FIGURE 104.1 Estimation of surface area burned on the basis of age This modification by O’Neill of the Brooke Army Burn Center diagram shows the change in surface of the head from 19% in an infant to 7% in an adult Proper use of this chart provides an accurate basis for subsequent management of the child with burn injury Deep partial-thickness burns involve destruction of the epidermis and most of the dermis Edema can lessen the exposure of sensory nerve receptors, making some partial-thickness burns less painful and tender, although there should be some intact pain sensation Deep partial-thickness burns have a paler, drier appearance than superficial injuries, at times making them difficult to distinguish from full-thickness injury ( Fig 104.3C ) Thrombosed vessels often give deep partial-thickness burns a speckled appearance Burns evaluated immediately may appear to be partial-thickness injuries and subsequently become full-thickness injuries, especially if secondary damage from infection, trauma, or hypoperfusion