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ensues. Deep partial-thickness burns can take many weeks to heal
completely. Significant scarring is common and skin grafting may be
necessary to optimize cosmetic results.
Full-thickness burns (formerly called third degree) involve destruction of
the epidermis and the entire dermis. They usually have a pale or charred
color and a leathery appearance ( Fig. 104.3D ). Important for recognition is
the fact that destruction of the cutaneous nerves in the dermis makes them
nontender, although surrounding areas of partial-thickness burns may be
painful. Full-thickness burns cause a loss of skin elasticity. The burned skin
cannot expand as tissue edema develops during the first 24 to 48 hours of
fluid therapy. Circumferential or near-circumferential burns of the torso,
abdomen, or extremities can therefore cause respiratory distress, abdominal
compartment syndrome, and vascular insufficiency of the distal extremities,
respectively. Full-thickness burns cannot reepithelialize and can heal only
from the periphery. Most require skin grafting.