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Bacitracin
17%
2/12
Pain relievers
Mafenide acetate
Excision and grafting
50%
6/12
Amputation
0%
0/12
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This patient presents with a burn on her right forearm that is significant for white color, and a dry and leathery texture. This is a full thickness, third degree burn and should be treated surgically with excision and grafting. Burns are classified by their extent and depth. First degree burns affect only the epidermis and present as painful and erythematous lesions. Second degree burns involve the whole epidermis and parts of the underlying dermis. Any burns with blistering are automatically qualified as second degree burns. Third degree burns are full-thickness burns and affect the whole epidermis and the whole dermis with possible extension into underlying muscle, fascia, and neurovasculature. Lloyd et al. discuss the diagnosis and management of burns. They state more than 95% of the burns can be managed in the outpatient setting if close follow-up is used. The goals in treatment for these burns are rapid healing, pain control and return of full function to the injured area. Though the patient above has no signs of smoke inhalation, Lloyd et al. also note the importance of checking the airway for edema, which then may require intubation. Kamolz et al. discuss the role of excision and skin grafting in full-thickness burns. They note that early excision and grafting leads to a decrease in mortality in patients with full thickness burns. They recommend a higher quality of care for the grafts post-surgery, and in their study found that the use of negative pressure of 75-120 mm Hg leads to a graft success rate of 95%. Negative pressure treatment for grafts was found to lead to improved morbidity and mortality for treatment of burns that are large, irregular, near joint lines, or in the elderly. Incorrect answers: Answers 1 and 3: Bacitracin and mafenide acetate would be appropriate therapies if concerned for infection in first or second degree burns. Answer 2: While pain relievers might be necessary for this person, they do nothing to treat the underlying problem of her burn. Answer 5: This patient has intact sensation and pulses in her extremity. She does not require amputation.
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