Burn Assignment 2024- Amber Schoenicke

Try to complete the assignment without your notes first – this will help you with recall
later and assist with your learning. (The goal is to help you learn, not just find the
information in your notes!) Then, go back and fill in the blanks using your notes if you
need to.

1. Fill in the following table:

Burn Deepest Burn Blanching/ Sensation Healing

Depth Tissue Layer Appearance Capillary Testing Time/
(Shallow to Damaged Refill (Y, N, Is Grafting
deepest) Fast, Slow) Required?
Epidermis red or pink, Yes, Fast Light touch, 3-5 days
Epidermal dry, no pin prick
blisters, mild intact, deep
edema, pressure
blanches
with
pressure,
peeling of
dead skin
occurs
Superficial Red to pink, Yes, Fast Light touch 1-2 weeks
dermis open blisters missing,
Superficial (papillary) that are but pin Minimal to
Partial wet/weeping, prick and no scarring
Thickness mild to deep
moderate pressure
edema, intact
blanching
will occur
Deep Dermis Red or pale Slow or no Light touch 3-10+
Deep (reticular) white, blanching and pin weeks;
Partial blisters prick scarring is
Thickness (rarely), missing, common
moderate but deep
edema, pressure Grafting not
tends to dry intact required but
quickly and could be
is typically done since
less wet wounds will
not heal
fully if they
are large
 hypodermis Dry, hard No Light touch, Grafting is
Full and leathery, blanching pin prick required
Thickness waxy white, and deep
yellow, pressure
tan/brown, are missing
could be
bright red
from scalds,
and also
black
Beyond the Blackened, No Full Grafting is
Subdermal subcutaneous charred skin blanching damage to required if
Burn tissue all sensory possible
(hypodermis), in the area otherwise
such as amputation
muscle or
bone

2. Clinically, how can you differentiate between a deep partial thickness and full
thickness burn?

Deep partial thickness has a longer healing time of 3-10+ weeks and only has
deep pressure, since light touch and pin prick are missing whereas in a full
thickness burn all sensation is lost and there is no blanching of the skin since
down to the hypodermis layer of the skin.

3. David Martinez was injured while cooking a Valentine’s Day dinner for his wife.
While transferring a pot of hot grease, he tripped on a dog toy and spilled the
grease onto himself. He was wearing a cooking apron and shorts when he was
injured. His wife carefully removed the clothing because she knew the grease
would continue to burn his skin (smart woman!), and she noted burns from his
stomach to his legs. She called you to come over because you are the only
medical professional they know. You noticed wet, weeping blisters on the
anterior lower half of his trunk and dry, tan/white areas on the anterior aspect of
his bilateral thighs to the knee. There was no pin prick or light touch and no deep
pressure sensation of his left thigh; deep pressure was intact, but no light touch
sensation was noted on the right. His groin area was spared.

a. Using the Rule of Nines, calculate the %TBSA that was burned.

9%= anterior lower half of trunk

4.5% each leg; 9% total in anterior bilateral thighs
18%= TBSA
 b. What is the suspected depth of his burn injuries based on presentation?

Based on the presentation he has a Full thickness burn on his left thigh,
with a deep partial thickness burn to his right thigh, and a superficial
partial thickness burn on his anterior lower trunk.

c. Will David require an escharotomy? Why or why not?

Yes, because he has a full thickness burn on his left thigh, but will not
need one on his trunk or other leg as it does not restrict breathing or
expansion.

4. David needed skin grafting to the burns on his thighs.

a. What type of skin grafts do you think he will get and why?

For his right thigh he could get a mesh split thickness partial graft,
whereas for his left thigh an autograft may be more suitable in order to
help replenish the skin that was already damaged. Therefore, I think the
best option for the full thickness burn is to take a graft from the patients
intact skin and use it on the affected area.

b. Explain why you might have to wait 5 days to work on hip and knee ROM
with David after the grafts.

You may have to wait and see how his body is able to adapt to the skin
graft, and whether it is able to “take” it or accept it. Once you know
whether his body will accept it and show signs of healing then you can
progress to more ROM exercises because you don’t want to open up the
wound even more so allowing for some healing is ideal early on in the skin
grafting process.

5. Explain the concept of composite stretching for a patient with burn scars. For a
patient with circumferential burns to the leg, explain the patient’s position for
stretching and explain how you would implement stretching into knee flexion and
then knee extension to maximize both joint ROM and function?

The concept of composite stretching is to put the patient in the most

optimal position in order to get the maximum amount of stretch of the skin
possible. The patient will be laying in supine if bilateral legs are burned
and can be in side-lying with the good or non burned leg down on the
table. When in side-lying the therapist is going to position the patient in
 knee flexion, hip extension, and plantarflexion of the foot in order to
working on stretching the skin on the anterior thigh. To stretch the
posterior side of the thigh extend the patients knee and move them into
some hip flexion, dorsiflexion of the foot in order to stretch the skin in the
back.

6. Explain the typical splinting positions of the upper extremity (shoulder, elbow,
forearm, wrist, hand) to prevent contractures (hint: after thinking through this, use
your O’Sullivan text to confirm).

Joint Typical Splinting Position

Shoulder Flexion and abduction (90 degrees)

Elbow Extension

Forearm Supination

Wrist/ Wrist extension, MCP flexion, PIP and DIP

Hand extension, and thumb abduction

7. How does the splinting position of the hand change if the burns are only on the
palmar surface?

If the burns are only on the palmar surface of the hand you are going to position
the hand into slight extension with the fingers extended. When the hand is
splinted you are going to create an extension moment with the gauze wrap
around the fingers and another extension moment around the thumb. When you
do this you are putting the finger flexors on stretch working on maximally
elongating them with put them back into extension a little bit.