Wound Care & Scar Management After Burn Injury

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Common problems scars with hypertrophic scars? What are burn hypertrophic Why form? doscars Hypertrophic scars: and generally less sensitive. ture” in 12-18 months. As scars mature they fadefew monthsafterthe burn,in color, peaks around become 6 monthsflatter, and will resolve softer or Scar healingcantake alongtime.“ma Scarring usually develops withinthefirst and appearance. disorganizedmanner,very whichgives thenew skin/scaradifferent texture organized manner, but inhypertrophic scarsthesefibersare created ina heal the damaged skin. Normally thecollagenfibersare laiddown ina very aged, as in the case of a burn. The body formsthe aburn. protein Scarscalled form collagen when tothe help dermal or lower layerScarring of the skinis related has been to dam age, ethnic origin, and the severity, depth and location of burns) andburnsthatrequire skingraftingare athighriskfor scarring. ring. Burnsthattake more than21days toheal(alsocalledfullthickness thicknessburns)healin14to21dayspartial andputyou atariskofscar than 10days generally have noscarring. More severe burns(also called deep severe thicknessburns) thathealinless burns(alsocalledsuperficialpartial It isdifficulttopredict whowill develop scarring. Research shows thatless function aswell asaffect theirbodyimage. andcanlimitasurvivor’scommon complicationofaburninjury abilityto scars (scarsinthearea oftheoriginalburnthatare raised)are themost hashealed.ring andwounds aftertheirinitial burninjury Hypertrophic burn canbecomefrustratedthattheyBurn survivors stillhave issueswithscar called contractures. Scars across joints cancauseadecrease inyour abilitytomove. These are movement are high. Are more prominent (noticable)around jointswhere skintensionand Can bewarmtothetouch, hypersensitive anditchy. the skin. Often have adeepred topurplecolorandare raisedabove thesurfaceof Develop withinthefirst few monthsafterthe injury. Stay withinthe area oftheoriginalburninjury. - - - - Itching can lead to scratching and skin break- Ask your doctor for recommendations on down. what moisturizer is best for you. Moistur- People with visible scars may feel self-con- izers with a high water content—such as those scious around others and avoid social situa- that come in a bottle—generally soak into the skin tions. This can lead to isolation, depression and faster and will need to be applied more frequently. lower quality of life. Moisturizers that come in a tube or jar are generally thicker and have less water, so they need to be Scars can be dry and result in cracking or applied less frequently. Be sure to avoid products breakdowns in the skin (ulcerations). that you may be allergic to, such as perfumed lo- Scars are more sensitive to sun and chemicals. tions. Contractures Moisturizers can be applied to all healed areas frequently throughout the day. Contractures can affect your ability to move and Moisturizers should be applied in thin layers take care of yourself. If your contractures involve and massaged in gently while the scars are your legs, you may have difficulty squatting, sitting, more fragile. As your scars mature, you can walking or climbing stairs. If your contractures begin to add more pressure to help your scars involve your trunk and arms, you may have dif- loosen so that they are not so stiff. ficulty with self-grooming, eating, dressing and bathing as well as working with your hands. Some Try to avoid soaking in a hot bath tub or using contractures are unavoidable, but many can be perfumed soaps as these will further dry your prevented with active involvement in your reha- skin and add to your itching. bilitation program. Here are a few reminders: Itching may be relieved somewhat with pres- Stretching should be performed a minimum of sure garments and topical or oral antihista- 5-6 times per day. To make stretching easier, mines. Talk to your doctor about how to use first moisturize your scars with a moisturizer antihistamines safely. recommended by your doctor. You should never use mineral oil, Vaseline or Your therapist may make a cast or splint to antibiotic ointments to moisturize your skin. help position your scar in a stretched posi- These can lead to allergic reactions and skin tion. It is important that you wear the cast or breakdown. splint as prescribed and tell your therapist if it Sun exposure becomes painful or causes skin irritation. You should avoid exposing your healing scars to Do as much for yourself as possible such as sunlight. Scars that are discolored and have not getting dressed and self-grooming. It may take matured burn easily. If you go out in the sun, we longer than you are used to, but movement recommend: and activity will improve your ability to move and take care of yourself. Planning activities in the early morning or late evening when the sun is the least intense. Itching Use a sunscreen with an SPF of at least 15 or Burns can damage or destroy the oil glands that wear protective clothing to minimize the expo- normally keep skin from getting too dry. Partial sure of your skin. thickness burns have few oil glands and full thick- Reapply your sunscreen every couple of hours Burn Injury Model System Consumer Information ness burns or skin grafts have no oil glands. The that you are outside. lack of oil glands leads to dry itchy scars. Many patients experience intense itching after Treatment of hypertrophic scars their burn. Studies have shown that the larger the You will need to work closely with your doctor burn, the more likely that itching will be a problem. and therapy team to make sure your scars heal as completely as possible. A strong commitment

Wound Care and Scar Management after Burn Injury Page 2 of 4 is required from you and your family member to can create blisters. Bumping your skin can create follow through with the treatment plan to ensure skin tears or ulcerations. Sometimes you may not the best scar result. even notice that your scar tissue has been damaged, so it is important to check your skin often. No single treatment is ideal for treating scars. These wounds generally become less frequent For many years, custom pressure garments were over time as your scars mature and become thought to be the best treatment for hypertro- more resistant to injuries. phic scars, but recent research has shown that pressure garments do not make any difference in Blisters how well scars heal. Blisters are most commonly caused by a If you and your medical team decide to use shearing or rubbing force on the scar. Blisters custom pressure garments, they should can develop from clothes that fit too tightly, be worn 23 out of 24 hours/day. Even though rubbing while putting on your pressure gar- the use of pressure garments may not improve ments, or rubbing a burn that itches. your scar, they can decrease itching and pro- Blisters should be pierced and drained as soon as tect the skin from injury. Some burn survivors you notice them. Use a sterile needle to make a also feel that the pressure garments look bet- small hole, drain onto a piece of gauze and then ter than the scars themselves. put a little antibiotic ointment on the area. Silicone gel sheets are pieces of thin, flexible If a blister opens up, you might need to ban- medical grade silicone that are placed over the dage it with a non-stick dressing. Adaptic or scars and may decrease itching and dryness. They Xeroform are two commonly used non-stick are generally durable and comfortable to wear. dressings that you can find at most pharmacies. They can be worn alone or underneath pressure garments, splints or casts. Some people find Do not use adhesive bandages or tape that is they are sensitive to silicone, so check your skin difficult to take off because your skin might frequently for irritation or rashes. tear when trying to remove it. Your therapists may recommend custom- Skin Tears to be worn under gloves, made inserts Skin tears happen most often when you bump compression bandages or custom garments into something such as a doorway, a counter to increase pressure on the scar and improve top or a piece of furniture. They can also be healing. These inserts can be made from a vari- cause by scratching. ety of substances, ranging from soft foam to a rubber consistency. If the area bleeds, put firm pressure over the wound for about 5 minutes until the bleeding stops. Massage can help soften and desensitize the scar. When combined with stretching, Wash the area gently and thoroughly with mild massage can make the scar looser, softer and soap and water. more comfortable. Talk to your therapists to Use a small amount of antibiotic ointment learn about specific massage techniques. and a non-stick dressing such as Xeroform or Surgical treatment is also an option if scar- Adaptic, and allow the wound to heal. ring prevents you from performing certain ac- If the surrounding area becomes red and tivities. It is important to stay in contact with warm, you might have an infection. Contact your treating burn physician for evaluation.

Burn Injury Model System Consumer Information your physician for further evaluation. Scar tissue wounds Ulcerations Scar tissue is fragile and easily damaged or Ulcerations are breakdowns in the skin that injured. Once your primary burns have healed, usually occur across bands of scar tissue your healed skin is vulnerable and you may ex- around your shoulder, the front of your elbow perience skin breakdowns or wounds. Rubbing and the back of your knee.

Wound Care and Scar Management after Burn Injury Page 3 of 4 These areas can be difficult to heal since physi- family. If you have concerns or questions about cal movements such as exercise can cause your healing process or treatments, contact your the wound to continuously crack open or get health care providers. bigger. Additional Resources for garments and Keep the wound covered with a thin film of scar products: For more information regard- antibiotic ointment, especially when you are ing compression garments, wound care and scar exercising and stretching. management products, please contact your doc- If the wound continues to crack open, enlarge tor or therapist so that they can make recom- or deepen, your health care provider may rec- mendations based on your specific needs. ommend a splint or cast so the wounded area References is kept still for a day or two. Anzarus, A., Olson, J., Singy, P., Rose, B., Tredget, E. (2009). The effectiveness of pressure garment therapy Allergic skin reactions for the prevention of abnormal scarring after burn Be sure to let your doctor know if you have injury: a meta-analysis. Journal of Plastic, Reconstruc- tive & Aesthetic Surgery, 62.77-84. any skin allergies. Durani, P., McGrouther, D.A., Ferguson, M.W.J. (2009) Allergic skin reactions can be caused by chang- Current scales for assessing human scarring: A review. ing the type of lotion or soap that you use or Journal of Plastic, Reconstructive & Aesthetic Surgery, by the elastic in your compression garments. 62.713-720. Edwards, Jacky. (2005) The use of silicone gel in hyper- If you have an allergic skin reaction, discontin- trophic scar management. Journal of Community Nurs- ue all soaps, lotions and ointments for 2-3 days. ing, 19.12.18-20. Once the reaction has gone away, soaps and Esselman, Peter C. (2007) Burn Rehabilitation: An Overview. Archives of Physical Medicine and Rehabilita- moisturizers may be reintroduced one at a time. tion, 88.2. S3-S6 Gabriel, Vincent. (2011). Hypertrophic Scar. Physical What can you do? Medicine and Rehabilitation Clinics of North America, Be actively involved in your recovery by asking 22,301-310. questions and participating in decision-making Urioste, S., Arndt, K., Dover, J. (1999). Keloids and about your care. Take a list of questions or Hypertrophic Scars: Review and Treatment Strategies. Seminars in Cutaneous Medicine and Surgery, 18.2.159- concerns to your medical appointments for 171. your health care provider to address. Williams, F., Knapp,D., Wallen, M. (1998). Comparison Always keep your skin clean and well moistur- of the characteristics and features of pressure garments used in the management of burn scars. Burns, ized. 329-335. Keep up your exercise program as recommended by your doctor. Source Our health information content is based on research Massaging your scars with lotion will keep evidence whenever available and represents the them moist, make them less sensitive and make consensus of expert opinion of the Burn Injury Model your stretching easier. It may also prevent skin System directors. breakdown. Authorship It is important to follow your providers’ in- Wound Care and Scar Management after Burn Injury was structions for using pressure garments, inserts, developed by Sandra Hall, PT, Karen Kowalske, MD, and Radha Holavanahalli, PhD, in collaboration with

Burn Injury Model System Consumer Information splints or silicone gel sheets. If they do not fit properly or cause problems such as pressure the University of Washington Model Systems Knowl- edge Translation Center. or skin breakdown, let your health care provider know right away. Disclaimer The healing process can often seem long and This information is not meant to replace the advice from a medi- frustrating for a burn survivor and his or her cal professional. You should consult your health care provider

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