skin grafts?

nekhismom · Jan 9, 2004

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

treddrn · Jan 13, 2004

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

renerian, BSN, RN · Jan 13, 2004

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:o

clgmezzo · Jan 20, 2004

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 · Jan 20, 2004

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 · Jan 20, 2004

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 · Feb 3, 2004

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 · Feb 12, 2004

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 · Feb 18, 2004

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!

courtneyalissa · Jan 6, 2006

In the Burn Unit where I work most grafts that are 8% would be outpatient. The donor skin comes from the patient usually the thigh (or back depending on how much skin is required) and is meshed so only a small area has to be taken. After the burn is debrided the donor skin is applied by using staples to keep it intact. A post-op dressing is applied which is usually tegaderm on the donor site and xeroform and the grafts and a lot of padding. The dressing is removed within 3 days and stapples come out 4-5 days depending on how the graft is healing. The donor site is basically like a second degree burn and most say it is more painful than the graft. It usually heals within 2-4 weeks if there aren't any complications. As for the Medicaid, they should pay. The doctors I work with are Plastic Surgeons but they specialize in burns, if Medicaid is refusing to pay the doctor can appeal to them. The doctor should be experienced in grafting burns and the care afterwards because it is a long and painful process. He may require PT or OT and will need to be monitored for scarring in the future. As for pain we usually start the patient out on Vicodin and if this doesn't help then we try different methods (as outpatient our docotors would prescribe Dilaudid 2mg.)

courtneyalissa · Jan 6, 2006

Wow, I guess I should have read the last post sorry my post was a little delayed.