Long Term Treatment
Length of hospitalization
The length of hospitalization depends on many factors. In
addition to the severity of the burn injury, these factors include whether
the person suffered lung injury from inhaling smoke or chemicals and whether
the person had pre-existing medical problems, such as heart disease.
Length of time for skin to heal
There are three phases in the formation of a scar. In the
first phase, which lasts less than a week, the body begins to remove dead
and dying skin tissue, fights infection, and sends cells that will begin
the healing process to the burned areas. In the second phase, which takes
a few weeks, the body makes collagen fibers to form scar tissue and creates
tiny new blood vessels in the injured area. In the final phase, which takes
months to years, the scar tissue matures, resulting in a stronger scar.
Early surgical removal of dead skin and replacement with skin
grafts usually accelerates healing. See the burn
treatment page for more information.
Loss of the ability to sweat
With a deep partial thickness or full thickness burn, sweat
glands are destroyed and are not replaced when the skin heals. Because sweating
is important in controlling body temperature, burn survivors often have
difficulty in hot and humid conditions. They may need to avoid certain forms
of exercise, recreation, or working conditions that could cause heat stroke.
The need for skin lotion
Glands in the skin (sebaceous glands) produce oil that lubricates and moistens
skin. Deep burns destroy the sebaceous glands, making it necessary to use
lotions to prevent the skin from becoming too dry.
Color changes in skin following burns
Skin color is created by cells in the epidermis called melanocytes. Melanocytes
produce melanin, the pigment responsible for skin color. Melanocytes are
destroyed by deep burns. Different areas of the body may have different
numbers of melanocytes (for example, areas with frequent sun exposure tend
to have more melanocytes). It may be necessary to use skin from a donor
site that is not a good color match for the graft site. For example, the
best color match for skin in the face and neck is skin on the chest above
the nipple line. However, if that area is burned other donor sites must
be used. Scars usually change color over time, becoming less red.
Changes in the strength of skin
Healed scars are about 20% weaker than the skin they replace. And while
burned skin is in the process of healing, it is particularly fragile and
prone to blistering. Clothes that fit well are important to prevent skin
breakdown. The healed skin is also more vulnerable to sunburns than regular
skin and may be more allergic to sunscreens and other skin products.
Changes in sensation
The amount of sensation following a burn depends on the depth of the burn.
For a superficial burn, sensation should be normal after healing. For deeper
burns, there is often a decreased sensation of hot/cold, sharp/dull, and
light touch. The sense of deep touch is usually preserved. Many individuals
are more sensitive to the air temperature than before being burned, with
a majority of these individuals being more sensitive to colder air temperatures
than is normal.
Pain
The extreme pain that people experience with a recent serious burn improves
as the wound heals. Burn patients can experience a feeling of skin tightness,
numbness, or a tingling or burning sensation as the skin heals. Because
the healed skin tends to be drier than normal skin, it may itch if not kept
moist.
Dermabrasion and Dermaplaning
In dermabrasion the surgeon scrapes away the outermost layer of skin with
a rough wire brush or a burr containing diamond particles attached to a
motorized handle. In dermaplaning the surgeon uses a dermatome, the same
type of instrument used by burn surgeons to obtain skin for grafting. Learn
more about dermabrasion and dermaplaning of burn
scars.
See our page on burn treatment centers for
more information about special treatment. Our burn
research page has information on medical research into treatment of
burns.
