The length of hospitalization depends on many factors. In addition to the severity of the burn injury, these factors include whether the person suffered lung injury from inhaling smoke or chemicals and whether the person had pre-existing medical problems, such as heart disease.
There are three phases in the formation of a scar. In the first phase, which lasts less than a week, the body begins to remove dead and dying skin tissue, fights infection, and sends cells that will begin the healing process to the burned areas. In the second phase, which takes a few weeks, the body makes collagen fibers to form scar tissue and creates tiny new blood vessels in the injured area. In the final phase, which takes months to years, the scar tissue matures, resulting in a stronger scar. Early surgical removal of dead skin and replacement with skin grafts usually accelerates healing. See the burn treatment page for more information.
With a deep partial thickness or full thickness burn, sweat glands are destroyed and are not replaced when the skin heals. Because sweating is important in controlling body temperature, burn survivors often have difficulty in hot and humid conditions. They may need to avoid certain forms of exercise, recreation, or working conditions that could cause heat stroke.
Glands in the skin (sebaceous glands) produce oil that lubricates and moistens skin. Deep burns destroy the sebaceous glands, making it necessary to use lotions to prevent the skin from becoming too dry.
Skin color is created by cells in the epidermis called melanocytes. Melanocytes produce melanin, the pigment responsible for skin color. Melanocytes are destroyed by deep burns. Different areas of the body may have different numbers of melanocytes (for example, areas with frequent sun exposure tend to have more melanocytes). It may be necessary to use skin from a donor site that is not a good color match for the graft site. For example, the best color match for skin in the face and neck is skin on the chest above the nipple line. However, if that area is burned other donor sites must be used. Scars usually change color over time, becoming less red.
Healed scars are about 20% weaker than the skin they replace. And while burned skin is in the process of healing, it is particularly fragile and prone to blistering. Clothes that fit well are important to prevent skin breakdown. The healed skin is also more vulnerable to sunburns than regular skin and may be more allergic to sunscreens and other skin products.
The amount of sensation following a burn depends on the depth of the burn. For a superficial burn, sensation should be normal after healing. For deeper burns, there is often a decreased sensation of hot/cold, sharp/dull, and light touch. The sense of deep touch is usually preserved. Many individuals are more sensitive to the air temperature than before being burned, with a majority of these individuals being more sensitive to colder air temperatures than is normal.
The extreme pain that people experience with a recent serious burn improves as the wound heals. Burn patients can experience a feeling of skin tightness, numbness, or a tingling or burning sensation as the skin heals. Because the healed skin tends to be drier than normal skin, it may itch if not kept moist.
In dermabrasion the surgeon scrapes away the outermost layer of skin with a rough wire brush or a burr containing diamond particles attached to a motorized handle. In dermaplaning the surgeon uses a dermatome, the same type of instrument used by burn surgeons to obtain skin for grafting. Learn more about dermabrasion and dermaplaning of burn scars.