Late management of burns

Abstract

Certain sequelae are expected after burn injury. The degree to which these sequelae affect the individual depends on the type of the injury, initial treatment and the patient. The late effects of burn injury are related to the loss of normal tissue and its replacement with scar tissue. Scars may be itchy, lumpy, discoloured and unsightly. They exert greater effect if they replace tissues with previous complex function: scars may limit movement, impair vision, make mouth opening difficult, cause pain, and otherwise prevent activity. Many patients have scars involving multiple sites, which affect many different functions, are aesthetically displeasing, and cause social embarrassment. The key to post-burn care is scar management, affecting improvement with therapy and surgery, in addition to promoting psychological acceptance and social reintegration. Burn management takes place within a multidisciplinary team (surgeon, anaesthetist, nurse, physiotherapist, occupational therapist, social worker, psychotherapist, dietitian, pharmacist, paediatrician). On completion of initial treatment, regular review is required to determine how the patient is managing the activities of daily life and to determine if he is experiencing problems. The review process assesses the function and aesthetic appearance of the burned area, assesses burn scarring and identifies areas to which treatment should be directed. The review process continues for many years. This contribution focuses on acute care, medical management of scars and burn reconstruction.