Regarding the pathophysiology and clinical features of thermal burns, all of the following statements are correct EXCEPT:

Question

Accepted Answer

D. Eschar formation in full-thickness burns is a protective barrier that should never be removed and always prevents infection. ## Thermal Burns — Pathophysiology and Complications

### Correct Statements (Options 0, 1, 3)

**Key Point:** The zone of stasis is the intermediate zone of tissue with compromised perfusion that may recover with aggressive fluid resuscitation, infection prevention, and wound care — this is a critical concept in burn management.

**High-Yield:** Hypertrophic scars are a major complication of partial-thickness burns (especially deep dermal injuries) and result from prolonged inflammatory phase with excessive myofibroblast activity and collagen remodeling.

**Clinical Pearl:** Curling ulcer (acute gastric ulceration) occurs in 10–15% of major burns due to increased gastric acid secretion, splanchnic vasoconstriction, and mucosal ischemia — prophylactic H₂ blockers or proton pump inhibitors are standard in severe burn patients.

### Incorrect Statement (Option 2)

**Warning:** This is the trap. Eschar is NOT a protective barrier that must be left in place. In fact:

1. **Eschar removal (escharotomy/debridement) is often necessary** — an eschar can act as a tourniquet, restricting blood flow to distal tissues and causing compartment syndrome.
2. **Escharotomy is a surgical emergency** in circumferential full-thickness burns of the trunk or limbs to restore perfusion and prevent tissue necrosis.
3. **Eschar does NOT prevent infection** — it is dead tissue that harbors bacteria and promotes infection; timely surgical debridement and skin grafting are the standard of care.
4. **Early eschar removal and grafting** reduce infection risk, length of hospital stay, and mortality in major burns.

| Feature | Eschar | Zone of Stasis |
| --- | --- | --- |
| Viability | Dead tissue | Compromised but potentially viable |
| Management | Remove surgically (escharotomy/debridement) | Preserve with fluid resuscitation and wound care |
| Infection risk | High (dead tissue is a nidus) | Reduced with appropriate care |
| Timing | Early removal indicated | Delayed removal; allow demarcation |

[cite:Park 26e Ch 20]

Answer

A. The zone of stasis in a burn wound represents tissue with compromised circulation that may recover with appropriate fluid resuscitation and wound care

Answer

B. Hypertrophic scars in burns are more common in deeper partial-thickness burns and develop due to prolonged inflammation and excessive collagen deposition

Answer

C. Curling ulcer (stress ulcer) is a well-recognized complication of major burns occurring due to increased gastric acid secretion and mucosal ischemia

Regarding the pathophysiology and clinical features of thermal burns, all of the following statements are correct EXCEPT:

Explanation

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