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foot were caused when the patient spilled boiling water on her foot. They were full-thickness burns which required specialist treatment from a burns unit.

foot were caused when the patient spilled boiling water on her foot. They were full-thickness burns which required specialist treatment from a burns unit.

Partial thickness burns are allowed to heal by secondary intention, as are some small full-thickness burns. Extensive full-thickness wounds need skin grafting.

Chemical burns may originate from proprietary remedies, including:

• Corn and callus removers, which contain strong acids or caustics

• Undiluted antiseptics applied directly to wounds

• Contact with noxious chemicals.

As with thermal burns, these can be difficult to assess. When corn cures have been used, as much macerated, acid-loaded callus as possible should be sharp debrided. Chemical burns should be cleansed with saline, covered with a dry dressing and reviewed within 48 h. Extensive burns or burns when tissue devitalization is obvious at first presentation should be referred to a specialist burns unit.

Zoophilic traumas

• Bites and scratches from domestic animals such as dogs and cats are common. Animal bites need tetanus prophylaxis. Deep bites may need surgical debridement

• Rat bites can be a problem. Paul Brand recommends that neuropathic patients keep a cat and avoid eating in bed in case crumbs attract rats

manifest themselves by white, devitalized tissue (Fig. 4.35) and subsequent eschar formation, need specialized care from a burns unit, as do all burns which are unhealed after 3 weeks. It can be difficult to assess the severity of recent burns to the diabetic foot since lack of pain may be due to diabetic neuropathy rather than full-thickness damage.

Recent burns should be seen at 48-h intervals until their depth is established.

Burns are common in neuropathic patients and the cause should always be established and action taken to prevent repetition. Infection is a serious complication of burns in the diabetic foot and prophylactic antibiotics may need to be given (Fig. 4.36).

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