ensues Deep partial-thickness burns can take many weeks to heal completely Significant scarring is common and skin grafting may be necessary to optimize cosmetic results Full-thickness burns (formerly called third degree) involve destruction of the epidermis and the entire dermis They usually have a pale or charred color and a leathery appearance ( Fig 104.3D ) Important for recognition is the fact that destruction of the cutaneous nerves in the dermis makes them nontender, although surrounding areas of partial-thickness burns may be painful Full-thickness burns cause a loss of skin elasticity The burned skin cannot expand as tissue edema develops during the first 24 to 48 hours of fluid therapy Circumferential or near-circumferential burns of the torso, abdomen, or extremities can therefore cause respiratory distress, abdominal compartment syndrome, and vascular insufficiency of the distal extremities, respectively Full-thickness burns cannot reepithelialize and can heal only from the periphery Most require skin grafting