Burn injuries are considered the most devastating wounds to treat due to many factors: severity of the wounds, the extent of the burn, how much of the anatomical skin was involved, patient’s pain level and patient’s family’s feelings.
Approximately 22,500 patients with burns are admitted annually into the U.S. Burn Centers. According to Podiatry Today, injuries can occur in many different age groups. 45% of burn patients are noted in children less than 8 years of age. Burn is the leading cause of death for those that are less than 2 years old. 75% of the young children with burns are males, especially African American. “Reach and pull” scalding injuries commonly occur in young boys. 5000 scald injuries to the feet, typically occurred in both lower extremities, are reported each year. Burn injuries to those at the age group of 65 and older result in 3-4 fold higher mortality than younger patients. Burn injuries can also occur in domestic violence situations, which in most cases are too disturbing to describe.
A good understanding of anatomy of layers of the skin is very important to burn management. The epidermis, the superficial layer of skin, is found varied in thickness but noticeably thicker on the bottom (plantar) surface of the foot and back. Five layers of the skin can be appreciated histologically such as: stratum basale, stratum spinosum, stratum corneum, stratum lucidum and stratum granulosum. Deeper layer of the skin is known as dermis. Dermis is essentially the only layer that receives vascularization and innervations. Dermis is also divided into two sublayers which are papillary and reticular. Mast cells, macrophages and myofibroblasts are found in the dermis. However, important key players in burn healing are epidermal appendages, hair, and eccrine glands which are arisen from the dermis.