Reference no: EM133223137

Burns can be classified into three types. First-degree burns occur when only the epidermis is damaged. These include sunburns and mild scalds, and typically heal on their own. Second-degree burns occur when the epidermis and part of the dermis are damaged. Third degree burns occur when the entire epidermis, dermis, and sometimes deeper tissue as well is damaged. Dr. Hassan notes that Olivia has second and third-degree burns covering both arms, shoulders, and her anterior chest.

The "rule of nines" is a quick method to assess the extent of burns in an adult. In this method, the body is divided into regions that each account for about 9% of the body's surface area. These regions are the head/neck, each arm, each anterior leg, each posterior leg, the anterior chest, upper back, anterior abdomen, and lower back. (Note that in the image to the left, some regions are grouped together). The genitalia account for the remaining 1%.

Burn coverage of greater than 20% is considered likely to be life-threatening.

1. Based on the above information, are Olivia's injuries likely to be life-threatening?

2.One of the first things Dr. Hassan orders is to start Olivia on IV fluids. Based on your knowledge of skin function and anatomy, why would a burn victim need to replenish their fluids?

3.The next thing Dr. Hassan does is to clean and dress Olivia's wounds to prevent infection. How does the skin normally protect our body from infection?

4. Dr. Hassan conducts a "pinprick" test, and determines that Olivia does not feel the sensation of a pinprick in the areas where she has third-degree burns. Why is this?

5. First-degree burns, such as sunburns, typically heal on their own without further treatment. Why is this? Which specific cells are responsible for re-growth of damaged epidermis?

Because Olivia's burns are mostly second and third-degree, they will not heal on their own and will require skin grafts. Dr. Hassan decides that the best treatment for Olivia is to perform an autograft. This means that he removes some portions of healthy skin from another area of Olivia's body (the area the skin is taken from is called the donor site: typically located on the thigh, buttocks, or back), and grafts that skin onto the burn sites. He decides to take a "split-thickness skin graft", meaning that he removes the epidermis and part of the dermis from the donor site. Donor sites (shown in image on right) typically heal within 2-3 weeks.

6. Why is it important to ensure that a skin-graft contains the entire thickness of the epidermis?

7. As mentioned above, donor sites for skin grafts can heal on their own, despite removal of the epidermis. Can you explain why this might be? (Hint: because split-thickness skin grafts only take parts of the dermis, they leave behind dermal appendages such as hair follicles and sweat glands. What do you know about the development of these appendages?