Burn injury

--What should I do if I suffer a burn?

Regardless of the size, there are actions you can take to prevent a burn getting worse. Burn injury causes an extreme inflammatory response that produces swelling and immune responses to help fight infection. These responses can further damage the skin and surrounding tissues. This damage can be reduced by applying first aid.

--What is good first aid after a burn?

1. If on fire, stop, drop and roll to put out the fire. Call 000 if an ambulance is required.
2. Apply routine first aid – DRSABCD.
3. Once the burned person and others helping are safe from further harm, remove clothing and jewellery and run cool, clean water over the burn for 20-25 minutes.
4. Cool the burn and warm the patient. Keep the body parts that are not burned covered with clothes, a towel or blanket.
5. Ideally, you should apply first aid within the first hour, but within three hours is of benefit. Once cooled, wrap the wound in a clean cloth and seek medical assistance to provide an appropriate dressing and opinion as soon as is practical.

--How do I manage my healed burn?

Rehabilitation starts on the day of injury. A burn injury may have long-term complications. After an experienced doctor or senior nurse has reviewed the burn, you can apply simple techniques to reduce or prevent scarring and other problems that might result from the body’s response to the injury.

Take pain relief regularly, not just when you feel pain. Your doctor will help prescribe a regime. The burn wound is painful because the nerves of the skin are damaged. The injured nerves are like a damaged electrical wire, they have no alternative except to give strong pain messages when the wound and unburned surrounding area are stimulated, regardless of why the nerve fires.

Swelling is your enemy. Swelling increases pain, so you should immediately start to manage swelling by applying compression over the dressed wound, elevating your limb when you are at rest and keeping your body part and surrounding joints moving. The pain from a burn can often be distressing and cause fear and anxiety. You will not damage your burn wound by continuing to move—in fact, it will help the swelling and pain if you use your muscles. Your physiotherapist can help you by prescribing exercise that will not only reduce swelling faster, but also maintain your function as the burn wound heals. Removing the swelling from under your burn will allow it to heal faster and have less chance of infection.

Burn-specific services in Australia are located in state capitals and generally accept referrals from GPs, the burn unit hospital emergency department and in-house specialists. If you have any concerns about your pain, scar, movement or returning to normal participation, please do not hesitate to engage your closest burn unit.

--What can I do at home?

Self-management after a burn is the key to the best outcome. A scar does not sleep. You are the most important person in the provision of treatment. The key to beating your scar is little bits, often. You can turn on your muscles and move. You can moisturise and massage your scars. You need to do this multiple times each day to prevent the scar causing a contracture and permanently taking your movement. Most importantly, follow the advice given to you by health professionals. Recovering from a burn requires compliance and persistence, often over a long period of time.

If your burn heals without surgery, you should regularly moisturise and massage the area with non-perfumed, water-based moisturiser. You may benefit from more specialised treatment if the healed scar continues to be red, raised, itchy or painful 4–6 weeks after injury. If this occurs, you should seek referral to your local burns unit. If exposed to the sun, healed skin can change to a darker colour. It is best to protect the area with high factor sunscreen and good sun care practices, but you do not have to stay indoors.

If your burn required surgery, then you should have an individualised program to minimise your scar. This is likely to include combinations of pressure garments, contact media, manual techniques and exercises to help you return to your chosen work and play.

--What can I do about tight or itchy scar tissue?

Active scarring is red, tight and often hypersensitive to any touch or contact, resulting in increased pain or itching. You should seek referral to an experienced burn team to develop the best plan to treat these symptoms. Drying out is one of the primary factors contributing to tightness, cracking (pain) and itching scars. The use of moisturising cream, non-drying soaps, simple analgesics and anti-histamines in discussion with your doctor, may assist with a tight or itchy scar. Consider your nutrition, including water intake, and minimise alcohol and other diuretic (increased production of urine) intake.

A scar never sleeps. Whenever you stop moving and rest, your scar automatically tightens due to the process required for scar healing and the type of tissue involved. Movement and exercise can help manage scar tightness.

--How can physiotherapy help with burns rehabilitation?

The aims of physiotherapy immediately after burn are to:

• help delivery of oxygen to the healing tissues. This may entail specific breathing exercises and manoeuvres
• reduce swelling with compression, exercises and positioning to increase the use of your muscles and improve lymphatic return
• restore your mobility
• commence exercises to help strengthen muscles
• prevent de-conditioning and joints getting stiff

It is ideal to consult a physiotherapist experienced in the management of burns as soon as possible after a burn, particularly if the burn involves the hand.

Burn wound healing requires lots of protein, so the body will steal protein from muscle when possible. After the first couple of days, the focus of physiotherapy will shift to education regarding ongoing management, as well as strengthening for muscles in preparation for surgery and the fight against future scarring. Early resistance training for muscle strength reduces the impact of the muscle loss due to protein mobilisation and helps maintain or restore movement.

--When should I start exercising?

After a burn, newly healed skin is fragile for around two weeks and is often not robust enough for strong contact. Care with exercising needs to be taken.

The principles to remember are:

• warm up well with five minutes of global body movement to get the blood flowing (exercise bike or gentle jogging)
• after warm-up you should gradually stretch out your scar over 30-60 seconds
• you should use your muscles to actively repeat the stretching movements until you have full range of motion. This can be measured when compared to your opposite side or expected normal movement of a joint
• your physiotherapist will guide you regarding your exercise program and progress your exercises throughout the healing process.

Speak to your physiotherapist before returning to competitive sport and intensive occupations. When returning to strenuous activity you might also notice that your burn scar area does not sweat and manage body heat as well as normal skin. You may need to increase your water intake and consider other methods of cooling such as exercising in cooler parts of the day.

--Should I be worried?

Care should be taken when returning to strenuous activity due to reduced capacity for your body to maintain normal core temperatures. You can discuss this with your physiotherapist.

If your scar becomes dry and cracked, or you bump your scar and cause a blister or breakdown it can easily become infected. If the scar rapidly becomes very red and painful or the non-burned skin around the scar becomes red and warm, you may have an infection, commonly termed cellulitis. These local symptoms can be accompanied by feeling generally unwell, like a cold or flu. You should seek medical advice immediately if you become aware of these symptoms.

--How long until I’ll gain full function of the affected area?

All burn injuries are different. A burn injury is by definition, a ‘chronic condition’. The natural healing of a burn can take months, even with a burn that has healed without surgery. That timeframe can increase if the burn scar is not managed daily, which can be challenging to understand after suffering a burn injury. It is an injury isn’t it? Once healed I should be OK, shouldn’t I?

Physiotherapists who work with burn and traumatic injury survivors can testify to the complex nature of the healing and scar maturation process. It is clear that there are long-term effects that can impact your psychological recovery and return to normal participation after a burn. These negative feelings, fear, and difficulties restoring body image are more common than previously recognised, even for those who experience burns in areas easily covered by clothing. Don’t be afraid to seek support from a specialist burn team should you encounter such feelings or challenges in normal social interactions.