A patient with burns needs permanent skin grafting. which grafts should the nurse consider

Discharge planning begins very early in your hospital stay. Depending on your needs, your medical team may suggest you go to either a skilled nursing facility or a rehabilitation facility. Both of these facilities can help you successfully recover and return home.

You should feel free to ask your medical team what the best discharge plan for you will be.

If you can go home, the medical team will assess your needs and develop a discharge plan with you and your family. You will be instructed on exercises to keep your joints mobile and build strength. You will be given orders for outpatient rehabilitation therapy. You and your family also will be instructed on wound care and a visiting nurse may be arranged.  You should anticipate several return visits to the burn clinic. You are encouraged to ask questions during these visits and bring up any concerns.  

Recovering from burn injuries is a stressful time for you and your family and any of you may experience mental health issues. Please discuss these with your medical team who can help determine the best treatment with you.

Watch for infection

While the burn or wound is healing, bacteria can get in and cause an infection. Watch for:

• Redness outside the burn or wound
• Warm or hot skin to the touch
• Swelling
• Florescent green to yellow drainage
• Foul odor (bad smell)
• Fever
• More pain than normal

These are all reasons to come in for a clinic visit. You may also have to stay in the hospital for IV antibiotic treatments.

When this is caught early, infections can be treated, and damage to your graft or donor site can be prevented.

Donor site

Donor sites are made to move skin from a non-injured area of the body to cover a burn or wound. This skin will attach itself and help heal your wound. The skin is most often taken from the thigh, belly, back, or scalp (most often used in kids).

The donor site is covered with a dressing of the doctor’s choice. The dressing may leak and will need to be patched or replaced. This is normal. The donor site should heal in 10 to 14 days. The drainage will be less and less over time.

After your donor site is healed it will need moisture so it does not get dry and itch.

Doctors may be able to take skin from this area again after it is healed, depending on the size of the burn that needs a skin graft.

Graft site

Over time, the color of the graft and how it feels will change. Because nerve endings were damaged, the new skin will be sensitive to hot and cold temperatures.

At first, the graft may look shiny and be pink, dark pink, or purple depending on:

• How it heals
• The temperature of your surroundings
• The time of day and your activity level

After care

After your skin graft and donor sites heal it is very important to put on a non-perfumed (unscented) lotion or mineral oil many times a day. This will help control itching and keep your skin soft, moist, and able to stretch. You do not want your skin to get dry and peel.

Follow the directions you are given by your caregivers. It may take 12 to 18 months for your scars to heal. During this time the color and feeling of the wounds may change. Also, your scars will learn to stretch as they heal and grow. For the best outcomes be sure to:

• Do your stretches.
• Wear your splints and garments if they are prescribed by your care team.
• Your graft and donor sites will be sensitive to hot and cold temperatures.
• You may have a tendency to overheat more easily. Rest as needed
• Be sure to wear warm gloves and clothing during the winter months.
• Wear sunscreen with an SPF of 30 or higher the rest of the year.
• Re-apply sunscreen often. Make sure you drink a lot of fluids because your body may not adjust to temperature changes the same as it used to.
• Pay attention to your body and rest when you are tired.

When to call us

Call us if you have:

• A fever over 100.4 F
• Signs of a wound infection
• A sudden onset of severe pain that is not normal, nausea, or vomiting (throwing up)
• Bleeding from the wound
• Redness outside of or streaking away from the wound
• Problems with or questions about your dressings

Daily care tips

Bathing

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.

Dry skin

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

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.

Bruises

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

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.

Cold

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.

Appearance

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.

Discoloration

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.

Scarring

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.

Exercise

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.

Diet

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.

Which types of skin grafts are considered Permanent Select all that apply?

Do 2nd degree burns need skin grafts?

Which type of burn injury requires skin grafting?

Do third degree burns need skin grafts?