Case Discussion - Burns and Wound Question
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[00:00:00] Great. You have a wound case. This occurred in May. We are now in December, pretty much. Second and third wound burns to 30 percent of their body face into chest circumferential around bilateral upper extremity and bilateral lower extremity. That sounds like more than 30%. They received skin grafts, but unsure specifically where from where they can tell they're doing wound care at home.
But this time it feels like the pain is more the limitation. Any suggestions for treating skin grafts precautions to be mindful of? Um, you're going to assess for pain, hypersensitivity or hyposensitivity contractures. Um, yeah, so great. So, um, When it comes to burns, think about this is a May we're now in December.
So technically speaking, you shouldn't have any wound care to address. Um, Because [00:01:00] that would be a, like a real chronic wound issue, right? So I would assume by this time they have addressed all wound issues. Um, and if they had the second or third degree third degree, meaning they would need skin grafts. So usually what they do for, for burn cases is they'll take from somewhere else.
So if they had burns on the legs, so they'll take on other parts of the leg or maybe the back, and then they'll use, usually put the skin through a measure to expand it. And then that's where you'll see the graph. So you'll see the graphs. Kind of like have little holes in it to kind of stretch it out.
But when they do that, it makes the skin really tight. So they put it down and the skin tightens up. Um, one of the biggest things that you can do Yes, assessing for pain, you know, asking the pain questions are general, looking at motion, looking to see where they're going to [00:02:00] have stiffness. So if they have it on the chest, and here's the thing, if it was a second degree, they might have avoided having surgery.
But then what happens is that second degree scarring, um, is very thin. thick and very tight by its nature. If they're in the between, like do I do the graft or don't do the graft and they decide not to do the graft, there's very, there's some things you can do for the skin, but they're always going to have that tightness.
So in your mind's eye, don't let that constant tightness, like deter you from doing the graft. from everything that you need to do in terms of getting more motion, getting the skin to move, getting the scar to move. Right. So it's a lot of scar mobilization, and I would encourage you to don't just think of scar as like the borders of the scar.
Think above below and think about, um, how everything gets twisted and wrapped around. Right. [00:03:00] And by that, I mean, don't think of just moving the scar in one direction or other, think about moving it in its rotation. You know, Take a look at your arm. Anytime you turn your palm up and down, that skin rotates, right?
And so if you think about the chest, like if they were burned on their chest, um, how do you move the chest, uh, skin? You go into flexion, so you can cave in, you can extend out, and then it'll stretch all of this. Remember that the skin, on to the chest is also affected by neck range of motion. So those are some things that you would, you know, consider and, and think about.
Scars are also very dry. I mean, scars and burns are very dry by their nature. So using something like a cream to do some of the, the manual treatment, um, they need to put cream all the time. Like, you know, as they massage things like that, [00:04:00] I'm a big fan of still working into ease versus restriction, shortening that scar soft, you know, and then working it versus always thinking like we have to stretch it and then work it.
So those are some insights I would encourage you to do. Um, the precaution I would. help you be mindful of is a lot of times the skin is very tight, very taut, right? So you look around the borders and anywhere where you're, uh, where the crease is, you can look to see because if it's really tight, it's going to pull and sometimes it blisters.
So be mindful of heat and stuff like that. It's been a while. It's been a while. It's been like six or seven months, so they shouldn't have those issues, but if their skin is real tight and it's constantly pulling and pulling, um, there's a lot of tension on those borders of the scars. And then when you put heat to it, it might burn.
you know, be a little bit too much. Um, so I would just be mindful of that. Again, I wouldn't be too worried about that. Like it's the [00:05:00] shearing effect. I wouldn't be too concerned about it because it has been six months. Um, but scars can stay active for a year to two years, um, after, uh, an injury. And I've, I've had, Changes to scars even years later.
So we can always affect how scars move and how they feel. Um, and so yeah, it just sounds like you just have to do your usual, you know, evaluation of pain, sensation, motion, strength and all that stuff with the, the concepts of, you know, skin grafts and burns and scar management, right?
