Burn Wound Care: Wound Closure

Wound closure of burn area is performed on the fifth to twenty-first day. It is depend on the extent of the burn area. Wound closure can prevent infection and loss of fluid, promotes healing and prevents contractures.

There are two types of wound closure techniques: temporary wound covering and permanent wound covering (autografting).

Temporary Wound Covering

1. Biological

Amnion:
The amniotic membranes from human placenta are used, and dressing is changes every 48 hours with amnion.

Allograft Homograft:
The donated human cadaver skin is used. Extra monitor for wound, sign of infection and sign of rejection. The rejection can occur within 24 hours.


Xenograft Heterograft
Xenograft over granulation tissue is replaced every 2 to 5 days until the wound heals naturally or until closure with autograft is complete.

Biosynthetic and Synthetic
Visual infection of wound is possible because dressing are transparent or translucent. Wound exudates and signs of infection should be monitored.

2. Autografting
Autografting is surgical removal of a thin layer of the client’s unburn skins, which then is applied to the excised burn wound that provide permanent wound coverage. This procedure is performed in the operating room under anesthesia. Bleeding following the graft should be monitored because bleeding beneath an autograft can prevent adherent. Autograft areas are immobilized 3 to 7 days following surgery to allow time to adhere and attach to the wound bed.

There are four types of skin grafts:

• Split Thickness: Graft of half of the epidermis, applied in sheets or postage stamp-like pieces.
• Full Thickness: Graft consisting of epidermis and dermis are used for reconstructive surgery months or years after the initial surgery.
• Pedicle Flap: This is used for reconstructive surgery months or years after the initial inury.
• Cultured Epithelium: The client’s unburned skin is used. Isolation of keratinocytes and culturing of epithelial cells in a laboratory and then are attached to the burn wound.

CARE TO THE GRAFT SITE:

1. Immobilize and elevate graft site and keep from pressure.
2. Avoid weight bearing
3. Remove exudates (if any) using roll a cotton-tipped applicator over the graft to prevent infections.
4. Monitor for foul-smelling drainage, increased temperature, fluid accumulation, hematoma, and increased WBC.
5. Instruct the client to lubricate healing skin with cocoa butter as prescribed, avoid using fabric softeners and harsh detergents in the laundry, protect the affected area from sunlight, and use splints and support garment as prescribed.

CARE FOR THE DONOR SITE:

• The methods of care for the donor site may varies depending on physician’s preference.
• A moist gauze dressing is applied at the time of the surgery to maintain pressure and stop any oozing.
• Keep the donor site clean, dry, and free from pressure.
• Apply lubricating lotions to soften the area and reduce the itching.
• Prevent the client from scratching the donor site.