A rehabilitation facility may be necessary depending on the severity of the burn. These facilities can further your rehabilitation needs once your acute care needs have been met. If you transfer to a rehabilitation unit, your therapist will design an occupational/physical therapy schedule to meet your needs. Your social worker will meet with you to arrange your discharge — either to go home or to a rehabilitation facility, depending on your needs.
Your newly-healed skin will require some special care and consideration when you return home.
You may continue to bathe in your usual manner, however, soaking in a bathtub is not recommended. Test your water temperature before getting into the tub or shower. Your new skin is sensitive to extremes of hot or cold and may be injured easily. Using a clean, soft towel and gently washing instead of vigorously rubbing will lessen any discomfort of bathing. If you have any open areas that cause you discomfort, use your medication as prescribed before washing. Continue to wash these areas as you have been instructed and apply medication as directed.
The dry, scaly appearance of your skin results from damage or destruction of the oil-producing glands. Some of these glands will begin to function again, but until that time you will need to use some artificial lubricant. Avoid lubricants that contain lanolin and alcohol as they tend to create blisters in the healed skin. There are many lotions available or you may use mineral oil.
Itching usually accompanies the dry, scaly, healed skin. Avoid vigorous scratching because this may break your delicate skin and leave open areas to heal. Reapply lotion or mineral oil as needed. If you're having a severe problem with itching, your physician can prescribe a medication to help relieve this.
Now that your burns have healed, you have a new layer of skin that is thinner and more sensitive and delicate than the rest of your body. These areas will bruise easily and must be protected against burns and sharp objects. Don't wear tight clothing or shoes that can cause pressure and blistering. Your body needs time to build up skin that can withstand pressure. The length of time will vary with each individual. For some it may take several months and for others a year or more. Gradually, as your skin thickens and toughens, it will become less sensitive. You will be able to go about your normal routine with less fear of bruising.
Blisters commonly occur in healed or grafted areas and are no cause for alarm. Friction from linen, rubbing and bumping against objects will cause blisters. Standing for long periods of time without appropriate support may also cause blistering. Some people tend to form blisters more readily than others. This tendency decreases as your new skin thickens. If blisters occur, you can obtain instructions on how to care for them in the burn clinic or from your physician.
Sun - Your new skin will be more sensitive to sunlight and will tend to sunburn in a very short time. You should avoid direct contact with sunlight at all times. Protect your skin by wearing light clothing to cover the areas that have been burned. Wear a large hat if your face and neck have been burned. Apply a sunscreen to protect your skin during the warm summer months. Your skin will remain sensitive to the sun for at least one year. After this period, you can test your skin by exposing small areas at a time to the sun.
Because your new skin is thinner, it will be more sensitive to cold. Slight tingling and numbness may be experienced, especially in hands and feet, when the weather is cold. This sensation will gradually decrease as your skin toughens. You can decrease your discomfort by wearing warm clothing and avoiding exposure to the cold for long periods. You will need to protect your skin for at least a year.
Your healed burn will continue to change over the next several months. You can expect some discoloration and scarring in the normal course of events.
The skin discoloration you see in your healed areas is a result of the normal healing process. It may appear light to deep pink, brown, or a grayish color; this is no cause for alarm. Discoloration varies with each individual, depending on your natural skin coloring. Natural color may return to superficial burns and some second-degree burns in several months. Other areas may take much longer and some discoloration may be permanent in burns of greater depth.
Discoloration of Extremities
If your arms or legs are involved, you may notice more discoloration after walking or having your arms down. You can help relieve this problem in your legs by sitting with your feet up on a chair. You may find that you experience less discomfort if you walk rather than stand in one place. Standing still for long periods allows the blood to pool in your feet and legs causing swelling and discoloration. Exercise in moderation will also improve your circulation in these areas and will decrease your discomfort. If you continue to have a great amount of discomfort, such as pain and swelling, tell your doctor on your next visit.
Discoloration is generally associated with scarring. Initially it is very difficult to tell how much scarring will be permanent. Some people have a greater tendency to scar. It is difficult to predict how much scarring any one person will have since the amount is also determined on an individual basis and by the depth of your burn.
Scarring from first-degree burns and light second-degree burns may disappear within a few months. Areas of deep second degree and third-degree burns may continue to build up scar tissue for at least two years. At this point, some of your scars may start to gradually disappear. You can also expect some of them to be permanent. Your physician, nurse or therapist will provide you with this information. Some of the scars that cause you concern about your personal appearance or difficulty in motion can be surgically improved. You may obtain the information concerning this from your clinic nurse or doctor.
Although not all burn wounds will look like these examples, you can see that scarring varies from person to person and with different depths of injury. Scars usually progress over a period of time. You can expect them to look the worst between 4 and 8 months post-burn and then gradually regress over 6 to 12 months.
As your skin heals, scar tissue will develop and your skin will tend to contract, causing tightness of muscles. You may notice a stiffness and slight pulling in the joints upon rising from sleep or after being inactive for long periods during the day. You will find that movement of the joints gradually decreases the stiffness. Regular exercise helps prevent arms and legs from becoming fixed in a rigid position.
Prior to discharge, the therapist develops a home exercise program for the patient and instructs the patient and the family in its use. The therapist also works with the patient and family to obtain necessary exercise equipment and arranges for out-patient physical therapy.
Nutrition is as important to your health after you leave the hospital as during recovery from a burn injury. It is important to maintain a good weight for your height. Choose foods rich in protein to complete healing and maintain good tissue structure. Protein may be obtained from beans, nuts, cheese, fish, eggs, meat, poultry and milk. Vitamins and minerals are essential for healing and maintaining normal body functions. They are provided by dairy products, whole grain cereals, enriched breads, fruits and vegetables. Include one good source of Vitamin C each day, such as citrus fruits, tomatoes, green vegetables and potatoes. Try to use a variety of foods since different foods have different nutrients. Control the amount of fat added to foods to help prevent excessive weight gain.
If you have special dietary needs, instructions will be provided before you leave the hospital.
University of Iowa Hospitals and Clinics
Department of Nursing
Critical Care Nursing Division