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Class Progress
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Chapter Listing

Wound Care Demo


Chapter 13: Burns

Third-degree burns generally are leathery in consistency, dry, insensate, waxy, and will develop eschar. Burn eschar is structurally intact but dead and denatured dermis. Over the days and weeks after a third-degree burn injury, unremoved eschar separates from the underlying viable tissue, leaving an open, unhealed bed of granulation tissue. Without surgery, these wounds can heal only by wound contracture with limited epithelialization from the wound margins, resulting in hypertrophic and unstable skin. Therefore, third-degree burns, especially those located on critical areas such as the face and hands, benefit from early skin grafting.

Grafting may use autologous skin grafts, biologic dressings such as xenografts, cadaver allografts, bioengineered skin substitutes, or some combination of these. There are a number of different products within each of these treatment categories and each has slightly different characteristics. The nurse involved in the care of a burn patient using one of these products should familiarize him/herself with the specifics and proper use of the product ordered. Excision and grafting, initially using biologic dressings or skin substitutes, which minimizes the risk of infection, permits closure of extensive burns in stages, with the use of autografting performed at a later date. The dressings and splints, applied after autograft surgery, are typically removed on the fourth or fifth day following skin grafting. They may, however, be re-applied for some period of time in order to maintain proper positioning as deemed necessary. Removal is recommended as early as possible to encourage independent activity. It is important to remember that the autograft donor site will also be a superficial partial-thickness wound that will require appropriate care. This site usually heals in about 10 to 14 days. Usual dressings are Biobrane®, a biosynthetic dressing, a semi-permeable transparent dressing, or a petrolatum gauze dressing, such as Xeroform®. Xeroform stays on the donor site for about 7 to14 days. A black scab forms on the Xeroform and it begins to loosen. The Xeroform is trimmed back as more and more loosens until all of it has come off the wound and the wound has healed.

Third Degree Burn
Q: [Eschar] - Thick, leathery, necrotic, devitalized tissue. Typically black/brown/khaki in color. Typically dry, hard and firmly attached.
Q: [Epithelialization] - The stage of tissue healing in which the epithelial cells migrate (move) across the surface of a wound.The process of covering a denuded surface with epithelium
Q: [Eschar] - Thick, leathery, necrotic, devitalized tissue. Typically black/brown/khaki in color. Typically dry, hard and firmly attached. [Image]
Q: [Granulation Tissue] - The pink/red, moist tissue that contains new blood vessels, collagen, fibroblasts, and inflammatory cells which fills an open, previously deep wound when it starts to heal [Image]
Q: [Scab] - Dried exudate covering a partial thickness wound
Q: [viable] - Capable of living, developing, or germinating under favorable conditions.
Q: [Autologous] - Derived or transferred from the same individual's body
Q: [Infection] - Invasion of the body by living microorganisms
Q: [Contracture] - Muscle shortening due to loss of joint motion or spasm
Q: [Superficial] - Of, lying near, or forming the surface
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