Fire-Related Injuries
About Burns
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
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