Physical medicine and rehabilitation clinics of North America
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Hypertrophic scars are common complications of burn injury and other soft tissue injuries. Excessive extracellular matrix combined with inadequate remodeling of scar tissue results in an aesthetically and functionally unsatisfactory, painful, pruritic scar that can impair function. ⋯ An interdisciplinary clinical program is necessary for best outcomes. Challenges to be met by the rehabilitation community include research into the quantification of burn scar measurement, the effects of mechanical forces on wound healing and scar management, and the best combination of surgical, pharmacologic, and therapy interventions to maximize outcome from reconstructive procedures.
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Whether a patient with burn injury is an adult or child, contracture management should be the primary focus of burn rehabilitation throughout the continuum of care. Positioning and splinting are crucial components of a comprehensive burn rehabilitation program that emphasizes contracture prevention. The emphasis of these devices throughout the phases of rehabilitation fluctuates to meet the changing needs of patients with burn injury. Early, effective, and consistent use of positioning devices and splints is recommended for successful management of burn scar contracture.
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The evolving shift in focus of burn care and research toward optimizing the long-term outcomes of persons with burn injuries has certainly increased the emphasis on burn reconstruction. There are an increasing number of persons surviving extensive injury who may have long-term reconstructive needs. Burn reconstruction, just as acute burn care, requires a coordinated team approach from initial consultation through recovery and rehabilitation. Clearly, in the future, one can expect evolution in surgical techniques and technologies that can improve the function and appearance of persons with burn injury.
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It is important to focus on community integration, including return to work and school, early during treatment after burn injuries. A careful analysis of the potential barriers to return to activities can help focus a treatment team and provide appropriate support for a return to work or school plan. ⋯ Vocational rehabilitation counselors and school reentry coordinators are valuable assets to coordinating with a treatment team and communicating with a workplace or school. A successful return to work or school is often achieved with a coordinated and supportive approach.
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Phys Med Rehabil Clin N Am · May 2011
ReviewNeurologic and musculoskeletal complications of burn injuries.
As more people survive burn injuries, there is an increasing focus on managing the complications of burn injuries with the ultimate goal of improving survivors' quality of life. Musculoskeletal and neurologic sequelae are significant complications of burn injury. Electrical injury is a subcategory of burns with multiple musculoskeletal and neurologic complications. Knowledge of these complications helps clinicians provide optimal long-term care for burn survivors and enables survivors to attain maximal recovery.