The blistering seen in the next several photos was not evident on day one. Once the initial bandages were removed these more than doubled in size.
A very clear demarcation line is evident from this view, indicating the kind of shoe the patient was wearing. As you can see, there is little in the way of blisters.
A day later the demarcation is even more evident and large blisters have appeared on the toes and above the shoe line.
A trip to the clinic to have the blisters debrided resulted in copious fluids on the floor. The physician told a nurse that it looked like someone had urinated.
A day later the debriding progresses.
Two days later the debriding is nearly completed. Notice that area which had initially appeared uninvolved is now scraped to the dermis. Also notice the small white patch of near-full thickness burn just distal to the knee.
The other leg/foot had some small involvement as well.
Another day passes and another dressing change. Inflammation is more evident and the extremity has become grossly edematous.
11 days post injury the rehabilitation continues. Weeping appeared less pronounced at the dressing change. Pain levels are somewhat diminished but still dependent on medication. Edema remains constant.
14 days post injury. Some very positive signs of healing. Edema is still a problem.
17 days post insult. We have some good healing, especially on the left leg and foot. Very soon there will be no dressing required of that leg only QID moisturizing creams.
Three weeks post insult we have some very satisfactory progress. The left foot no longer requires dressing, nor do the toes on the right foot. Walking remains painful due to slower progress around the lateral ankle.
Progress continues and the area requiring dressing is shrinking. The area proximal to the right, lateral ankle continues to be the slowest to heal. This is day 26.
At 28 days we have some dramatic improvement. Dressing size is greatly reduced although still too bulky to allow for wearing a shoe.
Final visit to the Parkland burn center on August 14th; 35 days post insult. Open lesions are almost completely resolved. All that is left is dead skin that will have to self-debride. Pain is minimal and positional Edema is still a problem, but the patient is able to wear a loose shoe. From this point forward the focus will be on limiting scaring.
Here we are at the six week mark. No more Silvadine and only minimal dressings. New skin has grown under those patches of dead. Now it is only copious application of moisturizing ointment, which will promote sloughing. The only remaining concern is the seemingly reluctant edema.
This will be the last update. The greatest portion of dead skin is sloughed. The scabbed areas are from localised, new blistering. This is to be expected as the new growth is still very tender and susceptible even brief exposures to heat or sunlight. This too shall pass.