Burn is a very devastating disease not only for its acute complications but also for the long term sequlae related to it. It is a long battle both for the patient as well as their family.
Frequent visits to Burn specialist, excruciating pains during repeated dressings, inability to eat /aversion to food due to gastric stasis and difficulty or inability to mobilize limbs are just some of the common difficulties faced by burn patients.
Prevention is better than Cure. Hence to prevent a burn injury is always better than treating it. But in case a person sustained a burn injury a patient specific appropriate treatment should be started at the earliest which should consist of management of acute burn injury and then management of post burn sequlae.
Burn treatment consists of dressing the wound using various burn dressing materials, giving analgesics to relive pain, maintaining adequate hydration of patient as well as doing psychological counseling of the patient to prevent burn psychosis. As the wounds start to heal patient start feeling much better.
Burn causes injury to skin layers leading to loss of its various functions, especially hydration and pigment control. Persons having deep burns heal with hypopigmented patches within burn scar tissue. In maximum patients color of skin return towards normal overtime but some may require surgical intervention in form of Skin grafting or Keratinocyte transfer. Also noted in them is complaint of itching in scar territory. Proper moisturizing is important to prevent this complication.
Post burn physiotherapy is an important rehabilitative tool to improve the range of motion of joints as majority of patients with deeper burns complaints of restriction of joint movement in healing period. It should continue for a minimum of 6 months to make the joints supple and help in achieving good results.
Post Burn complications could range from raw surfaces to scarring to contracture formation.
Raw areas which are not showing signs of healing should be taken up for debridement and split skin grafting as soon as wound bed is ready. The coverage of wound using skin graft will allow early healing as well as avoid late complications of contracture formation.
Post burn scar can range from simple change in pigmentation of burnt area to increased thickness of burnt skin (hypertrophic scarring).Many of these will respond to conservative management using massage and pressure garment application over time but those not responding may require intervention from Plastic Surgeon. Hypertrophic scars may cause restriction in movement of neck or upper limb and would require excision of hypertrophic scar and coverage using either local flaps or skin grafts.
Post burn contractures are dense scars which traverse across a joint. This results in restriction of natural range of motion of joints. Once they develop the only satisfactory treatment is surgical excision of contracture tissue and coverage of raw area with either a flap or skin graft whichever is best as per decision of surgeon. Patient is required to wear splints or cast for the healing period followed by wearing of pressure garment and aggressive rehabilitative physiotherapy to avoid reformation of contractures.
Yes, post burn scars can be managed without surgery in maximum of cases. Skin starts to heal and tries to attain normal functions over time. It is till that time that a person needs extra care and precautions to protect the newer layers of skin. Protection of skin using emollients and moisturizers can help prevent dryness. CO2 lasers are used in some patients to enhance scar modulation and in treatment of hypertrophic scars. Intralesional triamcolone injections can be given in some areas of hypertrophic scars/keloids to allay the symptoms of itching.
The quote that ‘Time is a great healer’ holds especially true in management of Burn injury.