Initial treatment and dressings
We first cleanse the burn wounds. At the same time, we determine a therapeutic approach based on degree and extent of the burn injury. After wound cleansing, we apply antimicrobial salves and dressings. In the first days after a burn injury daily dressing changes are required. If there is joint involvement, physical therapists are there to assist with passive and active motion exercise during the dressing change, in order to preserve or restore joint mobility as much as possible. Physicians assess the wounds at every dressing change and decide further treatment course.
Surgical treatment of burns
For healing of deep burns, the affected tissue areas must be removed until healthy, well-perfused tissue is present.
We use various skin graft techniques to optimize healing, to diminish scarring, and to facilitate free movement. We use both autologous as well as artificial skin.
Split-thickness skin grafting
In this method of skin transplantation, we harvest a thin layer of skin, so-called split-thickness skin, from a healthy site and transplant it to the prepared wound bed. Meshed enlarged split-thickness skin grafts are often used to cover extensive wounds. The harvest site heals spontaneously as would a superficial abrasion. The grafted skin heals into the wound within a few days, as long as the healing process is not impaired through infection, major metabolic disturbance, or inadequate immobilization.
Transplant of cultured skin cells
If you have extensive burn wounds comprising more than 50% of the body surface, we transplant cultured skin cells (keratinocytes). To this end, we harvest a healthy piece of skin the size of a postage stamp. We use this to isolate skin cells in the lab and multiply them in cell culture. This method allows for production of large grafts of your own skin cells within three weeks, which are then placed on the prepared wound bed. Treatment following a keratinocyte transplant is similar to that following split-thickness skin transplant, however, it is important to handle the new, initially thin, friable skin, which is easily injured and prone to infection.
Skin substitute for temporary wound coverage
If the patient's overall condition is poor or if it is not possible to find sufficient donor sites, the wound can unfortunately not be covered with autologous skin. To protect the wound surfaces from infections, limit fluid, elektrolytes and albumin loss, and reduce pain, we are dependent on a temporary coverage with skin substitutes (artificial or donor skin). However, as soon as a definitive coverage with split-thickness skin or keratinocyte sheets is possible, this artificial skin is replaced.
Physiotherapy and Ergotherapy
Physiotherapists and occupational therapists will support you during your entire hospital stay and beyond. The physical therapist is responsible for the physical strengthening program, i.e. the maintenance, and if possible, the improvement of the function of the motor system, but also for stimulation of all organ systems. The occupational therapist is concerned with preserving function.
Spontaneous healing of severe burns and skin grafts can result in extensive, thickened (hypertrophic) scars that contract and eventually lead to restricted joint mobility. However, the amount of scarring is very individual and cannot be estimated. Constant, even pressure through customized compression garments decreases the formation of thickened scars and helps improve the cosmetic result. It is important that you start compression therapy immediately after the burn wounds heal. Pressure should be exerted 24 hours a day, thus also at night.
Silicone inserts can helps distribute pressure evenly in areas of the body that are difficult to compress. It is also important to take good care of your skin by daily application of a fatty salve. It can take up to 12–24 months until the initially reddish discolored and itchy scars have matured enough so that exuberant scarring is no longer a risk; this is how long you must wear at all times the compression garments. It will require patience and discipline – we can show you how to accomplish this.