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Frequently Asked Questions
Burns
How do burns happen?
Hospital Stay
Does everyone who gets burned have to stay in the hospital?
Does the person have to stay in bed in hospital?
What happens in the hospital?
Healing
Do all burns heal spontaneously?
How long will I be in the hospital?
Why is there pain, no matter what medications I am on for pain control?
How long before my skin is done healing?
What can I do to stop the itch?
Why do I itch?
Why do I get open areas and blisters on my burn site?
Why do I sweat so much?
Why do I get pimples on or around my burn?
What should I put on my open areas?
Why do I have to walk if my legs are burned?
How long will my skin be tight?
Why are steroid injections used and how do they work?
What products, perfumes, bug sprays should I use on my skin?
Will taking vitamins help my burn to heal faster or better?
Why do I have nightmares?
Why can't I sleep?
I'm depressed and tired, I don't care and I'm sick of all this! When will I feel better?
Why do I have to wear pressure garments?
Why do I have to wear my pressure garments and face mask full time?
How long will I need my pressure garments and face mask?
How long do I need to use foam elevation wedges and keep my hands elevated?
What will the burns look like when they are completely healed?
Scars
What does a mature burn wound look like?
What can help the scars on the outside?
What happens to burns of the lungs?
Are burns and scars contagious?
What happens to scars as people grow?
When will my scars disappear?
Why is my donor site scarring?
How can I hide my burn scars?
Long-Term
Are burn surviors able to participate in all activities?
How can I help someone who has been burned?
Am I more susceptible to skin cancer because of my burn injury?
When can I shower in a normal shower at home?
when I was first burned?
When can I go swimming in a lake or a pool?
When can I go into the sun again?
Should I wear my garments and my neck splint or face mask while swimming?
When can I go back to work?
When can I start gym class or work out again?
When will I be able to drive again?
How do I find a counselor or a psychiatrist who has experience in burn cases?
When can I get a perm or color my hair if my donor is from my scalp?
How can I get eyebrows again?
| Burns |
How do burns happen?
They can be caused by:
- Fire: fireplace, barbeque, matches, fireworks, house fires
- Hot liquids: bath ,tea, coffee, water
- Chemicals: corrosive or caustic cleaning fluid
- Electricity: damaged cords, exposed live wires, electrical outlets
- Direct contact to heat: stove heaters
- Flammable liquids of gases: gas, gasoline, etc.
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Is someone always to blame?
Not always. Burns are sometimes caused purely by accident and no one is to blame. For example, an electrical short may cause a fire. But often someone might do something careless to cause a fire, such as playing with matches. Carelessness is dangerous, because it leads to accidents. |
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| Hospital Stay |
Does everyone who gets burned have to stay in the hospital?
Only those with severe burns, that cannot be managed at home, will require hospitalization. Also, if there is an inhalation injury (i.e. lungs are involved), the person will be hospitalized.
Does the person have to stay in bed in hospital?
No, there may be some periods when they may have to lie still, but mobility is encouraged wherever possible. In fact the patient will probably perform special stretching exercises taught by a physiotherapist to prevent tightening of their burn wounds. Sometimes, the occupational therapist may provide special splints, which are worn to maintain or improve range of motion at the joints.
What happens in the hospital?
If the burn survivor has breathing problems, he or she may be on a ventilator, which is a machine to help people breathe. This may be because the fumes or heat caused damage to lung tissue. The burn wounds are cleaned daily in a special bath and may be covered with medicated dressings to prevent infection and help healing. As burns can be very painful, medications may be required to relieve this pain. A special diet will be provided to increase calorie intake and maximize the healing process. With skin loss, body fluids that are lost may need replacement via an intravenous route, if enough fluids cannot be taken orally. If the person's hands are burned, they may not be able to grip their cutlery. If this is the case, their occupational therapist may provide a special spoon with a large handle so that he or she can eat independently. |
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| Healing |
Do all burns heal spontaneously?
No, a burn that is too deep to heal on its own will require a skin graft. Skin is removed from an unburned part of the body (the donor site) and placed on the burned are The part being grafted has to be immobilized for five days for the graft to stick or "take". Sometimes, burns can be so deep that muscles, tendons and bones are involved -- and this may result in a limb being amputated.
How long will I be in the hospital?
It is hard to answer this question because there are so many variables with each patient. An estimate sometimes used is one day for every percent of body surface area burned.
Why is there pain, no matter what medications I am on for pain control?
Burns produce two types of pain. The first type is background pain, which is present, tolerable, and described at a level of about two to three on a scale of ten. The second type of pain is the excruciating, and intolerable, pain that occurs during, for instance wound cleansing, dressing changes, or rehabilitation therapy. This second type of pain is often described as the worst pain the patient has ever encountered, and few patients can even make a comparison between it and previous pains. Since patients experience two distinct kinds of pain, The Burn Center uses two different kinds of pain medication. Methadone is used to control background pain, while Morphine IV is the drug of choice for the acute but transient pain. In addition, relaxation techniques in conjunction with medications often help relieve pain. No magic remedy is available for pain management, and the amount of medication that would eliminate all pain would also suppress the respiratory system to a dangerous level. Despite our best efforts, the fact remains that some pain will be associated with recovery from a burn injury.
How long before my skin is done healing?
Burn-injured skin heals in one to three years if hypertrophic scar tissue develops. Pressure garments and plastic orthoses may shorten healing time. If thick scars do not form, healing is complete when the pink color fades (six to twelve months). Burns, graft sites, and donor sites that are done healing are called mature wounds.
What can I do to stop the itch?
Here are some things that can help:
- Apply lotion 4 - 6 times each day.
- Wear tight pressure garments.
- Avoid alcohol or activities which make you perspire.
- Ask your doctor for anti-itch medicine.
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Why do I itch?
The itch sensation for burn survivors may be a tingling feeling caused by nerves regrowing, or from dry skin caused by the lack of natural oil production since oil glands may have been damaged or destroyed by the burn.
Why do I get open areas and blisters on my burn site?
After a burn site first heals, the healed outer skin layer (epidermis) is not tightly attached to the deeper layers of the skin. Newly healed skin is very fragile‹open areas, tears, and blisters are a common problem. It is also common to lose small areas of skin graft because of the build up of fluid under the graft that occurs right after surgery. Grafted areas aren't as thick as normal skin, and as a result open easily.
Why do I sweat so much?
No one knows for sure. Some burn experts believe that excess perspiration may be the result of an altered autonomic nerve transmission.
Why do I get pimples on or around my burn?
These inclusions form when the outer layer of skin heals over the drainage tubes of the sweat glands or over hair follicles and inclusions or cysts form. They appear quite similar to teen age acne; as a matter of fact, we refer to them as "burn acne". The sweat glands and hair follicles will eventually find their way to the surface such that they can drain normally. In the meantime, wash the healed skin a couple of times a day with a gentle soap and a wash cloth in an attempt to unroof the drainage tubes. If the skin is durable or tough enough, you can also use a Buf n' Puf TM (made by 3M and sold in drugstores) with soap a couple of times a week (not every day, it is too harsh against the skin). The Buf n' Puf TM cleans off the outer covering of the sweat glands so they can drain normally. Do not use the other over the counter acne medications as they are too harsh for this newly formed skin. These inclusions tend to clean up over the first few months and usually are not a long term problem.
What should I put on my open areas?
Several topical applications including Xerform, Unna zinc oxide impregnated bandage, Silver sulfadiazine (Silvadene® or SSD), and Bacitracin, might be used singly or in some combination on your open areas. If one topical does not work another is used. Often dressings are used on a trial basis to see if they will help close the wound. What works best for each patient is discovered by trial, error, and physician preference.
Why do I have to walk if my legs are burned?
Encouraging blood flow and circulation helps wounds heal faster. Exercise helps prevent complications such as contractures and blood clots in legs. Walking and exercise is important for total recovery, especially to the areas affected by the burn.
How long will my skin be tight?
If the burn extends over a joint maintaining range of motion will be a challenge. Skin tightness that limits range of motion can be permanent if the "tight" area is not stretched during the skin maturation phase of healing. Skin length must be promoted throughout the healing process (twelve to eighteen months). If skin tightness is present, anticontracture positioning is recommended twenty-four hours a day. As skin matures, it softens and feels less tight. A surgical release might also be necessary toadd skin to a contracted are The area most likely to be released is in the armpit (axilla).
Why are steroid injections used and how do they work?
Steroids are thought to soften tissue because of their effects on collagen (the strong fibers that connect skin cells to each other). Steroid injections are painful for one to two hours after administered, and work forty to sixty percent of the time.
What products, perfumes, bug sprays should I use on my skin?
Skin products that do not use alcohol or perfumes are generally less irritating. It is best to try a sample of the product on a small patch of skin to check for irritation. If no problems develop, application on a larger area should be fine.
Will taking vitamins help my burn to heal faster or better?
A healthy, balanced diet is adequate. Vitamin supplements will not hurt, but there is no evidence that they will change the rate of healing.
Why do I have nightmares?
After a terrifying or painful injury, many people will have nightmares for one to two weeks. If they last longer, inform your physician.
Why can't I sleep?
Nearly every burn patient has trouble sleeping after the injury occurs. Itching, temperature regulation problems (you're too hot or too cold), anxiety, and pain can all cause sleep disturbances.
I'm depressed and tired, I don't care and I'm sick of all this! When will I feel better?
There is a period of time after a burn when a variety of emotions are normal. Many times during the healing process after a traumatic experience feelings of sadness and anger seem overwhelming. Other times these seem manageable. These emotional ups and downs will pass and then reappear, but the time between these sad and normal feelings eventually will get longer. People often describe this process as being on an emotional roller coaster. It is important to have a friend or a family member to talk to for support because sometimes patients just need to talk about how they feel in order to let go and better cope. Frustration with pain and intensity of feelings change with the amount of sleep a person gets, so proper rest is especially important, as is some type of exercise, daily activity, and good nutritional intake. This roller coaster of feelings won¹t last forever. Most patients report that one to three months after the burn or the last surgery emotions start calming once again.
Why do I have to wear pressure garments?
Compression against scars is believed to help to flatten and soften hypertrophic scarring. Compression from the tight pressure garments also seems decrease itching.
Why do I have to wear my pressure garments and face mask full time?
The mechanism for scar formation is active twenty-four hours each day. Therefore, compression therapy is recommended at all times for optimal cosmetic outcome.
How long will I need my pressure garments and face mask?
Most patients wear the garments for one to two years. However, the hormones for normal growth in children also contribute to hypertrophic scar development. Therefore, children may need to use compression garments for a longer period of time (three years is not unusual).
How long do I need to use foam elevation wedges and keep my hands elevated?
Foam elevation wedges have two purposes: 1) to decrease edema in hands, and 2) to maintain desired stretch position (i.e. keeping the shoulder at a position of flexion and abduction). Foam elevation wedges can by discarded when elevation to control swelling is no longer necessary and/or when the positioning is no longer a part of the therapy program.
What will the burns look like when they are completely healed?
Healed burns and skin grafts may leave scars which appear red and bumpy (hypertrophic scars). These may be hard and tight and may affect movement e.g. the ability to run or use hands.
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| Scars |
What does a mature burn wound look like?
A mature burn wound is one in which the bright pink color has faded to a more normal color, and the skin feels soft and supple again. This process of maturing often takes longer than twelve months.
What can help the scars on the outside?
Scars take one to two years to heal completely, and during this time, special pressure devices should be worn to keep the scars as soft and flat as possible. These services may include elastic garments and plastic face masks which must be worn day and night to be effective. These devices fit tightly, like a second skin, but the person gets used to wearing them after a while. If the devices are properly made and worn, then the scars will be permanently minimized. Despite optimal treatment, healed scar tissue will never look like normal skin again. Emotional scars may last forever, but his or her friends and family can help these heal by understanding what he or she has been through and by showing their support.
What happens to burns of the lungs?
Healed burns involving the lungs and throat may result in an altered voice which may be whispering or raspy. If the burn was very severe, a tracheostomy (breathing hole at the front of the throat) may be required, because the person can no longer breathe through the nose and mouth.
Are burns and scars contagious?
No they are not.
If the skin is always shedding and replacing itself, why don't scars shed and go away?
The cells in the superficial or upper layers of skin, known as the epidermis, are constantly replacing themselves. This process of renewal is basically exfoliation (shedding) of the epidermis. But the deeper layers of skin, called the dermis, do not go through this cellular turnover and so do not replace themselves. Thus, scars, and foreign bodies (i.e. tattoo dyes), implanted in the dermis will remain.
What happens to scars as people grow?
Scars will often stretch out to accommodate growth, but sometimes "release" operations are required. This is most common when scars cross over joints and limit movement.
When will my scars disappear?
Scars never disappear. Scars can be altered through plastic surgery or can be camouflaged with creative use of makeup, thereby creating a more cosmetically acceptable outcome. The redness and appearance of the scars will decrease as the wounds mature, gradually becoming less noticeable. However, burn scars never never disappear completely.
Why is my donor site scarring?
Taking donor skin causes damage to the normal layers of the skin, similar to how a burn injures the skin. Therefore, although the layer of skin taken as a donor is very thin, it also has the potential to scar. Skin pigment change is the most common and noticeable scar in donor sites.
How can I hide my burn scars?
Many burn survivors use camouflage cosmetics to cover burn scars. Certified aestheticians are skilled in training people how to camouflage scars effectively. We recommend working with an aesthetician experienced with burn injury scars.
Long-Term
Are burn surviors able to participate in all activities?
Initially his or her skin will be fragile or their joints may be tight. They may not participate in rough sports and other activities. If he or she has been hospitalized for a long time and their lungs were involved, exercise tolerance may be quite limited. It will still be important for them to participate in gym class and break time activities so that they can still feel part of the group. Also, his or her new skin can burn easily so they must be protected from the sun. They may also miss some classes so that he or she can attend appointments with doctors and therapists.
How can I help someone who has been burned?
You can try to understand that although the person may look different on the outside, he or she is essentially the same person on the inside. You can remember that they've been through some tough times and just want to be accepted as one of the group -- as he was before. You may try to imagine what you would feel like in his situation. (Introducing a "buddy" concept may be helpful when he initially returns and is unable to participate fully in past activites).
Am I more susceptible to skin cancer because of my burn injury?
When neglected, chronic ulceration (a wound that is open for a very long time) results in a rare, but highly malignant condition known as a Marjolin's ulcer. This squamous carcinoma generally only occurs in neglected scars with chronic or recurrent ulcerations.
When can I shower in a normal shower at home?
Showers at home are usually allowed at the time of hospital discharge if the person is independent in bathing. When assistance is necessary, a tub bath is generally easier for the care provider.
My burned areas have permanent dark spots. Are the dark spots from the cream (Silver Sulfadiazine) used when I was first burned?
Silver sulfadiazene cream (Silvadene®) does indeed turn black as the silver ion oxidizes. However, the black pigments are not incorporated into the healing skin. Permanent skin discoloration is not from using silver sulfadizene on burn wounds. As healing skin matures, melanocytes, the cells that produce pigment return. People with little pigment in their skin (e.g. red headed, fair skinned individuals) seem to have less pigment in their healed burns. The healed burns of individuals with more pigment (e.g. Asian, Mediterranean, African) tend to have more melanocytes and more pigment than unburned skin, often leaving permanent dark discoloration. Also, some people who expose their recently healed burns to the sun experience a permanent dark discoloration. We recommend no sun (UV) exposure until the injured skin is mature, twelve to eighteen months post-injury.
When can I go swimming in a lake or a pool?
Swimming is possible when all open areas are healed and tests for MRSA ( Antimicrobial Resistance - Methicillin Resistant Staphylococcus Aureus) are negative. Sun protection is always recommended when swimming outdoors.
When can I go into the sun again?
Healed, pink colored skin is easily injured by the sun. Even tiny amounts of sunlight will cause the skin to tan a very dark brown color which lasts for years. SPF 50 sun screen will NOT prevent this color change. When the pink color fades, sun exposure is safer, provided a sun block of at least SPF 15 and barrier protections (i.e. clothing, hats) are used to prevent sunburn. We recommend no sun (UV) exposure until the injured skin is mature, twelve to eighteen months post injury.
Should I wear my garments and my neck splint or face mask while swimming?
Garments should remain on while swimming because they help decrease itching and provide good sun protection. After swimming the recommended routine includes compression garment change, a shower, and lotioning. It is not practical to wear neck splints while swimming because they make movement difficult. Face masks provide good sun protection, but wearing them in the water may be uncomfortable because of the wetness trapped under the mask. If the face mask or neck splint are removed, sun protection must be provided from an alternative source.
When can I go back to work?
Return to work indicates good adjustment following a burn injury, but each patient and each case is evaluated individually. Timing a return to work depends on numerous variables, such as the duties performed, environmental considerations (heat and cold), range limitations, skin integrity, and medications in use. Return to work may be gradual, for instance quarter days for awhile, then half, and finally full time return. Sometimes retraining is necessary because the injured person cannot do the work that was done prior to the injury due to physical limitations. In other situations, the injured person may not able to cope mentally if the work position had been instrumental in the cause of the burn injury.
When can I start gym class or work out again?
Non-contact sports may be resumed immediately after hospital discharge. It is best to wait until the skin is more durable and less susceptible to blistering, tearing, and breakdown before engaging in contact sports. Weight lifting in a gym can be resumed as soon as the injured person feels up to it, but a spotter is recommended since it takes time to build back strength and endurance.
When will I be able to drive again?
Patients must be off all narcotics and medicines that cause drowsiness before resuming driving. Other considerations for driving include eyesight damage and range of motion limitations, especially in the arms, hands, or neck.
How do I find a counselor or a psychiatrist who has experience in burn cases?
Ask for a referral or recommendation from your area burn center physicians and psychiatrist. It is, however, often difficult to find a counselor or psychiatrist outside the regional burn center who has experience in adjustment after a burn injury. Therapists who know about treating people who have survived other traumatic events would be a possible alternative. Talking to a trained professional about feelings after a traumatic life experience is important, especially if depression and anxiety continue and if you continue avoiding normal activities. Medications may also be recommended at times to help while a person regains more stable emotions and coping abilities.
When can I get a perm or color my hair if my donor is from my scalp?
Hair coloring products can generally be used six weeks after healing is completed and the scalp flakiness has ceased. Permanents or straightening products can be used three months after healing. Always perform the patch test to a small area as recommended by the manufacturers of the products, before application to the entire scalp.
How can I get eyebrows again?
Skin grafts often have small areas of graft loss from the build up of fluid right after surgery. If the burn injury did not damage the eyebrow hair root, the eyebrows will regrow. If the burn injury destroyed the hair root, eyebrows will not grow back. Three alternatives are available if eyebrow loss is permanent: 1) hair plugs removed from the scalp and transferred to the eyebrow area, 2) cosmetic tattooing in the shape of eyebrows, and 3) the use of camouflage cosmetics to draw eyebrows onto the face with makeup
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