Pathophysiology Mr. Eisner, age 43, sustained severe burns while welding a gasol
ID: 70010 • Letter: P
Question
Pathophysiology
Mr. Eisner, age 43, sustained severe burns while welding a gasoline tank that he had removed from a truck. He had full-thickness burns on his face and bald head and on both of his arms and hands – as well as a mixture of superficial and deep partial-thickness burns on his anterior trunk. His genital area, lower extremities, and posterior body were not burned.
After assessment and emergency stabilization, Mr. Eisner was transported to a regional burn center for care.
7. If he survives, will Mr. Eisner need any skin grafts? Please provide the rationale(s) for your answer.
Explanation / Answer
Yes, Mr. Eeisner would be needing skin grafts, provided he survives.
Rationale:
The skin consists of 2 layers - the epidermis and dermis. The epidermis is an external layer and is a stratified squamous epithelium that consists of mainly the keratinocytes. The epidermis has no blood vessels, and it receives its nutrition from diffusion from the underlying dermis through the basement membrane.
The dermis is a very complex structure and is made of 2 layers - papillary dermis and the reticular dermis.
The papillary dermis is thin and consists of loose connective tissue with capillaries, reticular fibers, elastic fibers and some collagen.
The reticular dermis is made up of thick connective tissue with large blood vessels, elastic fibers, and collagen fibers. Additionally, it contains fibroblasts, mast cells, lymphatics, nerve endings, and epidermal appendages.
Based on the anatomic position and the sex and age of the individual, the skin can vary in thickness. The skin is thickest on the palms and soles of the feet while it is thinnest on the eyelids and the postauricular region. Male skin is characteristically thicker than female skin in all anatomic locations.
As Mr. Eisner, age 43, suffered from full-thickness burns on his face and bald head and on both of his arms and hands – as well as a mixture of superficial and deep partial-thickness burns on his anterior trunk, he would require full skin grafts on his head, face, arms, hands and trunk regions.
Before talking about skin grafts, one needs to understand the skin anatomy.
The skin consists of 2 layers - the epidermis and dermis. The epidermis is an external layer and is a stratified squamous epithelium that consists of mainly the keratinocytes. The epidermis has no blood vessels, and it receives its nutrition from diffusion from the underlying dermis through the basement membrane.
The dermis is a very complex structure and is made of 2 layers - papillary dermis and the reticular dermis.
The papillary dermis is thin and consists of loose connective tissue with capillaries, reticular fibers, elastic fibers and some collagen.
The reticular dermis is made up of thick connective tissue with large blood vessels, elastic fibers, and collagen fibers. Additionally, it contains fibroblasts, mast cells, lymphatics, nerve endings, and epidermal appendages.
Based on the anatomic position and the sex and age of the individual, the skin can vary in thickness. The skin is thickest on the palms and soles of the feet while it is thinnest on the eyelids and the postauricular region. Male skin is characteristically thicker than female skin in all anatomic locations.
As Mr. Eisner, age 43, suffered from full-thickness burns on his face and bald head and on both of his arms and hands – as well as a mixture of superficial and deep partial-thickness burns on his anterior trunk, he would require full skin grafts on his head, face, arms, hands and trunk regions.