You will be seen by the adult burns team following your burn. At some stage and dependent on the progression of your wound healing you may need to see one of the occupational therapists from the scar management team.
This page will guide you through the process and aims to provide all the information you require alongside appointments with the scar management team. It is helpful to bring your booklet of this page to appointments to assist in progressing your treatment as required.
If your wound has healed on its own without a skin graft within two weeks then it is unlikely that you will develop scarring. The healed area will be red initially and gradually pale over several months. The skin may be dry and require moisturiser initially but you should be able to return to normal activity very quickly and have no long term difficulties.
If the wound takes longer than two weeks or has required a skin graft to the area then the risks of you developing some scarring is higher. For some people this scarring will cause no difficulties but they may develop into hypertrophic scars.
The reason for this is that it is likely to have been a deeper injury to the skin and therefore more of the skin structures are damaged. When the wound heals the connective tissue (collagen/scar tissue) is laid down to heal the wound. In burn wounds the inflammatory action that enables wound healing continues beyond the wound closure and can cause the area to become more irregular forming raised, thickened, sensitive, itchy and red scars. This type of scarring is called hypertrophic and can develop up to 3 months post wound healing.
There are other factors that can lead to higher risks of problem scars / hypertrophic scars after an injury. These include having an infection that causes the wound to deepen and healing to take longer, if the site of the injury is on areas that are more mobile particularly the chest and top of the shoulder. Your skin type and your genetics can also make you more likely to develop hypertrophic scars. There are a range of factors associated with hypertrophic scarring that make it important to treat:
Scarring can take up to 2 years and sometimes beyond to mature so treatment may continue for this long.
Unfortunately it is not possible to prevent hypertrophic scarring. It is, however, possible to minimise the effects and improve the appearance through:
Sometimes you may be referred to the burns doctors to assess for extra scar treatments, these may include:
Scars and skin graft donor sites require regular creaming to prevent the area from drying, cracking, and becoming sore. This can be because the oil glands in your skin that usually provide moisture can be damaged or destroyed during the injury and the surface layer that prevents water loss is damaged.
It is important to use a non-perfumed moisturiser to keep the area soft and supple, and prevent itching. Perfumed creams can react with the newly healed sensitive scars. Your therapist can provide you with some samples of creams if needed.
Moisturisers should be applied gently in thin layers while the scars are more fragile and should be done 2-3 times a day. It is important to fully cleanse the area each day to avoid build-up of cream and skin irritation.
Once your wound has healed we will advise you to start gentle massage called gliding. Before putting on your moisturiser place your fingers onto the scar and move in gentle circular motions – you are moving your skin not your fingers to prevent friction. Please ask your therapist to demonstrate. Spend a few minutes using this technique then apply your moisturiser.
As the scar matures you can increase the pressure of the massage to help soften scars. Your therapist will guide you in this process as massaging too firmly initially can make scarring worse.
As discussed previously the new skin which has formed following the injury lacks the moisture needed. Silicone then acts to seal in the moisture and hydrate the scar. Silicone treatment aims over time to flatten, soften and pale your scar, alongside reducing discomfort. Silicone can be in the form of a sheet, liquid, spray or stick and if recommended by your therapist they will discuss with you the most appropriate type for your scar.
Day | How long to wear |
---|---|
1 | 4 hours |
2 | 8 hours |
3 | 12 hours |
4 | 16 hours |
5 | 20 hours |
6 | 23 hours |
These are elastic garments that can be off-the-shelf or made-to-measure. They are worn over your scar with the aim of achieving scars that are flat, soft, pale, and comfortable. They could be required to be worn up to 2 years post healing.
They work by applying appropriate levels of pressure to the scar which aims to restrict blood flow/reduce the scar inflammation and inhibit the growth of hypertrophic scar tissue by using constant compression to the area.
To achieve the best possible outcome it is important to wear the garment for 23 hours a day, removing it only to wash, apply moisturiser and change garments.
If your occupational therapist has assessed that pressure therapy is an appropriate treatment for you, they will take appropriate measurements and either fit an off-the-shelf product or send the measurements to an external provider who will make a bespoke garment. You may be required to attend a fitting appointment 2-3 weeks after being measured to check the best possible fit is achieved.
Your garment may require further alteration following this appointment but can then be sent to you in the post along with your repeat garments. If it is not your first garment we may measure you again and you will be asked to contact us to inform of us of the correct fit before being issued with your repeat garments.
After this you will be reviewed around every 3 months as the elasticity of your garments will reduce and optimum pressure is not achieved. It is important to attend your appointments to monitor the progress of scarring and fit of your garments in order to achieve the best results.
Your garment does not protect you from the suns UVA and UVB rays so high factor sun protection will need to be applied underneath the garment. It is also important to continue with recommended cream and massage whilst wearing a garment.
Your therapist may also recommend Silontex which is a fabric backed silicone gel sheet that is stitched into your pressure garment.
Scars are extremely sensitive to sunlight and exposure to the sun without sufficient protection will mean scars burn easily and could cause long term damage darkening the scar which could be irreversible.
We recommend high factor sun cream with both UVA and UVB protection on scarred areas for 2 years post burn injury and also covering them with clothing to increase the protection.
Itching is unfortunately very common after a burn injury and can continue long after the wound has healed. It can be triggered by activity, heat, and manipulation of the scar.
If you are still experiencing problems after trying this advice then your therapist can discuss other options and may refer you to one of the burns consultants.
Hypersensitivity is caused by damage to the nerve endings due to injury of the skin. It can be painful and present as tingling, shooting/burning pain or a severe ‘pins and needles’. The nerve endings in the scar continue to send pain signals to the brain after the wound is healed when there is no longer a need to protect the area.
If possible it is important to continue normal activity and to not be over protective of the sensitive area, you will not be damaging the area. Your therapist will discuss the techniques with you and which are most appropriate in how to manage the hypersensitivity specifically to your current symptoms.
(Please do not use these techniques until advised by your therapist)
Sleep is essential for your health and wellbeing, protecting both your physical and mental health.
Following a burn injury or trauma there may be many reasons why sleep can be affected including disruption to your sleep pattern, anxiety related to the injury, pain and discomfort and taking medications.
If you are suffering from poor sleep some of the problems it can cause include:
If your scars have any of the following symptoms these can also affect the quality of your sleep:
The treatments you are having for your scarring will slowly help improve these symptoms but while you are recovering there are other things you can consider to help improve your sleep.
Worry relating to your burn injury, symptoms, or unrelated stressors can all impact on your ability to get a good night’s sleep. Worry and anxiety keeps the brain active and activates the body’s stress response. If you find that worry prevents you from falling asleep or keeps you up at night you may wish to:
If you are having difficulty with sleep please talk to your therapist or your doctor as there may be other things that can help including medication or support from the burns psychology service.
There are many useful resources online about improving sleep please see some links below:
It is not uncommon for people to experience some appearance related concerns after a burn.
Our skin camouflage service is available for free for those patients who have sustained a burn injury to their face or hands, for all other injury types and areas of the body there is a charge.
If the appearance of your scar bothers you and you would like to cover it up as much as possible. Your therapist can make a referral to the skin camouflage service where a specialist can trial specific make-up to cover your scar. You may also be to access camouflage through the charity Changing Faces.
A burn injury or a scar does not just affect someone’s skin but can also influence how they think and feel.
Common experiences are feeling low or vulnerable, some can find that the burn incident is going over and over in their minds; they may experience flashbacks, distressing dreams or are avoiding situations which are reminders of the incident.
People cope in different ways but some find that it helps to talk to someone outside your family or friendship group. We have a burn psychologist within the team who can listen to you and provide support and possible management strategies as part of your rehabilitation. There is also a support service called Outlook which offers psychological support for people with appearance concerns, your therapist can discuss referral to them with you if required.
Once your wounds are fully healed you should be able to bath or shower as previously using your usual washing products. You may also be ready to return to work and start doing any sports or hobbies you did previously.
You may need a graded return back to work due to reduced range of movement or stamina and are likely to require rest periods during the day dependent on the type of work you do. Please discuss this with your therapist or burns doctor if you require any advice.
Scar appointments at Southmead Hospital are held in Gate 24.
If you have an appointment booked that you can no longer attend or are unsure whether you need the appointment thathas been booked for you then please contact us to let us know. We also provide virtual appointments which can be completed via video call, we will discuss with you if this may be appropriate based upon your scarring and treatment provision.
Burns | North Bristol NHS Trust (nbt.nhs.uk)
Adult Burn Support UK – Information, support and advice about burns in the UK
A support resource for adult burn survivors in the UK.
Email: info@adultburnsupportuk.org
Funded by Dan’s Fund for Burns national charity.
Dans Fund For Burns – Giving burn survivors the help they need
Dan’s Fund for Burns is a national charity offering practical help to burn survivors in the UK. The charity identifies those most in need of help and provides it in a swift and practical way.
Changing Faces | Visible Difference & Disfigurement Charity
Changing Faces is a charity for people and families who are living with conditions, marks, or scars that affect their appearance.
www.katiepiperfoundation.org.uk
Offers a range of support, rehabilitation and scar management for burns survivors.
Outlook | North Bristol NHS Trust (nbt.nhs.uk)
Psychological support for people with appearance concerns.
A community sharing experiences and knowledge to make life with scars easier.
Medigarments Ltd – Designed Around You - Compression garments (jobskin.co.uk)
Welcome to medi - I feel better. (mediuk.co.uk)
ScarSil® Topical Gel. Scarsil gel – 15ml and 30ml (jobskin.co.uk)
Nourisil™ MD | Scar Gel | Scar Cream | Scar Removal (nourisilmd.co.uk)
Available through your GP or online purchase.
ALHYDRAN CO UK
Available through your local pharmacist, Boots or Superdrug.
Buy Best Skin Care Products Online - AVEENO
Available through your GP or Boots.
Epaderm | Mölnlycke
Available through your GP or on Amazon.
Products For Sensitive Skin | QV Skincare United Kingdom
Available through your GP.
Dry Skin from Doublebase – clinically proven moisturising emollient (mydoublebase.co.uk)
Available through your local pharmacist, Boots or Superdrug.
Welcome to CeraVe: Your Skincare Expert | CeraVe
We would really appreciate your feedback about the service we have provided to help with your scarring. Once you have been discharged from our service you can access a short survey to provide your views and it will take no longer than 4 minutes.
© North Bristol NHS Trust. This edition published February 2024. Review due February 2027. NBT002418
Scar Management Team
Occupational Therapy
Gate 33a, Level 2
Brunel building
Southmead Hospital
Bristol
BS10 5NB
07525 618421 (text or call)