Inpattient Treatment
The road to recovery from a serious burn injury includes several stages, each with its own unique challenges. Immediately following a serious burn the most important task is getting the survivor to a specialized burn center. These centers are staffed by professionals with specialized training and experience in the treatment of burn injuries. There are over a hundred burn centers in the United States. A list of those centers by state and their telephone numbers are included in this packet.
Common Types of Inpatient Treatment
Topical (applied to the skin) antibiotics
The skin is the body?s largest organ (averaging more than two square yards in adults) and performs many vital functions, including protecting the body from invasion by bacteria and viruses. Burned skin not only loses its ability to protect against invaders, it becomes a breeding ground for bacteria. Because infections slow healing and increase scarring, preventing and treating infections is one of the most important tasks of a hospital burn unit.
Bandages
Bandages 1) protect against infection; 2) reduce heat and water vapor loss from burned skin; 3) keep the patient more comfortable because the injured area is sensitive to air currents; 4) help keep limbs, fingers and toes in a proper position for healing; and 5) collect drainage from the wounds.
Elevating injured limbs or digits and escharectomies
A person with a serious burn injury goes into shock, which causes swelling. Badly burned skin becomes stiff and resists swelling, leading to increased pressure inside limbs, fingers or toes that can choke off blood flow. Keeping an injured limb raised reduces the pressure inside the limb by draining out fluid. Surgical cuts (called escharectomies) in the burned skin can also allow the burned area to expand and decrease the pressure buildup in the injured area.
Exercise
As injured skin heals, the skin around the wound contracts (shrinks) toward the center of the wound as scar tissue forms in the wounded area. If joints in the area of injury are not regularly exercised, the scarred skin may become so tight that the joint cannot move normally. This is known as a contracture. Contractures often have to be treated (released) surgically. Consequently, even though exercising burned limbs can be painful, it increases flexibility and reduces long term complications. Rehabilitation that is begun early and continues late in the healing process ensures the greatest flexibility.
Pressure garments
Some scars grow beyond or above the area of the wounded skin (known as hypertrophic scarring). While the reasons this occurs are not fully understood, keeping pressure on the scar as it forms helps reduce the amount of hypertrophic scarring. After scar tissue begins to form, garments that put pressure on the scar are often used.
Skin grafts
Skin grafts are used in treating partial thickness and full thickness burns. Early surgical removal (called excision or debridement) of burned skin followed by skin grafting reduces the number of days in the hospital and usually improves the function and appearance of the burned area, especially when the face, hands, or feet are involved. However, if the patient?s life is in danger skin grafting is usually postponed.
The best skin grafts come from the patient?s own unburned skin (donor sites). These grafts (called autografts) will ideally come from locations that are not ordinarily visible, such as the buttocks or upper thighs, because the donor sites will not be normal in appearance after they heal. However, the size of grafts that are needed and the location of burns will also determine where the grafts are taken from.
An instrument called a power dermatome is set to a particular depth and shaves off a uniform layer of healthy skin to graft onto a burned site. The thickness of the skin graft depends on the area needing the graft. Most grafts are "split" (partial) thickness. The donor site for a split thickness graft does not need to be surgically closed and will ordinarily form a new top layer of skin in 10 to 14 days. In many cases donor sites can be used again for additional grafts, although there is a limit to how many times a donor site can be "harvested" for grafts. Because skin around a split thickness graft usually contracts and grows tighter, full thickness skin grafts may be needed in areas such as around the eyes, where tight skin could prevent the eyelids from fully closing. A full thickness donor site needs to be surgically closed. For large areas requiring skin grafts, a "mesh" is made out of multiple skin grafts. The area to be grafted has the dead skin removed (debrided), often with a power dermatome, in preparation for the graft.
Skin banks
When the patient does not have enough healthy skin for autografts, burn surgeons turn to other sources for skin. Skin banks are similar to blood banks. They test for communicable diseases and store skin from individuals who agreed to be organ donors before dying. The donor skin (called an allograft) is preserved in a solution or frozen. Grafts from skin banks are used as a temporary covering to protect against infection, reduce pain, reduce fluid loss, and allow the tissues underneath to heal. However, because the body?s immune system recognizes an allograft as being foreign, it rejects the graft in 1 to 3 weeks. It is then removed.
High tech skin grafts and artificial membranes
"Biotechnology" has recently produced new types of skin grafts. CEA (cultured epithelial autograft) uses living skin cells from the burn patient to grow new skin cells in sheets in a laboratory. Because the skin cells come from the patient, they are not rejected and form a permanent new skin layer. The sheets of CEA are very thin (10 ? 15 cells thick) and fragile; they have the strength when first applied of wet tissue paper and are easily torn. In patients with massive burns, CEA produces a better cosmetic result than if it weren?t used, but CEA patients often require longer hospitalizations and more surgeries to release contractures because of the need to reduce movement to avoid damaging the delicate grafts until they are established. Products like Integra use products from animals, including collagen and condroitin, in combination with silicone to form a synthetic skin substitute as a temporary covering for massive burns.
Length of hospitalization
The length of hospitalization depends on many factors. In addition to the severity of the burn injury, these factors include whether the person suffered lung injury from inhaling smoke or chemicals and whether the person had pre-existing medical problems, such as heart disease.