Annals of Burns and Fire Disasters - vol. N - n. 2 - June 1996

RESULTS OF COMPLETE REHABILITATION OF BURN PATIENTS

Burns and Plastic Surgery Centre, Pirogova Emergency Medicine Institute, Sofia, Bulgaria

SUMMARY. The results are presented of 10 years' experience in the treatment of 3500 patients with important All individual rella bilitation programme is prepared immediately after the admission of each patient. The patient performs daily baths and under water exercises, massage, and physiotherapy. Particular attention is paid to pressure garments, masks, and elastic bandages lewd illtion with applications of Dorcil.

Correct rehabilitation therapy is essential if good results are to be achieved in the treatment of patients with important burns. At the Pirogova Burns and Plastic Emergency Centre in Sofia, an individual rehabilitation programme is prepared for each patient on admission. The programme is related to the gravity of the burn, which is a function of the extent, depth and site of the burn and of the patient's age. Our experience is based on the treatment of more than 3500 seriously burned patients admitted to our Centre in the last 10 years. In the first days of hospitalization, in addition to problems of intensive care and surgical treatment, we pay particular attention to the patients' mobility in bed, in order to get them on their feet as soon as possible. To prevent contractures of the articulations patients perform active and passive exercises and exercises with apparatuses while still in bed. The position of the extremities is important during hours of rest or immobility. Underwater exercises are also important. When patients have undergone surgery, it is important to perform special exercises, especially in surgically treated extremities, in order to maintain mobility of the joints and guarantee elasticity of grafts and scars. We perform early massage of grafts and scars with special procedures: stretching, spreading, and manual pressure with vibrations. From the beginning our attention is directed at the danger of scar formation. The prophylaxis and treatment of scars require thorough procedures. We apply pressure to the scar zone or zones of potential scar formation. In our daily practice since 1965 we have used elastic bandages. We later devised garments and masks of elastic material. We find that the pressure exerted by an elastic bandage, garment or mask should be 20-40 mm Hg. We have studied the degree of pressure in the treatment and prophylaxis of hypertrophic scars in different parts of the body, in relation to their importance and the function they perform. The pressure level varies according to the anatomical part involved:

• lower extremities: 35-40 min Hg
• upper extremities: 30-35 min Hg,
• chest and abdomen: 20-25 mm Hg
• neck and face: 15-20 mm Hg

We regulate pressure individually in the face and neck in relation to respiration and blood circulalion, especially in children, who may be inclined to remove gannenis, and masks. Since 1983 we have used our own method for inca, suring pressure by means ol' a inanometer in ordei to achieve greater precision in our work.
It is difficult to measure pressure accurately in inegular anatomic areas, the joints, the necl~ and the facc, In (lic.se locations we measure pressure by Meal of the plastic material Dorcil, which exercises unilbrin presstirc. The plaques are applied under elastic garments or a mask.
Pressure therapy was applied in 890 patienis as a prophylactic method in regions presenting ;i risl~ ofhyl)crtrophic scar formation. None of these patients developed hypertrophic tissue. In 1540 patients, pressure therapy was applied with the objective of treating scars that liad already formed. In 1220 of these patients therc was in inversion of scar development over a period ol'4-8 months, and stirgory was not necessary. In the remaining 320 patients, the scars were reduced and became pate in colour, but as they were located in functional zones or articulations they inlerfered with normal functions. Plastic surgery was necessary in these patients, 280 of whom were children.
Pressure therapy is related to complete rehabiliiation. The patients perform therapeutic cxcrci~,,es with massage and physiotherapy.
When patients are discharged the Centre pi-cpares a programme to be followed at home. In (he case ol childrell we teach the parents how to proceed with the, ncanncnt.
We assess the effectiveness ol' the pro~gramnw by systematic out-patient follow-ups.All patients recovering from serious, burns are invited to attend a specialized bathing therapy centre located 90 km from Sofia.

RESUME. L'auteur présente les résultats de dix ans d'expérience dans le traitement de 3500 patients atteints de brûlures importantes. Un programme individuel de rééducation est préparé pour chaque patient au moment de l'hospitalisation. Tous, les patients font des exercices quotidiens, la balnéothérapie et des exercices sous l'eau, le massage et la physiothérapie. On prête une attention particulière aux vêtements compressifs, aux masques, et aux bandes élastiques utilisées en association avec des plaques de Dorcil.

BIBLIOGRAPHY

1. Bowden M.: Rehabilitation in the burned child. In Feller J., Grabb W.: "Reconstruction and rehabilitation of the burned patient", pp. 410-4, 1979.
2. Cash J.E.: "Fisioterapia - recuperaci6n postoperatoria de quemaduras", pp. 29-42, Jima, Barcelona, 1969.
3. Feller J., Grabb W.: "Reconstruction and rehabilitation of the burned patient", 1979.
4. Larson D.L.: Prevention and correction of deformity after severe burns. Surg. Clin. N. Amer., 58: 1279-89, 1978.