Burn Rehab & Wound Management

Superficial Burn

• involves the superficial epidermis

• short-term moderate pain

• healing time: 3-7 days

• causes: sunburn, brief exposure to hot liquids or chemicals

• non-surgical

• no potential for scarring or contractures

Superficial Partial-Thickness Burns

• involves the epidermis and upper dermis layers

• pain is significant; wet blistering and erythema is present

• healing time: 1-3 weeks

• causes: severe sunburn or radiation burn, prolonged exposure to hot liquids, brief contact with metal objects

• non-surgical

• minimal potential for scarring and contractures

Deep (partial thickness) burns

• involves the epidermis, deep dermis layers, hair follicles, and sweat glands

• MOST PAINFUL STAGE!

• pain is severe, even to light touch

• burn has a high risk of turning into a full-thickness burn and infection

• impaired sensation

• causes: flames; prolonged contact with metal objects

• high scar potential

• healing time: 3-5 weeks

Full-Thickness Burns

• involves epidermis, dermis, hair follicles, sweat glands, nerve endings

• no sensation to light touch

• burn is pale and nonblanching

• causes: extreme heat or prolonged exposure to heat

• grafts are required

• scar potential is high

Subdermal Burn

• full-thickness burn with damage to underlying tissue such as fat, muscles, and bone

• charring is present

• peripheral damage is significant

• requires surgical intervention for wound closure or amputation

• causes: electrical burns and severe long-duration burns

• scar potential: extremely high

Emergent Phase

• 0-72 hours after injury

• life-saving measures

• fluid replacement

• infection control

• POSITIONING IN ANTIDEFORMITY POSTURES

  • avoid comfortable positions

• Edema management

• NO AROM OR PROM OVER FRESH GRAFTS

Acute Phase

• post 72 hours after wound closure

• wound care, grafting, preventing complications

• Gentle AROM after skin graft

• continue with positioning and splinting

• provide pain management techniques

• promote functional mobility and self-care

Rehabilitation Phase

• After wound closure or graft healing

• Assess function and come up with goals

• functional restoration and scar management

• GRADUALLY INCREASE STRENGTH AND ROM

• PSYCHOLOGICAL SUPPORT

• return to work or school planning

• skin lubrication several times a day (water-based lotion)

• serial-static/dynamic splints

• Compression pressure: 20-40 mmHg (desired)

Burns Correct Positioning Postures

Bad (Deformity Position):

• mouth: decreased vertical and horizontal opening

• neck: flexion

• axilla: adduction

• elbow: flexion

• wrist: flexion

• hand: flexion

• knee: flexion

• ankle: plantar flexion

Good (Antideformity Position):

• mouth: maximum vertical and horizontal opening

• neck: neutral or slight extension

• axilla: 90 degrees of shoulder flexion and abduction (airplane pose)

• elbow: extension

• wrist: neutral up to 45 degrees of extension

• hand: intrinsic plus or safe position

• knee: extension

• ankle: neutral

Mechanical Debridement

• Uses force: wet-to-dry, whirlpool, wound irrigation

• Can remove healthy tissue, so, not ideal for clean wounds.

Enzymatic (zymatic) debridement

• Topical enzymes (collagenase)

• Breaks down necrotic tissue selectively

• slower but more gentle

• monitor for signs of infection

Autolytic debridement

• Uses the body’s own enzymes & moisture

• Covered with occlusive dressings (hydrocolloids, hydrogels, films)

• Teach dressing application and monitoring

• Contraindicated with infection

Sharp Debridement

• Done by a surgeon or wound care specialist

- Removes necrotic tissue with a scalpel

• OT DOES NOT PERFORM THIS, but must coordinate with the wound team

Surgical Debridement

• Extensive removal in OR setting

• Monitor post-op healing, position for offloading pressure.

Hydrocolloid Dressing

• Best for stage II or III pressure ulcers, partial thickness wounds

• absorbs minimal to moderate exudate

• maintains moist wound bed

• promotes autolytic debridement

• looks like a pimple patch

Hydrogel Dressing

• Dry or necrotic wounds, Stage II ulcers, radiation burns

• Adds moisture

• Soothing for painful wounds

• May be sheets or gels

Alignate Dressing

• Very heavy drainage

  • infected wounds

  • Stage 3 and 4 ulcers

• Absorbs 20x its weight

• Forms gel when in contact with wound

• Requires secondary dressing

• Great for wet wounds with slough

• Heavy exudate

Transparent Film

• Stage 1 & 2 ulcers, skin tears, shallow wounds

• Thin, adhesive, semipermeable

• Allows oxygen change

• See-through for wound observation

• NOT ABSORBENT!

Tips and Keywords for Wound Dressing Types

• "Moist wound healing" is a common correct answer.

• If the wound is dry, pick hydrogel.

• If wet/heavy drainage, pick alginate

• If you see "autolytic debridement," think hydrocolloid or hydrogel.

• Transparent film = superficial wounds with little exudate.

  • Just for “observing” purposes.

  • Know the definition of exudate

Pressure Injury Stages

• Stage 1: Red, non-blanchable skin

• Stage 2: Partial-thickness loss (blister)

• Stage 3: Full thickness, visible fat

• Stage 4: Exposed bone/tendon

• Unstageable: Slough/eschar blocks view