FROM MY PT SCHOOL NOTES · WOUND CARE · CHAPTER 22
How Do Burns and Grafts Change Rehabilitation?
Burn injury and graft care demand individualized medical directions, skin protection and functional planning.
Differentiate depth and area considerations
Burns are classified by cause (thermal, chemical, electrical, etc.), depth and total body surface area (TBSA). Superficial burns affect the epidermis and are not counted in burn TBSA. Partial-thickness burns extend into the dermis and can be superficial or deep. Full-thickness burns destroy the epidermis and dermis and may have reduced sensation. Burn depth may evolve with time.
Burn-depth refresher: superficial burns are erythematous and dry; superficial partial-thickness injuries are often moist, blistered and painful; deeper partial-thickness burns may be paler and less blanchable; full-thickness injuries may be leathery and have diminished pinprick sensation. Adult TBSA can be estimated using the rule of nines; children require an age-adjusted tool because body proportions differ. Superficial erythema is not counted in TBSA. Source update: American Burn Association burn referral criteria (https://www.ameriburn.org/burn-care-team/resources/guidelines-for-burn-patient-referral).
Protect healing tissue and movement
Functional problems vary with location and severity: edema, pain, limited mobility, scar tightness, reduced joint movement, loss of endurance and contracture risk. Rehab may emphasize protected positioning, edema control, activity and range of motion within graft/surgical precautions, scar management when appropriate, and functional training.
Skin grafts and donor sites need specific surgeon-directed protection and mobilization timing. Do not assume the same stretch or weight-bearing rules for every graft or flap. Child-specific concerns, caregiver support and long-term growth effects are important when applicable.
The burn lecture includes split-thickness skin grafts, biologic/synthetic substitutes, edema control, scar protection, positioning and compression garments. Graft protection and initial motion depend on healing, location and surgeon instructions. Scar care may continue for months as the tissue matures. Work with the burn team on splinting, functional ROM, contracture prevention and individualized long-term garment management; legacy ’23 hours a day’ schedules are not a universal prescription.
Apply the course to a practical scenario
Check your reasoning: Can one generic ROM program be used without knowing graft location and postoperative protection?
No. Follow the surgeon/burn team’s graft, positioning, movement and loading restrictions.
Make the clinical connection
Scenario: A patient with a recent graft is eager to stretch the affected joint because the surrounding tissues feel tight.
What is the next reasoning step?
Reasoning: The graft’s location, age, healing state and surgeon/burn-team instructions determine whether that movement is appropriate. Protect donor and graft sites, consider pain and edema, and coordinate the functional plan before applying stretch.
Common mistake: Using a routine stretching protocol without checking graft protection. Remember: Burn and graft rehabilitation depends on healing and surgical directions.
Current reference (separate from my class notes): American Burn Association burn-referral guidance. Referral depends on severity, location, mechanism and patient-specific context; burn teams direct graft-protection instructions.
Source: my General Medical / Wound Care school-notes companion, wound section(s) 11 and 12. This is for studying concepts and clinical reasoning. It does not authorize debridement, compression, dressing selection or burn care without qualified training, evaluation and current protocols.
