Unit
- Burn depth classification: Superficial (first-degree) burns involve only the epidermis, causing erythema and pain without blistering. Partial-thickness (second-degree) burns extend into the dermis, producing blisters and intense pain. Full-thickness (third-degree) burns destroy both epidermis and dermis, appearing white or charred with insensate zones due to nerve damage.
- Systemic inflammatory response: Major burns trigger a massive release of cytokines and inflammatory mediators, leading to increased capillary permeability, edema formation, and potential organ dysfunction. This hypermetabolic state can persist for weeks and requires careful nutritional and hemodynamic support.
- Phases of wound healing: The inflammatory phase (days 0–5) involves hemostasis and neutrophil infiltration to clean the wound. The proliferative phase (days 3–21) features fibroblast migration, collagen deposition, and angiogenesis. The remodeling phase (weeks to months) involves collagen reorganization and scar maturation.
- Hypertrophic scarring: Excessive collagen synthesis and reduced degradation lead to raised, red, and rigid scars that can restrict movement. Risk factors include deep burns, prolonged healing, young age, and dark skin pigmentation.
- Contracture formation: Scar contraction across joints causes functional limitations. Prevention through early positioning, splinting, and range-of-motion exercises is critical to maintain tissue length and joint mobility.
- Time to heal and functional implications: Wounds healing within 2–3 weeks generally result in minimal scarring, while those healing beyond 3 weeks have significantly higher risk of hypertrophic scarring and contracture.
- Role of inflammation in rehabilitation: Persistent inflammation can delay therapy due to pain and fragility. Rehabilitation professionals must balance activity with respect for tissue tolerance to avoid reinjury.
- Impact on skin integrity and sensation: Burned skin loses its barrier function, increasing infection risk, and altered sensation can lead to neglect or overuse injuries. Education on skin care and protection is essential throughout rehabilitation.
Terminology
- Erythema
- Redness of the skin caused by increased blood flow, common in superficial burns.
- Hypertrophic scar
- A raised, thickened scar that remains within the boundaries of the original burn wound.
- Contracture
- Permanent shortening of skin, muscle, or tendons that restricts joint movement.
- Hypermetabolism
- An elevated metabolic rate that increases caloric and protein demands in severe burns.
Quick Revision
- Burn depth ranges from superficial to full-thickness, affecting pain, healing time, and scar risk.
- Systemic inflammation following major burns drives a hypermetabolic state requiring multidisciplinary management.
- Wound healing phases include inflammatory, proliferative, and remodeling stages, each with distinct cellular activities.
- Hypertrophic scarring and contractures are common complications that rehabilitation aims to prevent and treat.
- Early intervention with positioning and range of motion is critical to preserve function.