[nekhismom]

Hello all! I posted before about my brother with 2nd/3rd degree burns over about 8% of his chest. He is doing ok, but his physician still REFUSES to give him anything for pain other than the Lortab 7.5 mg. : Now, the dr. is talking about skin grafting. Do any of you know if skin grafts are being made using one's own cells to grow a graft? (sorry, can't remember what that is called). The dr. says he doesn't know if they are done anymore, but he will check. He also says the grafting will be an outpatient procedure? Scary to me, but I don't know about burns. I can only imagine the pain my brother will be in, especially with pain control such as he has been having. I have heard that the areas used for skin grafting are often more painful than the burned area...is this true? Are there any less painful alternatives that you know of that are being used for grafts?

Thanks you all, you have been very helpful already!

[nekhismom]

Wow, nobody knows anything about skin grafts?? Dang, I was hoping for a response!

[treddrn]

You can call Baptist's burn center and ask about the treatments you are talking about.

[renerian]

Your burn specialist does not know current practice for graphs? HMMMM. I would consider another doc.

I still feel bad about your brother's pain.

renerian

[clgmezzo]

sweetie here is a warning, unless this is a surgeon who is Routinely in burn care directly he may not know what the heck he is doing, especially if that is the only pain meds he is getting, YOU NEED A REGIONAL BURN CENTER. The docs at regional centers specialize in burn care. Grafting with "cultured Skin" which is what you are refering to about growing cells isnt done much anymore, the skin that the patient ends up with can be VERY fragile, this is coming from a nurse at the burn center where the technique was originally pioneered. It is a bad idea especially when he has only 8% , leaving much of his own skin to graft. Sometimes it can be outpatient but if it is a large area might not be because of the care afterwards, also donor site where the skin comes from(not the graft site that gets the new skin) are VERY painful for the first while. Be cautious, most docs dont know what they are doing when it comes to burn care. Also, although 3rd degree burn tissue will not heal on its own, if it is patchy with less burnt (even 2nd degree areas) it can fill in from the sides and heal without grafts, like i said this is very difficult and you need someone who knows what they are doing, be your brothers advocate!

[clgmezzo]

hey just another note, this is from the american burn association, note #3

BURN UNIT REFERRAL CRITERIA
A burn unit may treat adults or children or both.
Burn injuries that should be referred to a burn unit
include the following:
1. Partial thickness burns greater than 10% total body
surface area (TBSA)
2. Burns that involve the face, hands, feet, genitalia,
perineum, or major joints
3. Third-degree burns in any age group
4. Electrical burns, including lightning injury
5. Chemical burns
6. Inhalation injury
7. Burn injury in patients with preexisting medical disorders
that could complicate management, prolong recovery, or
affect mortality
8. Any patients with burns and concomitant trauma (such as
fractures) in which the burn injury poses the greatest risk
of morbidity or mortality. In such cases, if the trauma
poses the greater immediate risk, the patient may be
initially stabilized in a trauma center before being
transferred to a burn unit. Physician judgment will be
necessary in such situations and should be in concert with
the regional medical control plan and triage protocols.
9. Burned children in hospitals without qualified personnel
or equipment for the care of children or burn injuries
10. Burn injury in patients who will require special
social, emotional, or long-term rehabilitative intervention
Excerpted from Guidelines for the Operations of Burn Units (pp. 55-62),
Resources for Optimal Care of the Injured Patient: 1999, Committee on Trauma,
American College of Surgeons.[U

[nekhismom]

Thank you for this helpful information! My brother is disabled, so he receives Medicaid. Unfortunately, Medicaid often doesn't like to pay for specialists and the like. They seem to think it is ok for my brother to be treated by anyone with M.D. following his/her name. This surgeon has told me that he RARELY sees burns. When we went to his office, his staff commented that it had been so long since they had seen a burn that they didn't know what to do with it. I have asked about a burn specialist, but since I am not the legal guardian, he doesn't really tell me anything. I am scared for my brother. I will forward this information to my mom and see if maybe she can make some progress with the surgeon when she sees him. thank you so much!

[cimersrn]

I'm new to this BB, so I didn't read this back when you originally posted it. Please, please, please.........find the closest regional burn center and contact them!!!! Your brother needs and deserves the care that they are able to provide. My unit is in a county hospital, so we care for all, regardless of ability to pay. I don't know where you're at, but perhaps if you call a firefighters assoc or the Am Burn Assoc they could guide you in the right direction. I realize that this info is coming pretty late, but even post-op skin grafts require special care to prevent shearing, infection, etc. Your brother is also probably going to require PT and OT to maintain optimal ROM and function. Please, keep trying to get in touch with a qualified burn center. Best of luck to you and your brave little brother!

[vaughanmk]

What state does he reciece medicaid in? Typically, I believe, medicaid will cover your brother in any participating hospital state wide. someone correct me if I am mistaken. Somewhere in your state there must be some hospital or doctor who knows what to do and treat your brother properly.

Good Luck

[nekhismom]

Thanks all! He has had the skin graft, and the surgeon who did it was quite experienced in burn management. He's doing well, the graft is healing nicely, and so is the donor site. Thanks for all of your concern!