Skin Grafting

If the person's wound is full thickness (a deep second degree and deeper), they will require grafts to heal their wounds. An allograft (e.g., xenograft-pig skin or cadaveric skin) may be used to prepare the wound to receive the graft. The wound site must be free of dead tissue to allow interstices to close and the graft to grow/immesh with normal tissue.

An autograft is the most common type of graft. Skin is taken from another part of the body and removed to the second-degree level (partial dermal) for transplantation. The skin may be used directly over areas of high cosmesis (ones that greatly affect the patient's appearance, e.g., the face) without thinning it out. Skin doesn't stretch far enough to cover large body surfaces. After a graft is applied, the person must remain immobile for five days, to allow the graft to take.

Areas that are deep and may involve tendons will probably take weeks to months to heal. The wound bed often is treated with wet dressings, removing dead tissue and allowing some granulation tissue to form before the graft is applied. Granulation is the part of the healing process when small, grain-like "bumps" form over a raw wound area. Once granulation forms, close dressings are used to keep a "hood" over the wound. The granulation can become hyper-granulous and cause complications with scarring if a hood isn't used. There have been some advances in the use of cultured skin.

Before and after surgery

Before the surgery, the person receives daily rehabilitation therapy for mobilization, ambulation, activities of daily living, positioning to prevent burn deformities, splinting to prevent loss of functional position and muscle, tendon and tissue length.

After surgery, splints are used on limbs and axillas to immobilize and assist the graft take success rate. Usually on the fifth day after surgery, the therapists re-evaluate the wounds, grafts and mobilize the patient. At this time, the person is often measured for burn scar compression garments. They may start using temporary garments and scar management devices that prevent webbing and hypertrophic scarring. Tubigrip/tubular support bandages are used. Inserts made of closed cell foam, silicone based elastomers or gels and hard plastic (e.g., custom-made Uvex splints over faces. Uvex is a high temperature plastic that is the same as that used to make motorcycle helmets.) are used to mold the forming scar.

Scar healing and management

_{Information courtesy of Ann Burkhardt, OTR/L,
a fellow of the American Occupational Therapy Association}