SUMMARY. It is very important to follow up burn patients after their discharge in a long-term rehabilitation course. The Rehabilitation Department at the CTO in Turin (Italy) follows up patients after their discharge through the intervention of specialized local centres. This is possible thanks to the existence of a “communication channel” linking the various rehabilitation facilities.
The experience of the staff of the Rehabilitation Department at the CTO hospital in Turin, Italy, who attend to burn patients during their stay in hospital, has made it possible to create a project for a “communication channel” between the service itself and other specialized centres present in the local territory that take over responsibility for the patients’ rehabilitation when they return home.
The Turin CTO Burn Centre, as a regional and extra-regional point of reference, has functions that extend beyond strictly regional limits and consequently follows up various patients who reside outside the province of Turin.
In the year 2000, ten out of the 89 patients hospitalized came from outside the region, and another seven were foreigners. Of the 72 regional patients, 19 came from the city of Turin, and 53 from other parts of Piedmont.
If re-education treatment is to be effective, correct taking in charge by the medical team and the patient’s maximum involvement are both indispensable.
In order to set up this scheme, written notices were addressed to the rehabilitation services involved and an illustrated brochure was sent to the patients.
The importance of the rehabilitation project is pointed out, with reference to the patients’ specific problems as a result of their burns and, in particular, articular limitations, muscles and tendon retraction, muscular hypotonia and hypotrophy, hypertrophy, cicatricial bridles, and - not least - the patients’ psychological state. The project has to be personalized in relation to age, sex, extent and gravity of the burn illness, concomitant morbidity, and patient motivation. The rehabilitation treatment lasts for the entire duration of the evolution of the burn scar, covering the acute stage (2-6 months) and the evolutionary stage (6-24 months). We propose here the protocol utilized in our ward, which makes use of various techniques, including massage, lymphodrainage, kinesitherapy, physical therapy, and compression therapy.
It should not be forgotten that pain is a constant element during the rehabilitation treatment of a burn patient. Pain however can be controlled through the use of pain-relieving drugs, relaxation techniques, and psychological support.
Massage cannot be performed if the patient is wearing protective sheaths, and these therefore have to be removed before each treatment. It is necessary to use a basic cream and to pay particular attention to micro skin traumas caused by the massage itself.
The technique of lymphodrainage is used in second- and third-degree burns, especially in cases of peripheral oedema.
Kinesitherapy can be passive, active, and against resistance. The use of “pompages” and global techniques can prove beneficial.
Physical therapy includes vacuum therapy, ultrasounds, and ionophoresis.
In order to control cicatricial hypertrophy, patients have to wear compressive elastic sheaths for some 20 h a day for at least 6-12 months. It is also helpful to use silicon laminas.
The rehabilitation programme has to be continuously reviewed in order to ensure rapid recovery by the patients of their personal and social autonomy.
The second part of the project is specifically addressed to the patients. This consists of an illustrated brochure presenting simple drawings of global and local stretching exercises drawings that the patients can do on their own. The exercises are changed as time goes by, in relation to the evolution of the clinical situation.
The brochure also includes practical suggestions concerning daily life and personal hygiene, such as the exclusive use of cotton or silk clothing, the use of moisturizing cream on scar areas several times a day, and avoidance of exposure to the sun for 18-24 months.
The purpose of this project has been to optimize the treatment of patients with burn sequelae, using our experience to achieve a speedier and more complete functional recovery.
RESUME. Il est très important de suivre les patients brûlés après leur sortie de l’hôpital dans un cours de rééducation à long terme. Le Département de Rééducation du CTO de Turin (Italie) continue à suivre les patients après leur sortie de l’hôpital à travers l’intervention des centres locaux spécialisés. Ce programme est possible grâce à l’existence d’un “canal de communication” qui unit les divers services de rééducation.