Long-term medical treatment of patients with severe burns at exposed sites

ARTICLE HIGHLIGHTS

Research background

Face and hands are sites of high exposure in daily life, where burns can accumulate during a mass burn casualty event. In the late-stage of treatment, unhealed residual wounds, unpleasant appearance caused by scar hyperplasia and contracture, limited movements and heavy mental burden commonly exist in patients; however, numerous patients, their families and even surgeons have not paid enough attention to these factors.

Research motivation

In order to improve the clinical effect in burn patients, we summarize the experience of late treatment of severe burns in exposed sites in order to draw the attention of patients, their families and doctors.

Research objectives

To improve the effect of treatment in the late stage of severe burns at exposed sites and to improve patients’ quality of life to achieve an early return to society.

Research methods

Patients were bathed in Chinese medicine lotion for 20 to 30 min each time, 2 to 3 times a week. The wound was covered with recombinant human epidermal growth factor after each bath; wound secretions were sampled before and one week after bathing to document the healing time and the frequency and duration of relapses, and the VAS was adopted to evaluate pain during wound dressing. Patients started rehabilitative functional exercises of the hands two weeks after skin grafting. Comprehensive rehabilitation plans were made according to the injury severity of patients’ hands: (1) Active and passive finger movements; (2) Scar massage; (3) Chinese herbal bath therapy; and (4) Anti-contracture fixation during motionless periods. Silicone gel ointment, cicatricial paste and elastic clothing were used for long-term anti-cicatricial treatment. Finger massage and mouth opening expansion were used for special areas such as the eyelids and perioral area to combat cicatricial contracture, while DPL and micro-plasma treatment were used for accurate cicatricial therapy to reduce cicatricial formation. A psychological intervention was conducted in patients by improving the living environment, providing humanistic care, enhancing family and social support and establishing a communication-based platform.

Research results

We attempted to repair residual wounds using functional joint exercises, anti-scar treatment, and psychotherapy, which could be helpful for late-term burns. In the present study, we performed systematic treatment in 13 patients, we received satisfactory feedback from patients and their family, which might assist burn patients to safely return to society.

Research conclusions

We regard residual wound repair, functional joint exercises, systematic anti-scar treatment and psychotherapy as key points in the late-term treatment of burn patients, and these four components formed an integrated treatment.

Research perspectives

We used the combination of traditional Chinese and Western medicine to accelerate wound healing, reduce scar formation and relieve patients' pain. With the participation of professional rehabilitation therapists, individualized anti-scar and functional exercise schemes were provided according to the site of the scar, patients’ physical condition, and the nature of the scars. Psychological disorder screening and intervention should be carried out according to the symptoms of burn patients.