## Deep Partial-Thickness Burns (2nd Degree) **Key Point:** Deep partial-thickness burns destroy the epidermis and extend into the dermis, but dermal appendages (hair follicles, sweat glands, sebaceous glands) remain viable and intact at depth. ### Histological Architecture Deep partial-thickness burns show: - Complete loss of epidermis - Coagulation necrosis of superficial to mid-dermis - **Preservation of deep dermal structures** (pilosebaceous units, sweat glands) - Viable tissue at the base allows for re-epithelialization from appendages ### Burn Depth Classification Table | Burn Degree | Depth | Epidermis | Dermis | Appendages | Healing | | --- | --- | --- | --- | --- | --- | | **Superficial (1st)** | Stratum corneum only | Intact | Intact | Intact | 3–7 days, no scar | | **Superficial partial (2nd)** | Epidermis + superficial dermis | Destroyed | Partial | Preserved | 2–3 weeks, minimal scar | | **Deep partial (2nd)** | Epidermis + deep dermis | Destroyed | Mostly destroyed | **Preserved at depth** | 3–6 weeks, hypertrophic scar | | **Full-thickness (3rd)** | All skin layers | Destroyed | Destroyed | Destroyed | Requires grafting | | **4th degree** | Extends to muscle/bone | Destroyed | Destroyed | Destroyed | Requires grafting/amputation | **High-Yield:** The presence of viable dermal appendages in deep partial-thickness burns is the key distinguishing feature — these allow slow re-epithelialization from the wound edges and appendage openings, though healing is delayed and scarring is common. **Clinical Pearl:** Deep partial-thickness burns appear mottled red or pale, with blisters that do not blanch. They are painful to touch (nerve endings intact) and require careful assessment to avoid under-triage to full-thickness.
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