John has just been brought into the emergency room following a fiery explosion at a chemical plant. He is diagnosed with third degree burns over the anterior surfaces of his arms and trunk. What specific structural damage has occurred to his skin?

What risks to John's life have resulted from this damage?


John has lost approximately 27% of his skin's surface area (according to the Rule of Nines), which leads to severe systemic effects. The epidermis, dermis, subcutaneous layer and associated structures have been destroyed. Sensory function is lost. Loss of epidermis (and so, lost keratin and Langerhans cells) makes John susceptible to microbial invasion. Loss of keratinized structures and lamellar granules allows for extreme loss of water, plasma, and plasma proteins, which causes shock; leading to dehydration, reduced blood volume and circulation, decreased urine output and diminished immune responses.

Anatomy & Physiology

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