Face and Neck Burns Rehabilitation

Original Editor - Rhiannon Clement

Top Contributors - Rhiannon Clement, Rucha Gadgil, Samuel Mayah, Naomi O'Reilly and Shaimaa Eldib  

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Introduction

Burns injuries to the face and neck can have a long-term impact on an individuals function, as well as on their social interactions . Therefore, the use of both objective and patient-reported outcome measures are important to get an idea of the impact of injuries on an individuals life. There should be a focus on both the physical and psychological impacts of the trauma.

The treatment of facial burns is aimed at:

• Pain control
• Address inhalation injury
• Encourage movement and function
• Odema Management
• Tissue repair
• Scar Management
• Patient education
• Exercise regimen
• Cosmetic optimisation.
• Optimising the individuals' self-management of scar tissue

If a patient is able to comply with physiotherapy and occupational therapy advice in the long-term, this can make a huge difference to the overall outcome.

Rehabilitation after Burns: Face and Neck

Your face and neck at high risk of burns, as it is rarely covered by clothing or other protective gear.

However, there are protective characteristics that often reduce the depth of burns injuries to these areas :

• People tend to protect their face and shake / wipe off substances.
• Less likely to have materials over face that could absorb the heat and increase time in contact with skin.
• Skin on face is relatively thick (except eyelids) with a good blood supply to dissipate heat.

Risks by area

Back of head: Area of thin skin with risk of exposure of underlying bone. May also result in areas of alopecia.

Ears: Risk of exposure of underlying cartilage, which is relatively avasular and at risk of infection.

Forehead: Less fat and muscle in this area can increase risk of exposed bone.

Eye lids: Also thin skin and at risk of exposure of underlying tissue / eyes. They also provide little resistance to forces of contracture and are prone to forming ectropios, exposing the inner eyelid.

Nose: Risk of shrinkage of nostrils and nasal alar. Also at risk of exposure of underlying cartilage and bone, which are relavitly avascular and at risk of infection.

Cheeks: Mobile and thick skin. This area has good resistance to skin contractures. However, difficult to immobilise for healing post-surgery.

Lips: Prone to shrinkage or eversion as a result of contractures.

Neck: More prone to contractures in younger patients, due to reduced laxity. The skin loosens with age, creating more tolerance for shrinkage.

Aims of Treatment

• Pain control
• Address inhalation injury
• Encourage movement and function
• Odema Management
• Tissue repair
• Scar Management
• Patient education
• Exercise regimen

Outcome Measures

Passive Range of Motion

Active Range of Motion

Function

Young Adult Burn Outcome Questionnaire (YABOQ)

Precautions

• Damage to bone or tendon
• Tissue repair

- Both may require a period of immobilisation for healing or to allow skin graft adherence.

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