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Stage Description I Erythematous skin with no lesions II Lesions affecting the dermis or parts of it or presence of blisters III Full-thickness wound only IV Full-thickness wound with bone, joint, or tendon involvement Unstageable Full-thickness wound with eschar at the base Indications for Referral Initial Management in the Office Hand burn Partial-thickness burns >10% of TBSA Apply dressings including bacitracin, mafenide acetate (sulfamylon), mupirocin (Bactroban), aquacel, biobrane, hydrocolloids, mepilex, xeroform, or acticoat7 Third-degree burns Burns involving major joints Chemical or electrical burns Inhalation injury or concomitant trauma Special social, emotional, or rehabilitation needs Trigger finger Conservative and steroid treatments show no improvements. Provider is not comfortable with steroid injection to the stenosing tenosynovitis. Activity modification Splinting Short-term nonsteroidal anti-inflammatory drugs Hand laceration Bite Neurovascular exam Laceration caused by teeth Sensory exam Capillary refill greater than 2 seconds Motor exam Exposed bones Achieve hemostasis with pressure Contamination, early infection, and associated fractures Irrigation with sterile or tap water Provider unable to close the soft tissue Soft-tissue closure Pressure ulcers Stage 3 and 4 wounds Wound evaluation and staging Bleeding control Pressure reduction Correct any existing malnutrition Occlusive dressings Venous wounds Necrotic tissue debridement Compression and leg elevation Aspirin Pentoxifylline Arterial wounds Wound with poor perfusion Leg elevation No improvements with conservative treatment Management of modifiable risk factors Diabetic wounds Refractory to conservative treatments Wound culture Deep ulcers reaching muscle or bony tissue Antibiotic therapy Dressing changes Patient education Management of risk factors Lymphedema Stage III Decongestive therapy Patient education Skin tears Open fractures, tendon, nerve, muscle lesions, or skin tears in the eyelids Moist dressings: aquaphor, hydrogel, or bacitracin. Delayed healing (> 21 days) Encourage fluid intake Scar management Scars present for more than 1 year Structured scar assessment A concerning scar assessment Subjective evaluation Keloids, recurrent scars, contracture scars, atrophic scars, widespread scars, or patients with a positive family history of abnormal scarring Compression therapy Dynamic and static splints Antihistamines Hydrotherapy TBSA, Total body surface area.
