| Question | Answer |
| Superficial burn (first degree) | epidermis only
minimal pain and edema, no blistering
heal 3-7 days |
| Superficial partial thickness (2nd degree) | epidermis and upper dermis
red, blistering, wet
heal 7-21 days |
| Deep partial thickness (2nd degree) | epidermis and deep portion of dermis
red, white, elastic, potential for hypertophic scar is high
sensation may be impaired
potential to convert to full thickness due to infection
heal 21-35 days |
| Full thickness (3rd degree) | epidermis, dermis, hair follicles, sweat glands, nerve endings
white, waxy, leathery, non elastic
sensation absent, pain free, requires skin graft
hypertrophic scar
healing can take months |
| Subdermal (4th degree) | fat, muscle and bone
charring present
peripheral nerve damage significant
Wound closure and amputation |
| Emergent phase intervention | splinting in antiderformity positions |
| Antideformity positions: hands, neck, elbow, knees, shoulder, hip, LE | hands: intrinsic plus
neck, elbow, knee: extension
shoulder: abduction
hip: extension
LE: anti frog leg and anti foot drop |
| Acute phase intervention | splinting and positioning
edema management
early participation in ADL
client and caregiver education |
| Precautions and contraindications | no passive or active ROM with exposed tendons or recent grafts (wait 5-7 days)
treat 30 mins after pain meds
avoid pooling of fluid in LE while standing-- compression wrapping
use of volumeter should be avoided |
| Surgical and postoperative | between 3-10 days until graft adherence is confirmed
of donor site: 2-3 days if no active bleeding
walking: not resumed until 5-7 days after grafting in LE
after immob, start with gentle AROM to avoid shearing of new graft
exercise of unaffected ext. |
| Rehabilitation phase | wound closure is stable
skin lubrication several x per day
skin massage for desensitization
compression therapy: edema and scar compression |
| custom made compression garments indications | all donor sites, grafted sites, and burn wounds that take more than 2 weeks to heal spontaneously |
| compression garments | provide gradient pressure
24 hours a day excpet bathing, massage, and other skin care activity |
| Outpatient and community reintegration phase | compression therapy, skin conditioning, splinting and positioning, exercise
ROM and strength tolerance |
| For full thickness burns, rehabilitation | 72 hours after: dressing changes, splint all times
5-7 days: AROM, light ADL
>7 days: PROM as tolerated
massage, compression garments, otoform/elastometer inserts, strength |
| hypertophic scar | most apparent 6-8 weeks after wound closure
apply compression therapy early and continue till scar matures 1-2 years |
| heterotopic ossification | formation of bones in abnormal areas
elbow, hip, knee, shoulder
loss of ROM rapid, pain local and severe
hard end feel during PROM
D/C passive stretching (including dynamic splint) and begin AROM with pain free range |
| pruritis | excessive itching
compression garment, maintenance of skin lubrication, use of cold packs and antihistamine medications |
