Potential Complications of Burn Injury

An estimated 2 million people in the US are treated for burn injuries each year. Hospitalization is required for 100,000 of them.

Following the acute phase of a burn injury, medical complications can arise. Medical complications of burn injuries include

• infection
• itching
• open wounds
• painful scarring
• muscle contractures
• neuropathy (nerve damage)
• sympathetic pain
• heterotopic ossification
• osteomyelitis
• scoliosis
• amputation
• sleep disturbance

Infection

Serious burns result in the loss of body fluids, causing burn shock. In addition, some fluid releases into surrounding tissues, which creates edema or swelling. The body's immune system is suppressed, leading to the risk of infection. In fact, a 1997 study indicated that infection remains the leading cause of death in individuals with thermal burns, whether heat or cold.

Itching

Itching can occur in the burned area after healing. Unfortunately, the activity that relieves the itching can worsen the condition, and a wound may occur.

Early intervention is important. Lotions and medications such as antihistamines may be used to treat the area. If treated, the itching area may resolve over time, but if left untreated, it can last years.

Open Wounds

Open wounds can occur in severe burns (partial and full thickness), resulting in pain and scarring.

Your burn specialist will assist you in the healing process. Interventions include wound care and debridement (cleaning of the wound). Initially, wound care is performed frequently during the week for the first several weeks, and it may take up to several months for the wound to heal.

Skin grafts may be used to decrease pain and healing time.

Painful Scars

Although scarring is a normal result of many burns, some scars may be sensitive or painful.

Interventions include silicone gel sheets placed underneath compression garments, massage, and medications such as steroids to relieve pain.

Surgical removal of the severely painful scar may be indicated. If painful scarring persists beyond discharge from the hospital, consult your physician about treatment options.

Muscle Contractures

Muscle contractures may result from the scarring and eventual narrowing of the burned area. The narrowing is called a contracture.

Muscle contracture may result from protective holding of the burned area due to the pain in that area. It results in loss of range of motion ability. Once diagnosed by your physician, physical therapy may be used for stretching and other interventions.

Generalized Peripheral Neuropathy

Peripheral neuropathy, or peripheral nerve damage, is a malfunction of the peripheral nerves. It can disrupt sensation, muscle activity, or the function of the internal organs. It may be a result of an infection that destroyed a nerve.

Generalized peripheral neuropathy may occur during the first few weeks post-injury. This condition may manifest itself as pain, numbness, tingling, swelling, or blushing in the upper and/or lower extremities (arms and legs). The condition is usually diagnosed through EMG, muscle testing, or nerve condition studies.

To treat the condition, your doctor may recommend physical therapy. Splinting may also be used with this condition to prevent contractures.

Reflex Sympathetic Dystrophy (RSD)/Complex Regional Pain Syndrome

Reflex Sympathetic Dystrophy is a type of pain that is accompanied by swelling and sweating, changes in the blood flow, or changes in the tissues. RSD can be a severe and debilitating condition that occurs when the nerves "go haywire."

RSD usually begins soon after the injury, before the wound has closed. Joints contract, unable to bend or to straighten completely. RSD seems to occur more commonly in the hands.

Symptoms include increased sensitivity in the affected area, with painful swollen joints, moist skin. and "shiny" or glossy skin.

Tests may be performed by your physician to diagnose this condition. Without treatment, contractures and chronic pain may result. Early, aggressive treatment can result in remission of the symptoms. Treatment may include the use of nerve blocks, which can be further explained by your physician.

Heterotopic Ossification (HO)

Heterotopic ossification (HO) is a condition where new bone forms in the connective tissues and muscles surrounding joints, where it isn't normally found. HO usually occurs in large joint areas (hip, knees, and elbows).

To diagnose HO, an x-ray or a bone scan may be recommended. HO may resolve on its own. PT or OT may assist in recovery, by increasing range of motion as much as possible. Splinting may also be recommended.

If treatment is unsuccessful, surgery may be required, followed by therapy.

Osteomyelitis

Osteomyelitis is an infection involving a bone and usually caused by bacteria.

When the bone is infected, the bone marrow may swell. The swollen tissue presses the outer wall of the bone and blood vessels in the marrow become compressed. This pressure reduces or cuts of the blood supply. The bone may die as a result.

Unfortunately, the infection may spread from the bone to form abscesses in the muscle. Osteomyelitis may occur if the burn was very deep with exposed bone, which resulted in a long-term open wound.

A physical exam is the first means to diagnose osteomyelitis. Laboratory tests may also be required. If the infection is in the vertebrae, a needle can be used to sample bone tissue. A bone scan usually successfully reveals the condition; however, an MRI or CT could also be used.

If treatment is required, it usually consists of several weeks of intra-venous treatment with potent antibiotics. During the four to six week course of treatment, oral antibiotics may also be used. Treatment lasts several months in some individuals.

Surgery may include draining abscesses, bone removal, or removal of an infected artificial joint. However, if osteomyelitis is diagnosed early, surgery may not be necessary.

Scoliosis

Scoliosis often occurs in children with asymmetric hip, trunk, and shoulder burns. The child may have a curved spine, with wedging of vertebrae.

Mild scoliosis produces no symptoms, or perhaps only fatigue after prolonged sitting or standing. A physical exam may reveal scoliosis. An x-ray can be used to confirm the diagnosis.

Functional scoliosis will respond to therapy using paraffin, sustained stretch, and range of motion of trunk. A cast may be worn to hold the spine straight. Electrospinal stimulation may be performed to stimulate spinal muscles that allow the spine to straighten.

Treatment should involve semi-annual monitoring until age 18. Surgery may be required in the form of skin grafting, metal rod insertion, or release of contracture.

Amputation

Amputation may occur when there are deep full thickness burns or electrical injuries. Loss of the extremity is the result.

Prior to having a prosthetic fitted, Range of Motion exercises and strengthening may be used to prepare the limb for a prosthesis. Surgical modification of the stump may be required for the prosthesis. (See Amputation section)

Sleep Disturbance

Sleep disturbance may occur after discharge from the hospital. It may be caused by pain and discomfort, or from fear and anxiety related to the burns. Depression, decreased energy, or decreased coping ability can result.

Psychological/counseling intervention, medication, or a support group may be helpful. Usually sleep disturbance improves with time post-injury.