Occupational Therapy Support - Rehabilitation Phase

Persistent contractures may necessitate the use of such splints as microstomia splints, knee/elbow extension splints, shoulder abduction splints or various types of hand splints to increase thumb webspace, finger flexion and extension.
The potential for hypertrophic scarring cannot be predicted. The treatment of choice for prevention or minimization of scarring is the application, at the earliest possible date of external pressure.
External pressure applies a counteractive force on the immature hypertrophic scar, acting to flatten and smooth the skin. There are several theories as to why external pressure works:

The outer skin layer normally puts a certain pressure on the contents below, causing the collagen in the skin to be aligned in a parallel and organized way. When the skin coverage is damaged or lost due to a burn, the healing skin has lost this counteractive pressure, and has no pattern for its regrowth. Collagen is then laid down in an unorganized fashion, causing the skin to appear raised, bumpy and firm.

The increased blood flow to the area of the burn (which gives the healed burn its pink, red or purple appearance) results in excess deposits of collagen causing the raised appearance.

External pressure therapy can be divided into 3 phases, according to the amount of healing.

When the healing skin or graft is fragile and prone to friction blisters, tensor bandages can be applied to the limbs or trunk and Coban wrap to the hands (see Appendix 3). Tensors and Coban wrap should be reapplied every 4 hours. Tensors can be applied over dressings if necessary.

When few open areas remain, Tubigrip can be applied (usually 1-2 weeks post healing/grafting). Tubigrip is a cylindrical or tapered elastic "stocking" that is applied and removed gently. Once in place, it need only be removed for bathing or lotioning. For the hands, Isotoner gloves can be used as an intermediate step between Coban and a custom fitted glove.

The third phase of pressure therapy involves custom made garments, clear face masks and splints which put a counteractive force on the maturing scar. The garments are ordered from a company such as Jobst and usually take 2-3 weeks to arrive. Masks and splints are fabricated by the occupational therapist as needed.

These garments must be worn 23 1/2 hours a day as the skin is constantly growing and remodelling. They are removed only to bathe or reapply lotion, while facemask and gloves can be removed for meals. Two sets of garments are therefore required that are worn and washed on alternate days. As custom made garments last approximately 4 - 6 months, it is not unusual to reorder 3 - 4 times. They are very expensive, and financial arrangements are usually arranged prior to ordering, such as self payment, I.C.B.C. or W.C.B. coverage. Those with extended health benefits can usually receive approximately 80% of the cost refunded, but they must pay the cost at the outset.
Pressure garments should be worn while the scar is still red and raised indicating an immature stage. The length of time to achieve scar maturation, where pressure is no longer required or helpful, varies for every individual, but usually takes 8-12 months and sometimes even longer for children.

Next Page Previous Page Burn Info E-mail

This sight is maintained by the B.C. Burn Network Society. We welcome contributions and comments from interested parties.

No part of this document may be reproduced or transmitted in any form by any means graphic, electronic, or mechanical - without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.