First, we clean the burn wounds. At the same time, we determine a treatment concept based on the depth of the burn and the extent of the wound. After cleaning the wound, antimicrobial ointments are applied and a dressing is applied. In the first few days after the burn, daily dressing changes are necessary. If joints are affected, physiotherapists will help you during the dressing change with passive and active movement exercises to maintain or restore joint mobility as far as possible. Doctors assess the wounds at each dressing change and decide how to proceed.
We use various skin grafting techniques to optimize the healing process, reduce scarring and ensure freedom of movement. We use both the patient’s own skin and artificial skin.
Transplantation of split skin
In this skin grafting method, we remove a thin layer of skin, known as split skin, from a healthy area and transplant it onto the prepared wound bed. Mesh-like enlarged split-thickness skin grafts are often used to cover larger wounds. The donor site heals spontaneously like a superficial abrasion. The transplanted skin heals within a few days, provided the healing process is not impaired by an infection, severe metabolic disorders or insufficient immobilization.
Transplantation of cultured skin cells
If you have very extensive burn wounds that cover more than 50% of the body surface, we transplant cultured skin cells (keratinocytes). To do this, we remove a healthy piece of skin the size of a postage stamp. Skin cells are isolated from this in the laboratory and multiplied as a cell culture. With this method, large grafts can be produced from your own skin cells within three weeks, which are then placed on the prepared wound bed. Treatment after keratinocyte transplantation is similar to that after split-thickness skin transplantation, but special care must be taken with the new skin, which is initially still thin, easily injured and susceptible to infection.
Skin substitute for temporary wound coverage
If the general condition is not very good or it is not possible to find enough donor sites, the wound can unfortunately not be covered with the patient’s own skin. In order to protect the fresh wound surfaces from infection, to limit fluid, salt and protein loss and to reduce wound pain, temporary coverage with a skin substitute (artificial or donor skin) is required. However, as soon as definitive coverage with split skin or keratinocyte cultures is possible, this artificial skin is replaced.
Physiotherapy and occupational therapy
Throughout your stay in hospital and beyond, you will be accompanied by physiotherapists and occupational therapists. The physiotherapist is responsible for the physical strengthening program, i.e. for maintaining and, if possible, improving the function of the musculoskeletal system, but also for stimulating all organ systems. The occupational therapist is concerned with maintaining function.
When deep burns heal spontaneously and after skin grafts, excessive, thickened (hypertrophic) scars can develop, which contract and possibly lead to limited joint mobility. However, the severity of scarring is very individual and its extent cannot be estimated. Constant, even pressure from customized compression garments reduces the appearance of thickened scars and helps to improve the cosmetic result. It is important that you start compression therapy as soon as the burn wounds have healed. Printing should take place 24 hours a day, including at night.
Silicone inserts can help to distribute the pressure evenly in areas of the body that are difficult to compress. It is also important that you take good care of your skin by applying an oily ointment every day. It can take 12-24 months until the initially reddish and itchy scars have matured to such an extent that there is no longer any need to worry about excessive scarring; you must always wear the compression garment for this period. This requires patience and discipline – we will show you how you can achieve this.