In addition supportive therapy like fluids, blood infusion and pain medication is required. In some patients, the burn may lead to intolerable and excruciating pain for which even lV morphine may be required.

For first degree burns and open wounds, topical creams like silver sulfadiazine and bacitracin may be applied. Often dressings may be applied.

Q. What is skin grafting?
A. Skin grafting consists of excision or removal of burnt devitalised tissue, removal of healthy skin from a donor site to cover the cleaned burnt area. An instrument (dermatome) gently shaves a piece of skin about 1/100 of an inch thick from the healthy skin and that skin is grafted over the burnt area. Skin can also be used from dead people (cadavers).To help the graft become secure, the area of the graft is immobilized for at least 5 days and later normal daily activity is started. Skin grafting is usually done under anesthesia.

There are other types of artificial skin grafts available which can temporarily cover the wounds:-

1. Xenograft or Heterograft:- Skin is taken from animals.
2. Collagen

Meshing is a process by which the donor skin is enlarged to cover a large burnt area when there is not enough healthy skin available. The disadvantage is that it is a less durable graft and leads to more scarring. However, it helps by allowing the blood and body fluids to drain under the graft and thus preventing graft loss and it allows the donor skin to cover a great burnt area.

Grafts are held in place with surgical staples or stitches. Once the graft usually becomes stable within 4-5 days, the staple/stitches are removed.

Q. What happens to the donor site from where the skin is removed?
A. Although the skin taken from the donor site is very thin, it can cause scarring and pigmentary changes at the donor site.

Q. How do you prevent contractures?
A. Contractures usually occur due to extension of burns over a joint limiting movement. Skin tightness may be the first sign of a contracture and anti contracture positioning may be required for 24 hours a day. Exercises to stretch or elongate the skin are recommended. Sometimes surgical procedures like release of the band area (z-plasty) may be required. Before surgery, casting of the limb may be required as a constant stretch is applied by the cast to elongate the skin.

Q. How do you prevent ugly scars (hypertrophic scars) from developing?
A. Compression garments are worn over the burnt area. Compression can also be given by splints, orthoses and casts. Compression garments help the burn heal with minimum amount of scarring by pressing and flattening the scars. Compression is given for 22-23 hours a day. It is required until almost 12-18 months post- burn or till the burn completely heals (matures).


Last created on 8-12-2000
Last updated on 18-11-2006