Introduction
Recovery and rehabilitation of high-grade burn take years to treat; we need multiple surgeries to achieve the desired outcome; the health care provider should educate the victim about every stage of treatment and educate their family and caregivers to support them psychologically and encourage them about the possible outcome as the treatment may require many surgeries, the victim and the family have to be mentally prepared for the multiple treatments needed and rehabilitative phase will help to gain a better outcome.
What Are the Types of Burn?
The skin comprises three layers epidermis, the outer layer acting as the shield between the environment and the internal body; the dermis, the middle layer that contains connective tissue, hair follicles, nerves, sweat glands, also vascular tissues; and the subcutaneous layer, also called hypodermis the deeper layer consists of fat cells and connective tissue to protect the internal organs and muscles from temperature change, also from any trauma. Depending upon the involvement of skin, burns can be first-degree, second-degree third degree; the first degree of burn is superficial and involves only the outer layer of skin; they can be mild with reddening of the skin; this can be caused due to allergic reaction to some chemical or trauma due to touching heated object, or any friction. The second degree of burn may affect the superficial and middle layer of skin, causing redness, swelling, and formation of blisters; there will be exposure of the intermediate layer due to the burn, it is also called partial thickness burn, and the third-degree burn may involve full-thickness burn, it may affect the subcutaneous tissue and result in necrosis of skin, the skin may appear black and charred.
What Are the Stages of Burn Healing?
The stages of burn healing start with primary healing which progresses to form secondary healing that includes closure of the wound, depending upon the severity of the burn the immediate recovery may take time, the superficial burn may heal in 2 to 3 days of time, the second degree may take a little more time but the primary healing is done in 2 to 3 days and secondary recovery in 15-20 days and later formation of scar, for deep burns initial phase starts from day 1 to 3 there is the formation of edema, fluid resuscitation helps in preventing from loss of electrolyte, and promotes wound healing and prevent secondary complication, in the second phase it is crucial to take care of own which will help from dressing drainage of edema and create a moist environment for bone healing application of topical antibiotics and dressing will prevent from external factors, in the third phase temporary wound is covered and if required skin grafts are done for partial thickness and total thickness burn, surgical removing of burned skin followed by grafting help in improving the appearance of burned area, in the fourth phase reconstruction, , rehabilitation , recovery helps to perform the daily activities better, that will benefit patient too regain confidence by doing small activities which were not possible post trauma.
What Are the Types of Burn Rehabilitation?
Burns can be painful physically and psychologically for a person as they can damage the appearance of skin one can become conscious of it, and it can be painful for the person to go through various treatments to recover from the damage; sometimes, it can take years for the rehabilitation which can impact a person physically mentally emotionally and financially the scars of burn can remind someone of the trauma and affect the psychological well being.
It is essential to take care of burn wounds to restore the skin texture, function, and appearance; if, at the primary level, treatment is not given, then there are chances of scarring and difficulty in healing and maintaining the strength and function of the skin; removing of dead tissue helps in healing of the skin, prevent from secondary infection such as bacterial growth on the lesion and plan for the restoratives phase of grafting.
After the primary healing to remove the scar grafting is done, xenograft, homograft, heterograft, autographed, split-thickness graft, full-thickness graft, synthetic graft are used to rehabilitate the burn scar. The autograft is collected from patients own skin usually taken from the tie for back muscle as they are the thickest and are better accepted crafting is generally done after the healing is completed to avoid the chances of rejection.
In burns associated with the neck region, it becomes challenging for one to swallow food. In addition, exposure to the trachea can lead to inhalation of foreign bodies as tracheostomy is done, and rehabilitation is vital to avoid complications that can cause infection of the lungs.
Splitting helps in multiple functions post-burn treatment as it immobilizes the organ that has been grafted, facilitating correct position and preventing contraction of joint; splinting is usually indicated when the burns involved at tendon or joints,
Exercise helps to maintain the active and passive range of motion during burn rehabilitation; various activities like stretching, manual therapy, physical therapy, therapeutic exercise, transcutaneous electric nerve stimulation, hydrotherapy, and aerobic and resistance training help in the restoration of function and achieving a normal range of motion for one to do an activity of daily livings and ambulate on their own.
Occupational therapy helps to encourage one to perform their activities without any assistance; this can boost the confidence of one that they have become independent and self-sufficient, and they have recovered from injury mentally and physically as they achieve small goals of daily activities.
The impact of a burn can be traumatizing for one physically and mentally, and it may take years to deal with the effects and recover one can suffer from post-traumatic stress disorder, anxiety depression as activities of daily living life has changed from routine and are dependent on someone, and the appearance of burn may aggravate the pain psychologically. This impairment can impact one negatively and their ability to cope with this situation; psychiatric treatment helps in rehabilitation postburn to find help to deal with the situation.
Conclusion
The primary goal of burn rehabilitation is to make one reach a position before the trauma by restoring the daily activities independently, with a normal range of motion, taking self-care, with good strength in muscles and joints, and having the ability to ambulate on own will.
