Burn reconstruction and rehabilitation
After the burn and skin grafts have healed, rehabilitation and reconstruction are critical to achieving positive outcomes.
A scar is made up of disordered collagen rather than highly structured collagen of skin prior to a burn. Recently grafted skin and deep burns become raised and red. It takes about 3–6 months for this process to take place. The severity of the scar may be the result of an inflammatory response.
Over the next six months and several years, the scar(s) will soften. This is called scar maturation. Scars never become non-scars, but do soften, lose the intense red inflammatory color, and may flatten.
Hypertrophic scars are scars that are raised above the wound. These kinds of scars remain confined to the wound itself.
Keloids are scars that expand beyond the margins of the original wound.
The earlier a burn (or any other wound) is covered with the patient’s own skin, the less the intensity of the inflammatory response which, in turn, can lead to reduced scarring. This is the primary reason we try to excise and graft burns as soon as possible after the burn occurs.
Neither healed burns nor grafted skin should intentionally be allowed to tan as the skin will permanently change color (hyperpigmentation). A sunscreen with an SPF greater than 15–30 is recommended.
Massage the scars
Massaging the wound, skin graft and/or scar with moisturizing cream is done three to four times a day. The grafted skin has no oil glands present, so moisturizing creams are required. Massage helps to flatten scar tissue and keep it soft.
Customized pressure garments are made on site at the hospital and are worn by the child after healing and/or skin grafting. The pressure garments are made specifically to cover healed wounds and skin grafts that have taken longer than two to three weeks to heal. Pressure is initially applied in the form of elastic bandages until these customized garments are made.
Pressure applied to healed wounds does not prevent scarring; however, clinical experience and experimental evidence has shown that pressure flattens the tissue and makes the long-term result more acceptable. When garments or other forms of pressure are prescribed, we recommend that they be worn 23 hours a day.
Surgical intervention may be necessary
A burn wound that has healed may need reconstruction or plastic surgery to improve function or cosmetic appearance. As children grow, their scars may not grow with them. When this happens, contractures occur.