Written by Dr. Felicia Williams on December 20, 2021
In this advice column for Burn Support Magazine, a panel of experts draws on their personal and professional experience to offer guidance. They do their best to make it good advice, but remember that their opinions and views can never replace the diagnosis, treatment, or care of a licensed physician or mental health professional.
For this issue, the experts shared their answers to "frequently asked questions" they often encounter in their own practices.
This is by far the most frequently asked question I get from patients and from parents. The answer is based upon the depth of wound, how long the wounds are open, inflammation, infection, and patient characteristics (skin type, tone, age, etc.).
Third-degree, or full-thickness wounds are “easy” to answer. Any wound that heals by secondary intent or contraction will form a scar. The wounds that are more challenging are partial thickness burns, or second-degree wounds. My usual answer is, “The only surgeon that can promise no scarring is God. I have seen deeper wounds not scar, and more superficial wounds scar.”
Scarring depends on so many factors: how quickly we can get wounds to heal, if we can keep wounds from getting inflamed or infected, and even genetics play a role. Despite all of our efforts, scarring may be unavoidable and inevitable.
Depending upon the size of burn, these are our priorities from the healthcare provider perspective.
For large burns: Our priorities are to save your life, then to preserve as much function as possible. If in the process of doing this we are also able to provide a cosmetic result, we will do all that we can. We will involve our Occupational Therapists (OT) and Physical Therapists (PT), as well as our Plastic Surgery and Psychiatry colleagues to optimize outcomes and expectations. If there is any way to optimize outcomes without sacrificing survival, we will do it.
For small burns (when survival is supposed to be the rule and not the exception): Our goals are to preserve as much function as possible. We will do all that we can to also provide a good cosmetic result by engaging our OT and PT colleagues, as well as our Plastic Surgery colleagues and Psychiatry colleagues if needed.
None of us can promise or guarantee that we can erase any evidence of what has happened, but we are here to help in any way we can.
Dr. Felicia Williams