Face and Neck Burns Rehabilitation: Difference between revisions

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Table adapted from Glassey 2004
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wound should be cleaned and dressed within 6 hours of presentation to provide a moist environment of wound healing and reduce risk of infection. Individuals should also be assessed by a dietitian using a MUST tool within 24 hours of presentation, with daily follow-up.
 
Individuals are also screened for functional changes and referred as needed to occupational therapy and physiotherapy.


== Risks by area<ref name=":0" /> ==
== Risks by area<ref name=":0" /> ==
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== Outcome Measures ==
== Outcome Measures ==
Total Burns Surface Area (TBSA): Used to determine the optimal management and treatment pathway.
Passive Range of Motion
Passive Range of Motion


Revision as of 19:54, 28 December 2020

Original Editor - Rhiannon Clement

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

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (28/12/2020)

Introduction[edit | edit source]

Burns injuries can be the result of thermal (flames, hot liquid, contact with hot surfaces), or non-thermal (electrical, chemical, friction or radiation) contact[1].

Burns injuries to the face and neck can have a long-term impact on an individuals function, as well as on their social interactions [2]. 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[2][3]:

  • 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[2].

Rehabilitation after Burns: Face and Neck[edit | edit source]

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 [2]:

  • 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.

Healing[edit | edit source]

The skin in made up of a number of layers[1]:

  • Epidermis:Superficial layer which is avasular
    • Capable of regeneration. However, cannot regenerate if a large portion of this layer is destroyed.
  • Dermis: Deeper, thicker layer of connective tissue
    • Contains blood vessels, nerves, glands and hair follicles.
  • Subcutaneous tissue: Deep, contains arelar and adipose tissue
    • Contains large blood vessels, fat cells and connective tissue overlaying muscle and bone.

A first degree burn damages the edipermis, a second degree burn will also damage the dermis layer, a third degree burn is deep and damages the subcutneous tissue. The depth of the burn will affect the risk of skin pigmentation, risk of scaring and also the length of time to heal.

Table adapted from Glassey 2004
Degree MOI Scar / contracture Healing time
1st Sun exposure, hot liquid (low viscosity) None 3-7 days
2a (superficial) Hot liquids, chemical burns, flash Minimal 1-3 weeks with pigment change
2b (deep) Flame, electrical, hot liquid (high viscosity) High risk 3-6 weeks with scar
3rd Flame, electrical, chemical, blast Severe risk Requires skin graft
4th Prolonged exposure to flame, chemical, blast Definite Requires excision

wound should be cleaned and dressed within 6 hours of presentation to provide a moist environment of wound healing and reduce risk of infection. Individuals should also be assessed by a dietitian using a MUST tool within 24 hours of presentation, with daily follow-up.

Individuals are also screened for functional changes and referred as needed to occupational therapy and physiotherapy.

Risks by area[2][edit | edit source]

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[3][edit | edit source]

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

Outcome Measures[edit | edit source]

Total Burns Surface Area (TBSA): Used to determine the optimal management and treatment pathway.

Passive Range of Motion

Active Range of Motion

Function

Young Adult Burn Outcome Questionnaire (YABOQ) [4]

Precautions[edit | edit source]

  • Damage to bone or tendon
  • Tissue repair

- Both may require a period of immobilisation for healing or to allow skin graft adherence[3].

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 1.0 1.1 Hale A. et al Physiotherapy in Burns, Plastics and Reconstructive Surgery. [Online: Available from: https://physio-pedia.com/images/3/30/Burns_and_Plastics.pdf?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal] <Accessed 27.12.20>
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Greenhalgh D. G. Management of facial Burns. Burns and Trauma (2020) vol 8
  3. ↑ 3.0 3.1 3.2 Edgar D and Brereton M. Rehabilitation after burn injury BMJ (2004) 329(7461): 343-345
  4. ↑ Ryan C.M. et al The Effect of Facial Burns on Long-Term Outcomes in Young Adults: A 5-Year Study, Journal of Burn Care & Research (2018) Volume 39, Issue 4 Pages 497–506, https://doi.org/10.1093/jbcr/irx006
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