a moist dressing is applied then manually removed. This can be excruciatingly painful for the patient. However, there have been advances in burn treatment and alternative types of debridement such as autolytic debridement are being used in certain cases. Autolytic debridement uses occlusive or semi-occlusive dressings to maintain wound fluid contact with the necrotic tissue. This encourages the body's enzymes and fluids to re-hydrate, soften and finally liquefy hard eschar and slough. Only necrotic tissue is liquefied. This debridement method is virtually painless for the patient but cannot be used in all cases.
After the initial treatment, the patient is likely to require a skin graft. Doctors generally perform an autograft, where skin is taken from another location on the person’s own body, usually the thigh or buttock, and is grafted to the burned area. However, in patients with more extensive burns, surgeons will use an isograft which employs skin from the patient’s close relative, preferably an identical twin. Skin banks also provide skin from cadavers to utilize in homografts. The rejection percentage for homografts is high. Surgeons generally use this measure as a temporary covering for the burned area until the patient is healthy enough to undergo an autograft. Pig skin can also be used in the same way. This method is known as a xenograft. Scientists are also working on developing artificial skin which will provide great advancement in the field of reconstructive treatment for burn patients.
C. Hartley
July 11, 2006

The following text is copied from this website which I utilized in part of my research:
http://www.medicaledu.com/debridhp.htm
Types of Wound Debridement
Autolytic Debridement:
Description:
Autolysis uses the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. Autolytic debridement is selective; only necrotic tissue is liquefied. It is also virtually painless for the patient. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue. Autolytic debridement can be achieved with hydrocolloids, hydrogels and transparent films.
Best Uses:
In stage III or IV wounds with light to moderate exudate
Advantages:
Very selective, with no damage to surrounding skin.
The process is safe, using the body's own defense mechanisms to clean the wound of necrotic debris.
Effective, versatile and easy to perform
Little to no pain for the patient
Disadvantages:
Not as rapid as surgical debridement
Wound must be monitored closely for signs of infection
May promote anaerobic growth if an occlusive hydrocolloid is used

Enzymatic Debridement:
Description:
Chemical enzymes are fast acting products that produce slough of necrotic tissue. Some enzymatic debriders are selective, while some are not.
Best Uses:
On any wound with a large amount of necrotic debris.
Eschar formation
Advantages:
Fast acting
Minimal or no damage to healthy tissue with proper application.
Disadvantages:
Expensive
Requires a prescription
Application must be performed carefully only to the necrotic tissue.
May require a specific secondary dressing
Inflammation or discomfort may occur

Mechanical Debridement:
Description:
This technique has been used for decades in wound care. Allowing a dressing to proceed from moist to wet, then manually removing the dressing causes a form of non-selective debridement.
Hydrotherapy is also a type of mechanical debridement. It's benefits vs. risks are of issue.
Best Uses:
Wounds with moderate amounts of necrotic debris
Advantages:
Cost of the actual material (ie. gauze) is low
Disadvantages:
Non-selective and may traumatize healthy or healing tissue
Time consuming
Can be painful to patient
Hydrotherapy can cause tissue maceration. Also, waterborne pathogens may cause contamination or infection. Disinfecting additives may be cytotoxic.

Surgical Debridement:
Description:
Sharp surgical debridement and laser debridement under anesthesia are the fastest methods of debridement.
They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind
Surgical debridement can be performed in the operating room or at bedside, depending on the extent of the necrotic material.
Best Uses:
Wounds with a large amount of necrotic tissue.
In conjunction with infected tissue.
Advantages:
Fast and Selective
Can be extremely effective
Disadvantages:
Painful to patient
Costly, especially if an operating room is required
Requires transport of patient if operating room is required.

Maggots
Click here and scroll down to see the nasty pictures.
These images were supplied by David Janssen, M.D.
Dr. Janssen used to have a very detailed website, but now it's gone.
Other web resources, click here.

Folks, as a trained medical person my stomach is made of fairly strong stuff. During my EMT training we would eat our dinner while viewing slides of gruesome trauma and none of us were fazed. But maggots in a wound, and me knowing they were there? That makes my stomach turn in ways I didn't know it could! Sorry, arm/leg/whatever, but there wouldn't be any saving you if there were maggots involved! Excuse me while I go lose my lunch.

Hopefully the advancements in burn care and reconstruction will continue--without maggots, thanks!

Cie