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INTRODUCTION

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LEARNING OBJECTIVES

  1. Describe the anatomy and physiology of the skin as an organ in the healthy state and damaged condition that occurs with a burn injury.

  2. Discuss the pathology, symptoms, and sequelae of burn injuries.

  3. Compare the treatment for various depths and extent of burn injury in relation to medical, surgical, and rehabilitation management.

  4. Identify the consequences of contracture formation after burn injury and the treatment of this condition.

  5. Differentiate the options for management of hypertrophic scars.

  6. Determine the type of skin care necessary after burn wound healing.

  7. Design a physical therapy plan of care that appropriately incorporates positioning, splinting, and exercise.

  8. Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.

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Burn injuries are one of the major health problems of the industrial world. In the United States, 450,000 to 500,000 burn injuries require medical treatment each year with an estimated 3,500 related deaths.1 In addition, it has been estimated that burn injuries account for 45,000 hospitalizations per year, with about 25,000 patients being admitted to specialized burn treatment centers and the balance to other types of medical facilities.1

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Although these data report the extent of the health care problem caused by burn injury, recent medical advances have significantly reduced the number of deaths from burn injuries and have improved the prognosis and functional abilities of surviving patients.1,2,3 The survival rate has improved annually owing to improved resuscitation techniques, the acute medical and surgical care now practiced, and continued research into the management and care of the patient with burns. The American Burn Association (ABA) reported an overall survival rate of 94.8% from 2000 to 2009.1 As a result of improvements in care, treatment, and survival of patients with burns, more physical therapists will become responsible for treating these patients for a significant portion of their rehabilitation in settings other than a hospital burn center (e.g., outpatient clinics, community hospitals).

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This chapter introduces the clinical presentation of different depths of burn injury and the complications that can result from thermal destruction of the skin. Current techniques used in the medical, surgical, and rehabilitative management of the patient who has been burned will be described. For more in-depth information regarding the examination and treatment of the patient with a burn injury, the reader is referred to additional sources.4,5,6,7

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EPIDEMIOLOGY OF BURN INJURIES

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Although the morbidity and mortality rate of patients with burns has dramatically decreased in recent years, the epidemiology of burns remains basically the same. The most common cause of burn injury in children 1 to 5 years of age is from scalds from hot liquids.8,9,10,11 The primary cause of burn injury in adolescents and adults is accidents with hot ...

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