Neobook — clinical reference

Developed by Prof H Rhode, Dr Albie van der Merwe, Dr Stephan Fourie & Prof A Millar & released as Circular H62 of 2011

(& updated 2016 by Dr S Cox, Dr R Martinez & Prof H Rhode)

Superficial partial thickness: destruction of only superficial layers of the skin.

These wounds will re-epithelialise spontaneously within 3 weeks; excision is contra-indicated & the wounds rarely cause functional or cosmetic defects or hypertrophic scars.
They characteristically have an erythematous, moist, homogeneous surface with blister formation, are painful & hypersensitive to touch, blanch readily on pressure & have a normal to firm texture on palpation.

Indeterminate depth (deep dermal burn): destruction of epidermis and varying amounts of dermis.

These wounds are difficult to assess during the first 3 to 4 days after injury due to the ongoing evolution within the burn wound, which can be modulated by infection & dehydration.
These wounds present with a reticulated red, white, dry surface & may blister.
Capillary circulation may be sluggish or absent when pressure is applied to the wound.
Wound pain is perceived as discomfort & the wound is often less sensitive to pinprick than the surrounding normal skin.
The healing time for these wounds may be variable & may require several weeks leading to severe hypertrophic scarring.
It is better to graft the wound if not healed within 2 weeks.

These wounds will not heal spontaneously within 3 weeks & have unsatisfactory functional & cosmetic results.
There is general consensus that the best treatment entails early (within the first week of injury) eschar excision & immediate grafting.
These wounds may mimic the appearance of an indeterminate burn & are usually mottled, white, red or charred & dry in appearance, insensitive to pain & leathery to palpation.
Blisters are unusual & if present are thin walled & do not enlarge. Clotted superficial vessels may be visible.
The appearance of the burn remains static with little change over the ensuing days.