Burn rehabilitation

Scar tissue shortens as it matures, and the range lost while it does so is far harder to regain than it is to preserve. Positioning, splinting and daily range work run from the earliest safe point.

This is why burn rehabilitation is scheduled rather than offered once healing is complete.

Pressure, silicone, massage and where indicated laser work on the scar itself, alongside the movement work.

The goal is stated in tasks — a hand that closes, a shoulder that reaches, a face that expresses — because those are what the person lost.

Silicone is the best-supported scar treatment. International scar management guidelines, developed by a group of twenty-four specialists, place silicone sheeting or gel as the first-line option for both preventing and treating hypertrophic scars 1, and an evidence review rated silicone and tension reduction as high-efficacy for prevention 2.

The honest part is what the same review says about the rest: pressure garments and scar massage were rated low-efficacy for preventing hypertrophic scars, although massage is rated effective for treating scars that have already formed 2. Pressure garments remain the standard for widespread burn scarring 1 and we use them for that, but we do not present them as proven prevention.

After a deep partial or full-thickness burn, after grafting, and wherever a scar crosses a joint — the neck, the axilla, the elbow, the hand, the knee. Also for burns treated years ago where a contracture has since developed and movement has been lost.

Open wounds belong to the burn service first; rehabilitation runs alongside wound care rather than waiting for the skin to close, because the range lost during that period is the range that is hardest to get back.

This is the longest programme on the site — twelve weeks to a year or more — because it is tied to scar maturation rather than to a course of therapy. It runs as intensive blocks with home programme between them, not as continuous attendance.

At each block, joint range, a scar assessment and hand function are measured, along with the specific tasks the person named at the start. Those tasks are how the programme is judged: a hand that closes, a shoulder that reaches overhead, a face that expresses.

In the hand, small amounts of range are lost quickly and regained slowly, so splinting and daily range work start earlier and continue longer than anywhere else. The face is treated for the same reason with different tools: expression is function, not appearance.

In children a scar does not grow with the child. A contracture that was released can reappear during a growth spurt, so follow-up is scheduled through development rather than closed at discharge, and the family is told that at the outset rather than at the first relapse.