Burn Care: FAQs
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What is a burn injury?
The most common type of burn injury is a thermal burn, resulting from exposure to fire, scalding water, or hot objects (including the sun). Chemical burn injuries are another type of burn injury.

Burn injuries include damage to muscle, nerve tissue, and bones as well as the skin. Burn injuries are frequently accompanied by other traumatic injuries, such as fractures or other complications due to smoke inhalation or surgery.

One way to classify a burn injury is by depth of injury. This is useful when giving a prognosis for recovery and for making clinical decisions. There are three "degrees" that define burns:

• A first-degree burn is a superficial burn. It includes only the top layer of the skin.
  
• A second-degree burn includes all of the epidermis (skin) and a varying depth of the dermis.
  
• A third-degree burn, or full-thickness burn, includes the epidermis, the entire dermis, skin appendages, and at times deeper tissue. Such a burn, even when it includes a small surface area, usually requires hospitalization.

Why are burns so complicated?
Recovery from a burn injury requires skilled and highly specialized care. Open wounds must be meticulously cared for to prevent infection and to encourage wound healing as quickly as possible. Treatment may include respiratory treatment, speech therapy, swallowing therapy, and closely monitored nutrient and fluid intake.

As a burn injury becomes less acute, other issues require intervention. These include muscle, skin, and soft tissue extensibility (flexibility); daily living and walking skills; the building of a new self-image; the incorporation of previous leisure interests; emotional support; and re-adjustment to family and community life.

Why do scars form after the healing of burns?
The thick formation of scar tissue happens because the body produces a fibrous tissue called collagen after the wound has closed. This will cause the scar to become thick, tight, raised, and red in color. If the scar crosses a joint, it will cause joint tightness or contractures.

How can burn scar contracture be controlled?
The use of pressure garments, exercise, and splints can prevent or reduce the degree of scar contracture. Good Shepherd's occupational and physical therapists will instruct you in proper exercise techniques.

Why am I stiff in the morning?
Mornings are always the worst. The skin will probably have contracted overnight since you were not able to exercise. Many persons find that massaging their skin with a moisturizing cream before stretching helps significantly. Be sure to do your stretching exercises early every morning.

Why does my skin turn white and hard when I stretch?
Immature scar tissue will change from a red to white color while stretching. Be sure to pay extra attention to these areas because they can get much tighter if you do not stretch them on a regular basis.

What special care does healed burn skin need when exposed to sunlight?
Healed burn wounds, grafts, and donor sites are very sensitive to direct sunlight. They can burn very quickly and also become very dry. After burn wounds have healed, you should avoid direct exposure to sunlight for at least six months. Following six months, it is okay to allow short exposures to sunlight. It is important to use a sunscreen with a sun protection factor (SPF) of at least 15. Apply the sunscreen approximately 30 minutes prior to sun exposure. Also, try to avoid direct exposure to the sun at its strongest period (10 a.m. to 3 p.m.). Reapply sunscreen often and try to stay out of direct sunlight. You can gradually increase your exposure to sunlight over a period of time.

What can be done to reduce the itchiness of my healed burn skin?
Applying a moisturizing skin cream, such as cocoa butter, Keri® Lotion, or Elta® Creme, can help greatly with this problem. Also, speak with your physician about Benadryl®, which may also be helpful.

Why do some patients need to wear special garments?
These special garments help to manage the modeling of scar tissue. Without this compression, scar tissue often becomes thick and much less pliable than normal skin. It can significantly limit motion, and depending on the location, impact a person's ability to perform daily tasks. The garments, in most cases, must be worn for 12-16 months around the clock to produce desired results.

Why do burn patients require special nutritional supplements?
Someone who has sustained a burn injury has a caloric requirement that far exceeds normal values. Even individuals who were overweight prior to injury will require increased calories as the body will burn protein first in preference to their own fat. Sometimes 4,000-5,000 daily calories are required to prevent weight loss. This sometimes necessitates tube feedings.

How long does burn recovery take?
Recovery varies with location and type of injury, but scar tissue does not mature for at least a year and can sometimes require surgery.

For more information on the Good Shepherd Burn Care Program, contact us today or call 1-888-44-REHAB (24 hours a day, 365 days a year).