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Burn Classification
*Prevent contractures - place in the THERAPEUTIC POSITION!
Use custom made or prefabricated
splints or everyday household objects.
Care: Clean silicone sheeting twice daily with mild soap & water and rinse well. To dry, pat with a non-fluffy towel.
Surgery involving the transplantation of skin, typically used for treating partial thickness and full thickness burns.
(Pendleton & Schultz-Krohn, 2006)
TBSA=Total Body Surface Area
Autograft: permanent surgical transplant of the body's own skin taken from an unburned donor sight (most common)
Allograft: processed human cadaver skin
Xenograft: processed pigskin
Photo retrieved from: http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/10303.jpg
(Pendleton & Schultz-Krohn, 2006)
Although skin grafts placed as sheets are more aesthetically pleasing, larger area's may require the skin to be "meshed."
Rule of Nines
Head = 9%
Trunk = 36%
Upper extremity = 9% each
Perineum = 1%
Lower extremity = 18% each
Photo retrieved from: http://biomed.brown.edu/Courses/BI108/BI108_2007_Groups/group11/ProcDerm.jpg
(Pendleton & Schultz-Krohn, 2006)
Photo retrieved from: http://www.intechopen.com/source/html/18943/media/image2.jpeg
(Spires et al., 2007)
Photo retrieved from: http://www.medicalexhibits.com/obrasky/2009/09102_08X.jpg
(Spires et al., 2007)
Inflammatory Phase:
Reconstruction Phase:
Maturation Phase:
(Kockrow, 2006)
Age: Children & young adults have a higher survival rate, but require more fluid per burned TBSA
Clients under the age of 50 have the best prognosis
Pre-existing medical issues: prolong tissues healing
i.e. vascular disease, diabetes, poor nutrition
presence of systemic infection
Lack of a strong social/family network: psychological
Type & Mechanism: Superficial burns have better outcomes than partial, full thickness, or deep burns
Inhalation Injuries worst prognosis
TBSA: <30% fewer complications; burns of only 50% TBSA can be fatal to an elderly adult
(Hettiaratchy & Dziewulsk, 2004)
(Garren & Kelly, 2009; Greenhalgh, 2011)
A contracture is a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.
(Schneider, Holavanahalli, Helm, Goldstein, & Kowalske, 2006)
Early ROM/Stretching
(Schneider et al., 2006)
(Procter, 2010)
Joint
Position of Comfort
Therapeutic Position
(University of Colorado Health Sciences Center, 1995)
Joint
Position of Comfort
Shoulder
Therapeutic Position
Shoulder, Elbow, Wrist, & Hand
(Procter, 2010)
(University of Colorado Health Sciences Center, 1995)
(Procter, 2010)
Functional deficits resulting from burns:
Elbow
(Procter, 2010)
(Garren & Kelly, 2009)
Joint
Position of Comfort
Therapeutic Position
(University of Colorado Health Sciences Center, 1995)
Wrist/Hand
Pressure garments and silicone gel sheeting are two optimal techniques for managing and preventing hypertrophic scarring. Although they are individually effective, some research demonstrates that combining the two techniques may be most effective, especially in instances where burns cover concave areas such as on top of joints and between fingers.
(Procter, 2010)
Etiology: Mechanisms of Injury
(Momeni, Hafezi, Rahbar, & Karimi, 2009; Burn Care Centre, 2006)
(Pendleton & Schultz-Krohn, 2006)
A burn injury can be sustained through a variety of sources including thermal/heat (flame, scald, and contact), electricity, chemicals, or radiation (sunlight).
(The Brigham and Women's Hospital, 2009)
Thermal Burns:
Flame: Inhalation injuries; 50% of adult burns
Scald: Spilled hot drinks, hot bathing water; 70% of pediatric burns; common in older adults
Contact: Object extremely hot or contact extremely long; Hot iron
Common in epileptics, older adults, those abusing substances
Electrical Burns: Current travels through body, creating an entry & exit point, damage is done between two points; 3-4% of burns
"True": Voltage passes through the body; 1000V or greater
"Flash": Caused by the heat of a voltage arc
Chemical Burns: Industrial accidents or household products; 9% of burns
Hydrofluoric acid most common culprit
Radiation Burns: Sunlight; 6% of burns
(Hettiaratchy & Dziewulski, 2004; Hall, 2009)
Superficial partial-thickness:
Appear moist, red, blistered, blanched or colorless, and are extremely painful.
Superficial burns:
Appear red, dry and painful, like sunburns.
(Spires et al., 2007)
Photos retrieved from: http://media-cache-ak0.pinimg.com/236x/04/e4/70/04e4706eb801649960cbb6dda870fd40.jpg
Burn Classification Con't
Full-thickness burns:
Appear red, white, brown, or black in color, dry, leathery and cause little pain due to damage of the dermal plexus of nerves
(Spires et al., 2007)
Photos retrieved from: http://media-cache-ak0.pinimg.com/236x/04/e4/70/04e4706eb801649960cbb6dda870fd40.jpg
Hypertrophic scarring is common following burn injuries, and is a response of the body’s natural healing process. The body sends high blood flow and increased levels of collagen to these areas, resulting in raised, red, rigid scarring.
(Procter, 2010)
Retrieved from: http://images.alfresco.advanstar.com/alfresco_images/HealthCare/2014/03/27/6e6ee7d5-fbc3-4c21-b125-046312d019ee/Hypertrophoic_Burn_Scar_SP3_Laser_Treatment.png
Fit: Apply the silicone sheet, adhesive side down, to the scarred area.
Avoid open wounds, infected areas, or unhealed tissues. Avoid contact with eyes.
In rare instances, an allergic reaction leading to rashes or irritation may occur. Discontinue use and contact therapist.
Retrieved from: http://www.rejuveness.com/mc_images/product/image/armscarsiliconesheet.JPG
Compression is a common tactic used for managing edema; however, compression techniques can also be used for scar management.
(Momeni, Hafezi, Rahbar, & Karimi, 2009)
(Momeni, Hafezi, Rahbar, & Karimi, 2009; Burn Care Centre, 2006)
(Momeni, Hafezi, Rahbar, & Karimi, 2009)
(Procter, 2010)
(Momeni, Hafezi, Rahbar, & Karimi, 2009)
Use: Pressure Garments are worn to treat & prevent abnormal scarring following a burn injury.
Initiation: 2 weeks following wound closure
Total Wear Time: 6-12 months, minimum
Wear Duration: 23-24 hours/ day; remove for bathing or interference with therapy
Wear Frequency: 7 days/week
Fit: Garments should fit tightly & apply direct pressure to the skin.
Avoid: garments that are too tight or cause numbness, tingling, or pain, as this will result in additional damage.
Custom Fit: Circumferential dimensions of a wounded body part are obtained using a truncated measuring tape.
Exerted Pressure: Manufacturers of custom pressure garments report that they provide 25 mm HG of pressure.
(Atiyeh, 2013)
(Hettiaratchy & Dziewulski, 2004)
(Atiyeh, 2013)
Photo retrieved from: http://www.gottfriedmedical.com/custom_compression-garments/boleros/images/441-FR.png
Photo retrieved from: http://cirrie.buffalo.edu/encyclopedia/images/pediatricburns_9.jpg
Care:
Hand Wash: Wash daily with warm water & mild soap and allow to drip-dry.
OR
Machine Wash: Wash garment daily with laundry detergent in warm water on gentle cycle & allow for air-dry only.
Avoid: Clothes drier, sunlight, heaters, hot water, bleach, dish washing soap, coco butters, vitamin E lotions & oils
All of which can weaken the elastic
(Atiyeh, 2013)
Olivia George