Skin Care for Burn Wounds
Understanding skin care for burn wounds is a very important part of your rehabilitation program. Simply put, your skin needs extra attention. Here are the areas you should be attentive to:
Naturally, it’s important to keep your skin clean. Once a day, you should bathe or shower using a soft, soapy cloth to gently remove dried skin and ointments.
Other tips include:
• Avoid rubbing your skin hard when bathing or showering because this can cause your still-fragile skin to break down.
• Pat yourself dry with a soft towel.
• Use lukewarm, not hot, water.
• Consider adding a few drops of bath oil to the bath water to help moisturize your skin, but be careful not to slip in the tub.
• If your skin is very dry, do not soak in the bath. Choose to shower instead.
• Always moisturize your skin after a bath or shower with your recommended moisturizing product and, perhaps, more often throughout the day.
It is vital to keep healed burn/grafted skin supple and moist. After a burn injury, the skin’s glands are not able to produce the same amount of lubricating oils as before. Your skin may feel tight and less supple, and may be dry and scaly in appearance. Consequently, until your skin is able to produce enough of its own oil, you will have to use moisturizing products to lubricate your skin.
Choosing a moisturizing lotion
Most skin care and burn care experts recommend mild, non-perfumed, non-irritating, water-based lotions. These products will make your skin feel more supple and provide you with greater comfort. There are a few excellent products available at pharmacies with therapeutic effects that are equally good, but you may prefer one over another. Experiment with different products; talk to your pharmacist and try the ones recommended by the burn team.
Two recommended products are Smith & Nephew’s Professional Care® Lotion and Schering-Plough’s Complex 15® Therapeutic Moisturizing Lotion.
Avoid Vaseline® and mineral or lanolin oil-based products. These tend to clog the skin’s pores and are not effectively absorbed into the deeper layers where the dryness problems begin.
Applying moisturizing lotion
Gentle massage not only increases the pliability of the skin but decreases the sensitivity of the healed skin and scar tissue.
1. Massage the lotion gently onto your skin with light stroking motions so as not to cause friction.
2. As time progresses and your skin becomes less fragile, you can massage more firmly.
3. Lotions should be applied as often as is necessary.
4. The amount applied should be enough to be absorbed by the skin without forming any greasy build-up. If oil is allowed to accumulate, you may notice small pimples or whiteheads forming on your skin.
Related: Taking care of your skin
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Pressure ulcers have been given many names – bedsores, skin ulcers, wounds, decubitus ulcers – but they all mean essentially the same thing. The important thing to understand is that the information in this book Pressure Ulcers: Prevention and Treatment can help all these conditions
Avoid itching of the skin
A healing burn injury is usually dry compared to normal skin and there may be areas of unsettled scarring. These two factors can cause itching. The problem of itching is related to the damage scratching can do to the skin. Breaking the integrity of the skin can slow down the healing process, cause possible infection and make scarring worse. Eventually, as the skin becomes more naturally lubricated and the burn scars settle down, the itchiness will stop. In the meantime, here are some tips to cope with the itching problem:
• Cleanse with lukewarm, not hot, water.
• Maintain lightly lubricated skin at all times.
• Add bath oil to a bath or apply after a shower.
• Avoid warm places.
• Apply cool towels to areas that are itching.
• If recommended, wear pressure garments.
• Wear loose, 100% cotton clothing next to the affected skin.
• If possible, adjust humidity and temperature in your home to avoid excessive dryness.
• Avoid scratching or rubbing the itchy area.
If you do have to scratch, wear gloves or at least use the pads of your fingers. Never scratch with your fingernails; this can cause damage to the delicate, healing skin.
If you live in an extremely dry or hot climate, such as in the mountains or desert, consider purchasing an air conditioner and limit your time outdoors.
New sensitivity to heat and cold
Your newly-healing skin will be thinner than before your injury and you may experience greater sensitivity to heat and cold. It is possible you may feel a tingling or numbing sensation in your hands and feet in cold weather, or find you sweat more from uninjured areas of your body when it is warm. Over time, as the long healing process takes place, these feelings should diminish.
The key to coping with these unusual feelings is to adjust your activities and clothing in line with your tolerance and reactions.
Avoiding overexposure to sunlight
Your newly-healed skin will be sensitive to sunlight, particularly for the first six months after healing. There are three major problems when you expose your healing skin to sunlight:
• You can sunburn very quickly.
• Healed burn areas can turn permanently dark brown.
• The sun withdraws much-needed moisture from your skin.
The most important advice here is to avoid direct sunlight at all times. In fact, with a burn injury, it is advisable to stay out of direct sunlight for at least six months. After that time, you may expose yourself to direct sunlight for very short periods, as frequently as possible. Protect your injured skin with light-coloured cotton clothing. If your face and neck were subject to burn injury, wear a large-brimmed hat and sunglasses. Also, apply total sunblocks to protect your skin from the sun’s rays. You can ask your pharmacist for sunblocks containing high levels of para-aminobenzoic acids, or PABA, to ensure the greatest protection possible. Remember, however, that a sunblock does not totally block the sun’s rays – it only increases the time required for the sun’s rays to take effect.
Dealing with blisters
It is common for pressure or friction exerted against the sensitive areas of healed skin to cause blisters to develop. Over time, as your skin becomes thicker, blisters will develop less frequently. Do not deliberately puncture your blisters. If they should burst, keep them clean and open to the air to promote healing. If you are wearing pressure garments, small blisters or areas of skin breakdown can be protected with a small piece of plastic kitchen wrap, such as Saran™ Wrap. If the open area is large and does not heal within a week, stop wearing pressure garments temporarily and contact your physician or burn team as soon as possible.
Dealing with skin discolouration
The good news is that, over a period of less than two years, most discolouration will fade. Areas of deeper burns may not return to exactly the same colour as before the burn injury, but you will notice improvements.
The range of discolouration can vary from pale pink to deep purple. This colour is influenced by temperature, the level of your activities, whether you are sitting or standing, if your arms are hanging down by your sides for prolonged periods of time, and your schedule for wearing pressure garments.
As long as you have some form of redness, the newly healed skin will be vulnerable to a number of problems, such as blistering, which are related to fragile skin. You are advised to keep to the skin care recommendations for the period of time it takes for things to settle down.
Once your healed skin is past the blistering stage, you may be interested in paramedical cosmetic camouflage. Both men and women can learn to use these cosmetics that are specially blended for people recovering from burns. These cosmetics, which have high levels of pigment, are usually waterproof, and can be blended to match the colour of your adjacent, uninjured skin. If you are interested in learning more, ask your burn team.
Here are some brands highly recommended by the burn teams we spoke to:
• Eva Bouchard®
• Corrective Concepts®
• Cover FX®
Managing your maturing scar
This aspect of skin care is a critical and specialized topic that will require your vigilance and discipline to ensure a successful outcome. Once your burn has healed, only the first stage of recovery is completed. The second and longer stage involves the management of the maturing burn scars.
Over time, you will notice that your flat, smooth burn is not only becoming redder, but is increasingly raised and tight as well. These changes are normal for a maturing burn scar and will continue to occur unless an equal and opposing force is applied.
Your occupational therapist and burn physician may recommend one or more of the following pressure products: a tensor bandage; an elastic tubular support bandage called a Tubigrip®; Isotoner® Gloves, or Coban® Self-Adherent Wrap. There are also rigid face masks and custom-made pressure garments.
To be effective, all products must be worn continuously, for 23 ½ hours a day, taken off only for bathing or showering. It’s necessary to do this for a year to a year and a half, or until the redness and elevation of your scars have settled. This sounds like a long time but it’s a necessary part of treatment. After the 12 to 18 months, you will be glad you persevered.
It is important to note that these pressure products are not effective once your scars are mature. So be disciplined and stick to your schedule for wearing these products during this optimal period of recovery.
When burn scars are either extensive or thickening and will not respond to alternative methods of pressure, your physician may prescribe custom-made garments for you. You may be measured for these garments in the hospital before being discharged or in the burn clinic during one of your follow-up visits. Again, you must wear these garments at all times; it is recommended that your purchase two sets so that one is available while the other is being laundered.
It takes time to get used to these garments, because maturing burn scars are fragile. Your burn team will advise you how to use them. For example, you may wear them for just one or two hours the first day, five or six hours the second day, six to twelve hours the third day, and so on. By the end of the first week the garments should be worn for the full 23 ½ hours a day.
Changing burn dressings at home
You or one of your family members may be required to change a dressing at home. This will probably occur after you have had many dressing changes carried out at the hospital. You should also have received careful instructions from the burn team or have received home care nursing services for a time.
The most important simple factor is to ensure that everything that touches the wound is clean.
What you need
• A work area with a clean, flat surface in a warm room
• A bathtub, sink or basin
• An abrasive cleaner
• Mild soap
• A clean, soft washcloth and a towel
• A small, clean cup
• A wooden applicator
• The recommended topical ointment
• Dressings and gauze bandages
What to do
• Place all the equipment on the work surface.
• Scrub the tub, sink, or basin with cleanser and rinse thoroughly.
• Wash hands thoroughly with soap and water; dry them on a towel.
• Fill the tub, sink, or basin with lukewarm water; mild soap may be added.
• Remove the outer dressing by cutting it off with scissors. Do not pull the dressing off if it is sticking to the wound; instead, soak it in the tub.
• Soak the wound in lukewarm water for 10 to 15 minutes.
• Gently wash the burned area with the washcloth, removing old cream, dried blood and loose skin.
• Using the cup, rinse the wound with clear water.
• Using clean fingers or the wooden applicator, cover the wound with a topical agent or ointment.
Cover the topical agent or ointment with a gauze dressing, taking care not to touch the sides of the dressing that will come into contact with the wound. Wrap snugly with 6 to 7 layers of bandage.
Wash the tub, sink or basin with a cleanser and then rinse thoroughly.
Launder the washcloth and towel so that they will be ready to use again within 24 hours.
In the early stages of your burn injury, your body needs lots of calories and high amounts of protein to provide the energy and building blocks to help your skin recover. Thus, your dietician will provide a diet high in calories and protein throughout the critical period of your injury.
As you recover from your burn injury, your nutritional requirements decrease. Consequently, on leaving the hospital, you no longer require these rich diets. You should evolve back into regular meal planning with one important consideration: keep to a nutritious meal plan.
Proper rehabilitation requires that you have all the important food groups as well as vitamins and minerals. Your daily food choices should include selections from each of the four food groups in the standard food guide, referenced at the back of this book.
In summary, you need the following every day:
• Meat and meat alternatives, for protein, vitamins and minerals vital for skin build-up.
• Milk and milk products, for protein and calcium.
• Breads and cereals, for carbohydrate energy.
• Fruits and vegetables, for vitamins and minerals essential for skin, hair and muscle function.
• Fluids, such as water, orange juice and milk. Use your thirst as an indicator of your fluid needs.
If ever you feel you need guidance or counselling on your dietary needs, contact either your dietician from the hospital or your family physician who can direct you to a local dietician for assistance.
Throughout your stay in the hospital, you will probably be on a program of exercises to help maintain your range of motion, strength and endurance. It is important to continue this program after your discharge. Your physical and occupational therapists will likely confirm this and provide you with a suggested exercise program to further your recovery.
Even though you may be completely recovered in terms of being as mobile as you should be, you may feel stiffness and slight pulling in your joints after a period of inactivity or sleep. Exercise will help decrease this stiffness and help you maintain your mobility and avoid contractures.
More often than not, burn survivors have limited movement in some joints at the time of discharge from the hospital. It may be necessary to continue seeing a physical therapist and/or occupational therapist. You may be referred to a rehabilitation hospital when you leave the burn centre or you may be scheduled to visit the rehabilitation medicine department at your local hospital.
It’s important to have realistic expectations – aim for a gradual recovery. You cannot recover overnight; it takes time, patience and sustained effort. When you first come home, you’ll probably feel more tired than usual. Over time, your energy will return and you’ll be able to do more. Try to develop’ regular exercise routines and feel good about what you’re able to accomplish.
Your occupational therapist may advise you to use splints to help in the recovery process. There are two types:
1. Serial or static splints
These are used following your range of motion (ROM) exercises in order to maintain a joint at the maximum range achieved. These splints may be used at rest or throughout the night in order to apply a constant stretch to tight joints.
2. Dynamic splints
These apply a direct and opposing force to reverse any contracture which may already be present. Since these splints apply a strong stretch force to contracted joints, they should only be worn for up to two hours at a time, three times a day.
Splints may be necessary for up to 18 months or until your joints have reached a maximum range of motion.
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