Long-Term Outcomes in Patients Surviving Large Burns: The Skin

The objective of this study was to evaluate persons who have survived severe burns and to describe the long-term residual problems relating to the skin. This is a cross-sectional descriptive study that included a one-time evaluation of 98 burn survivors (18 years old or older) who survived >= 30% TBSA burns, were >= 3 years postinjury, and consented to participate. Study participants were required to undergo a physical examination conducted by the Physical Medicine and Rehabilitation physicians in addition to completing study questionnaires. Participants were predominantly male (63%) and Caucasian (69%). The average time from injury was 17 years (range 3-53 years), and the average TBSA burn was 57% (range 30-97%). Problems with hot and cold temperature, sensory loss, raised scars, and itching continued to pose problems many years after burn injury. Reports of open wounds, skin rash, painful scars, and shooting pain in scars tended to decrease over time, whereas reports of fragile burns, including cuts and tears, tended to increase over time. Findings from the physical examination of the participants include hypertrophic scars in grafted areas (92%) and in nongrafted areas (38%), decreased sensation to pin in grafted areas (71%), hyperpigmentation in grafted areas (53%), fingernail deformities (35%), and skin breakdown (32%). Individuals with large burns deserve more long-term attention. As survivors of large burns continue to face significant burn-related issues, there is a critical need for long-term follow-up both in the clinic and in research. (J Burn Care Res 2010; 31: 631-639)