Wound Healing and Post-Burn Care

Burn Wound Care in the Hospital
Burn Wound Care at Home
Blisters, Itching and Skin Sensitivity 
Skin Changes and Scarring
Compression Garments
Nutrition
Pain Management

Burn Wound Care in the Hospital

Sanovia Lee-Oden, wound care technician, changes a patient's dressing.

While in the hospital, your wounds may be cleansed in the shower or at the bedside. The decision to use the shower is based on safety concerns and pain tolerance. In either event, we try to have only one dressing change per day. Further debridement may be done each day depending on how your wounds are healing.

Creams, ointments and dressing products
The depth and location of your burn wounds will determine which cream, ointment or dressing product we use to treat your wounds. Most of the dressing products that we use are effective for about 24 hours, so you can expect your dressings to be changed once a day. It is also important that we monitor wounds on a daily basis for signs and symptoms of infection. Some dressings can be left on for 2-3 days or longer depending on your specific burn wound. The doctor or nurse will explain what type of dressing you have, and the reason why it was chosen.

Burn Wound Care at Home

 Bathing                                                            

• You need to bathe daily in either a shower or tub.
• Clean the bathing area before and after each use. Avoid using harsh chemicals.
• It is best to use white towels and washcloths (dyes may be irritating to the skin)
• Use lukewarm water. Avoid extremes in water temperature.
• Use a mild soap without deodorant (such as Dove or Ivory).
• While washing remove all build up of creams and lotions.                                   

Wound Care
Individual wound care instructions will be provided by your wound care team. When performing your wound care, observe for signs of infection, which may include: 

• Increased redness
• Odor
• Swelling
• Increase in the amount of drainage from a wound or change in drainage color.
• Fever (check your temperature each day and notify your doctor if your temperature is greater than 101.5F).

Healed Skin

Your new skin is thinner and more fragile and requires special care.

• Examine your skin daily when bathing.
• Avoid tight clothing and shoes.
• Watch for signs of breakdown and/or blistering.

Blisters, Itching, & Skin Sensitivity

Blisters
Blisters caused by friction and pressure are very common.

• If you develop blisters do not break them.
• If they open, you can treat them with whatever you are using for your other open wound areas.
• If you develop blisters under your pressure garment, apply a light dressing and continue to wear the garment.

Dry Skin/Itching
Oil producing glands are sometimes destroyed with a burn injury. This can cause your skin to be dry. Itching often accompanies dry skin.

• Avoid scratching, this can tear and damage your new skin.
• Use a mild lotion that does not contain fragrance (such as Vaseline Intensive Care, Eucerin, Lubriderm, or cocoa butter).
• You may also try:
  • Cool showers or baths.
  • Pat or massage the affected area gently.
  • Eliminate alcohol and caffeine as this may make the symptoms worse.
  • Your doctor may prescribe a medication to help

Sensitivity to Temperature
Your new skin may be more sensitive to hot and cold temperatures as well as sunlight.

• Avoid direct sunlight.
• Use a sunscreen with SPF 30 or greater. Be sure to reapply often.
• Wear protective clothing when outdoors. Wear light long sleeved clothing, a wide brimmed hat, and sunglasses.
• Drink plenty of water. Avoid alcohol and caffeine.
• In cold weather dress warmly, in layers to prevent frostbite.

 Skin Changes and Scarring

Skin Discoloration
Each day your skin is changing and becoming more mature. However, you will see some changes that you may not understand. There may be some discoloration in the healed areas.  Your skin may look purple, pink, brown or gray – this is to be expected. Some reasons for the skin to remain discolored are: (1) an increase in circulation- extra blood in the area, (2) thin and fragile skin, and/or (3) excess blood pressure/pooling in the lower extremities from sitting or standing with your legs down too long. Your natural color may return, but it will take time (6-18 months). 

If you have numbness or tingling in the burned area, it may be because your nerves were damaged – they may grow back, but it will take time. If your legs or arms were burned, you will probably see more discoloration after walking. You can decrease this by putting your feet up on a chair or by resting your arms up on some pillows until the discoloration decreases.  Remember that just standing in one place too long (ex. washing dishes) can cause swelling. If you have a great deal of pain or swelling, elevate your arms or legs. If this persists be sure to tell your doctor. Wearing your compression garments as instructed (23 hours a day) should help prevent swelling and related discomfort.

Scarring

In the beginning, it is very hard to tell how much or how badly you will scar. It will depend on how deeply you were burned, how old you are, and how long it took your skin to heal. The formation of scars is a part of the healing process after a burn injury, even if your burns were grafted with new skin. If you had a first or superficial second-degree burn, you may not have any lasting scars. If you had a deep second or third degree burn, you will probably always be able to tell you were burned.  Scars are different in everyone. They can be minimized if you WEAR YOUR COMPRESSION GARMENTS, do your exercises and scar massage. The scar tissue can grow for up to 2 years. The tissue will probably look the worst between 4-8 months after your burn and gradually start improving 6-12 months later. Some scars that affect your movement may be altered with surgery- ask your doctor in the Burn Clinic. Remember the scarring process takes time.

Scar tissues tend to be thicker, firmer and raised above the normal level of the skin.  Scars can be dark pink or purple, but as they age or mature, the colors start to become more like your own skin.

 Compression Garments

1. There are different types of compression for your scars:
   Ace wraps are rolls of elastic bandage that are worn over your dressings or when other garments are being washed. To put them on, ALWAYS start at the base of the toes or fingers and go up, wrapping with an even, diagonal pressure of pull, overlapping each layer about ½ way.  When on, Ace wraps should feel snug but comfortable.
2. Tubular elastic bandage is an elastic stocking material for your arms or legs.  Tubular elastic bandage is usually temporary until you get fitted for your garments, or can be used when your regular garments are being washed. 
3. Pre-fabricated garments are ready-made and come as gloves, sleeves, pants, and chin straps. 
4. Custom made garments are measured and made specifically for you.  If you need a custom garment, the compression garment representative can measure you at the Burn Clinic.

ALL TYPES OF COMPRESSION GARMENTS MUST BE WORN 23 HOURS EACH DAY IN ORDER FOR THEM TO WORK. They should be removed only for dressing changes and bathing. You will need to wear compression garments until your scars are mature. This can take anywhere from 6 months to 2 years after you are healed. The growth of the scar tissue must be controlled 23 hours a day to decrease the chance of thick, raised scars.

Your rehabilitation therapist or compression representative will make sure you get the right type of garment. Your therapist will make sure that your garments fit properly and address replacements as needed.

 Caring for Compression Garments

1. Gently hand wash all garments as needed with mild detergent or soap.  Be sure to rinse out all of the soap. Do not use bleach to remove stains. This will damage the elastic. 
2. Lay garments flat to dry, or hang to dry. 
3. DO NOT put garments in the washer or dryer because this will wear out the elastic and cause the garments to fit too loosely. 
4. When your regular garments are being washed, make sure you have another form of compression to wear like Ace wraps or tubular elastic bandage.  Remember that you must have compression over your scars at all times, day and night.

Nutrition

High Protein Diet

The high protein diet helps you meet your increased nutrition needs to build and repair your body, and heal your wounds. When you eat well, you will be able to maintain your weight, heal more quickly and fight infection. If you have additional dietary needs, please contact a dietitian to help you formulate a plan specific to your needs. You should return to your normal eating habits once your wounds are healed, and you have returned your normal or ideal weight.

Although everyone’s needs are different, the best diet after a burn injury is high in protein and calories. Your diet should consist of regular foods with a concentration on protein-rich foods such as milk, cottage cheese, yogurt, ice cream, cream soups, cheese, eggs, meat, chicken, fish, and beans.  In may be beneficial to take a daily multivitamin in addition to your balanced diet. 

TIPS:

• Choose at least one item from each food group, at each meal.
• Eat protein-rich foods with each meal and snack.
• Eat three meals a day with snacks between meals.
• Drink beverages between meals.
• Limit intake of “diet” foods and beverages.

Pain Management

Pain is different for everyone. We know you will have, sharp, burning, stinging or itchy feelings while you are treated and your skin heals. Different burns on the same body part may even feel different depending on the damage to your nerves and underlying tissues.

The doctor(s) will prescribe any number of medications and creams to help reduce your pain and/or itching. Some of the medications used are opioids or narcotics, which are prescription “pain killers”. These medications vary in their strength and length of effect. You should only take these as directed by your physician and nursing staff. They can all make you drowsy and unable to concentrate on tasks. Driving or operating machinery is dangerous and a prohibited by law. Other side effects of these drugs include constipation, nausea, loss of appetite and increased tolerance over time. Tolerance means your body becomes less responsive to a particular type and dose of medication. Some of these medications also have a maximum safe dose.  

Good pain management does not mean you will become addicted. True addiction has multiple components. Physical addiction to an opioid or narcotic may occur without a psychological component. We anticipate you may need to have your opioid or narcotic pain medication reduced or tapered over a month or several months depending on your pain management needs, and the dose you have been taking. Our Burn Clinic staff and your burn physicians will monitor this tapering, and you should notify them if your pain is not being relieved with each dosage change. Do not stop taking these medicines suddenly as you may trigger withdrawal symptoms.  These symptoms may include, nervousness, irritability, sweating, and high blood pressure that could cause a seizure if untreated. Please notify your physician immediately if you are experiencing any of these symptoms.