Monitoring

Wounds should be surveyed for signs of infection. Patients with a suspected wound infection should be admitted immediately to minimise the risk of systemic infection.

With increasing survival from serious burns, and increasing expectations of the quality of survival, burn aftercare programmes have assumed an increasingly important role.[101]

Burn aftercare care programmes have several interacting components and objectives.

  • Durable and functional wound closure:

    • The primary objective

    • Requires attention to areas of fragile healing and to any residual or new areas of functionally limiting contracture.

  • Scar management:

    • Particularly important in the first years after injury

    • Although the available tools are limited, attention to programmes of massage and compression, supplemented with judicious use of surgery, can improve function and appearance, and reduce pruritus.

  • Emotional support:

    • Essential to a complete recovery, for both the patients and their loved ones[102]

    • Ideally co-ordinated through the burn centre.

Feelings of guilt, fear, anger, and depression must be recognised and addressed. In cases where intentional burning is suspected, either from self-immolation or abuse, efforts should be instituted to protect the patient from further harm.[24] Aftercare is best provided in a multi-disciplinary burn clinic, in co-ordination with the acute care and reconstructive staff. When managed in a comprehensive follow-up programme, even those who have suffered devastating burns can have a satisfying quality of life.[103]

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