Written by Brianna Bolinger, RN, BSN and Rebekah Reishus Allely, OTR/L on December 07, 2020
Those two words can instill dread in any burn survivor. But their initial fears often give way to hope and appreciation.
As deep second- and third-degree burns heal and mature, the collagen fibers are hyperactive. This often results in scar that is red, raised, and firm, called hypertrophic scar. For many, it’s painful and itchy. The tightness of the scar can limit movement when it’s over or near a joint surface. This can limit a person's functional ability.
Pressure garments are worn to help burn survivors control scar maturation, and they often improve the overall appearance. This is achieved by applying 20-25 millimeters of mercury (mmHg) pressure to the maturing scar 20+ hours a day. Hypertrophic scar can develop within weeks to a few months post injury and continue for twelve to twenty-four months. Pressure garments are customized to each survivor and are commonly provided by a member of the burn team per a physician’s order.
Not everyone will be a candidate for pressure garments. The likelihood of forming hypertrophic scar is individualized. The burn team is skilled at assessing a person's tendency to scar and will recommend the appropriate treatments. You can always reach out to your burn team and ask questions if you are wondering whether pressure garments would be beneficial.
Massage your skin with lotion. Applying a moderate amount of pressure as you massage will help make your skin less sensitive. Massaging also helps to lengthen the scar, especially if you have hypertrophic scar over or near a joint with limited motion.
Many burn units will have you wear a milder elasticized garment in preparation for the custom compression garments. These elasticized garments provide 10-15 mmHg pressure in preparation for tighter, custom garments.
Although the goal is to wear your custom pressure garments 20+ hours a day, you may need to gradually work towards that, increasing the number of hours over a period of time.
Based on a child's development, it can be hard for them to understand that something painful or uncomfortable is helping them.
Do your best to help your child understand what the pressure garments are and how they are helping. Solved curiosity can go a long way.
Many companies who customize pressure garments have color options. See if your child's favorite color is available.
Allow your child to pick the clothes that they get to wear each day. Maybe they don't have a choice in wearing their pressure garments, but they can choose what to wear with them.
See if you or someone you know can get crafty. Put some cloth around your child's favorite doll, stuffed animal, etc. to mimic the child’s pressure garments. Perhaps all they need is a "buddy" who looks just like them.
Garments can be washed by hand or put into the washing machine on the gentle cycle. It is always best to hang them out to dry. Do not put them in the dryer. The pressure garments are already tight and customized to you, let's not shrink them!
Many companies will state that garments should be replaced every three months. Pressure garments are expensive, and this is not always possible. Many patients make the original garments last for the duration of their scar maturation. You may also ask your burn team if there is any funding available to help with the cost of new garments if they are needed.
Once a scar fully matures, it will no longer be affected by compression. Initially, when you remove the garments to shower, you will notice your scars appearing flatter. If the scar is still "active," it will rise again in the time that the garments are off. As the scar matures you will eventually see that there is no change with the garment removed. Remember, the length of time it takes a scar to fully mature is individual. It is always best to consult with your burn team about when you should stop wearing the garments.
Never forget that burn injury recovery is a long journey. In order to get the optimal results in recovery, mobilization, and appearance, it takes compliance, dedication, and TIME.
Be patient. Your future self will thank you.
Brianna Bolinger, RN, BSN, is currently serving as a Phoenix Society Fellow. She received her BS in Nursing from Western Michigan University with Honors and now works as an RN in a burn unit in Indianapolis, IN. Previously, she has served as a medical volunteer in Africa. Brianna is a childhood burn survivor with a passion for serving the burn community, with a special focus on holistic care and the psycho-social needs of the burn survivor.
Rebekah Reishus Allely, OTR/L received her BA in Mental Health/Human Services from Franciscan University in 1983 and a BA in Occupational Therapy in 1985 from Eastern Michigan University. While interning at the University of Wisconsin Hospital, Rebekah spent a month working on the Burn Unit. In December of 1985, Rebekah began working at Medstar Washington Hospital Center in Washington, D.C., as a burn rehab therapist. In addition to being part of the rehab team that provides care to the Burn ICU, step-down, and outpatient burn population, Rebekah is a Phoenix SOAR coordinator. Rebekah works with the D.C. Firefighter Burn Foundation, organizing and running a local Outdoor Recreation Program for burn survivors and taking burn survivors to The Adaptive Sports Center in Crested Butte, CO.