4th degree; areas of destruction: deep soft tissue damage to fat, muscle, bone, blood vessels thrombosed, nerves. charred or mummified appearance. dry with minimal edema may have exposed tendons, muscle, fascia, cartilage, capsule, and bone. sensation and blanching absent. requires surgical excision and graft or flap. may require fasciotomy and/or escharotomy due to compartment syndrome. may require amputation may have muscle paralysis due to permanent nerve damage.