REHABILITATION PHASE OF BURN CARE
Although long-term aspects of burn care are discussed last, rehabilitation begins immediately after the burn has occurred—as early as the emergent period—and often ex-tends for years after injury. In the aftermath of the acute stages of injury, the burn patient increasingly focuses on the alter-ations in self-image and lifestyle that may occur. Wound heal-ing, psychosocial support, and restoring maximal functional activity remain priorities. The focus on maintaining fluid and electrolyte balance and improving nutritional status continues. Reconstructive surgery to improve body appearance and func-tion may be needed.
Burn injuries can have a major impact on quality of life. Changes in physical activity and social, psychological, and em-ployment status may occur. Therefore, psychological and voca-tional counseling and referral to support groups may be helpful to promote recovery and quality of life. Family members also need support and guidance in assisting the patient to return to optimal health.
The wound is in a dynamic state for 1.5 to 2 years after the burn occurs. If appropriate measures are instituted during this active period, the scar tissue loses its redness and softens. Healed areas that are prone to hypertrophic scarring require the patient to wear a pressure garment (Fig. 57-6). These devices are especially use-ful for partial-thickness wounds that required more than 2 weeks to heal and for the edges of grafted skin. Applying elastic pressure garments loosens collagen bundles and encourages parallel orien-tation of the collagen to the skin surface, with the disappearance of the dermal nodules. As pressure continues over time, there is a restructuring of the collagen and a decrease in vascularity and cel-lularity (Serghiou, Young, Ott et al., 2002).
The physical therapist, occupational therapist, or a representa-tive of the manufacturer of elastic pressure garments measures the patient for correct fit. While awaiting the arrival of the garment, soft, tubular, knitted elastic pressure bandages can be used to help desensitize the patient’s skin, protect healing areas, apply pressure, and promote venous return. Patients must be instructed about the need for lubrication and protection of the healing skin and the need for pressure garments for at least a year after the injury. A program including elastic pressure garments, splints, and exercise under the supervision of an experienced physical and occupational therapy team is recommended for optimal functional and cosmetic results.
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