Facial and neck burn implants are a surgical procedure used to repair the wound, improve the patient’s appearance and restore physiological functions. The implantation method often takes a medium-thickness skin slice graft, in which a skin slice containing epidermis and part of the dermis is cut from the autologous site and grafted and sutured to the burned area after debridement, and the stitches are removed in 2 weeks under infection-free conditions and discharged after 1 to 2 days of observation. Home care after discharge is very important for preventing and reducing wrinkles, dysfunction and color transformation in the implant area. The main points of home care are introduced as follows.
1.Dietary adjustment
The principle of dietary adjustment after burn implant surgery is to give a diet with high protein, high caloric energy, high vitamin and moderate fat. The purpose is to improve the patient’s general condition to the greatest extent possible, enhance the body’s resistance, reduce the chance of infection, and ensure the success of skin grafting and smooth recovery. Some people think that fish, shrimp and other river and sea products are hairy products, and food with pigment has influence on the skin color of implantation area, which is a misunderstanding. In fact, the former is high protein food, which can promote the healing of the implant area and play a nutritional role for the implant area, so there is no problem of hair products. The latter has nothing to do with the pigmentation of the implant area, because the pigmentation of the implant area depends on the site, thickness and skin color of the skin piece taken. Patients can eat more food containing colloid, such as pig’s feet, such food contains more collagen, which has a nourishing effect on the skin and is beneficial to the recovery of the skin implantation area.
2.Life conditioning
(1) Keep the skin implant area clean: The newly healed skin is delicate, so use neutral cleanser or soap to clean it, and then rinse it with water, once a day in the morning and once in the evening, and keep it dry after washing.
(2) Prevent trauma: The newly healed skin is delicate and easily damaged. In daily life, avoid doing housework in too narrow a space and prevent hard objects such as tables and cabinets from touching the implant area; when there is pain and itching in the implant area, you can gently pat the implant area with your hand, which has a certain effect on reducing the pain and itching, and you can also rinse with warm water and dry with a clean soft towel and apply anti-itch emulsion.
(3) Prevent exposure to sunlight or frostbite: The blood circulation in the new implant area is poor, and ultraviolet radiation is easy to cause pigmentation. In winter, it is necessary to keep warm and prevent freezing.
3.Medication care
(1) Early medication care: To prevent scar hyperplasia and skin contracture at the edge of the implant area, massage the edge of the implant area with scar cream, see this section for the specific method of local massage and pulling. In addition, scar paste can be applied externally, which is applied directly after cleaning the implant area, and should be temporarily discontinued if there are scattered traumas in the implant area.
(2) Late medication care: The skin in the implant area is less nutritious than normal skin, easy to dry, and easy to cause pigmentation when out in the sun. Three to six months after the skin implantation, the softness of the skin piece is gradually restored, and skin care products (available in stores) with nutrition and sun protection can be used, which have certain effect on preventing pigmentation.
4.Special care
(1) Semi-exposure therapy: Cover the wound surface with a layer of antibacterial wet gauze after clearing, without dressing. It is suitable for patients who have some residual small trauma. Specific methods are as follows.
(1) Clean the trauma surface: Clean the scattered trauma surface of the implant area with warm water, and then use sterile cotton swab or sterile gauze to absorb the cleaning solution.
②Cover the trauma: Place sterile gauze in a sterile container, wet the gauze with 0.25% iodophor and cover the trauma, then irradiate the trauma with a 45-60w bulb at a distance of 30cm-40cm to keep it dry.
(3) Intermittent trauma drug application: When the trauma surface is dry without secretions, use sterile cotton swabs dipped in 0.25% iodine volt directly on the gauze, 3 to 4 times a day, irradiate the trauma surface with a light bulb after each application, and stop irradiation after drying. The purpose is to promote trauma surface drying, accelerate trauma healing, shorten the treatment period, and carry out post-rehabilitation care as soon as possible.
(2) Pressure therapy: A face mask and neck elastic sleeve made of elastic fabric are used to apply continuous pressure on the implant area to achieve the purpose of preventing and reducing the hyperplastic contracture of the implant area and marginal scar. This method is simple, easy and effective, and is suitable for patients with no traumatic residue in the viable skin graft. The specific methods are as follows.
①Production: The neck elastic cover is cut according to the circumference of the patient’s neck, and Velcro is sewn on the joints. A face mask is also available, usually purchased by asking at a burn specialist hospital.
②Wearing: Family members are required to assist in the early stage of wearing, and the inner surface is lined with 1 to 2 layers of gauze, laid flat and glued with Velcro for pressure. In addition to daily washing and massage, in principle, the mask should be worn continuously for 24 hours and adhered to for six months to one year.
③Improve the therapeutic effect: The root of both sides of the nose should be filled with gauze rolls when the mask is worn to achieve uniform force on each part and increase the pressure on the face.
④Strengthen the adaptation: When wearing the mask in the early stage, individual patients may experience discomfort, such as dizziness, slightly labored breathing and other symptoms, which are mostly normal and can be gradually adapted after 1 week. If this symptom continues to aggravate without relief, wear should be suspended, and if possible, consult a hospital.
⑤ Protect the trauma: when a small trauma appears, you can continue to wear it, and a small hole should be cut in the same part of the elastic sleeve to expose the trauma and keep it dry to facilitate healing.
5.Local massage and traction
Planned massage and pulling on the implant site is one of the effective methods to prevent or reduce the contracture of the implant area, as follows.
(1) Eye: with the patient lying down, the operator (or family member) is located at the head of the patient’s bed and massages the upper and lower eyelid implant area respectively. The method is to fix the massage area with the left hand and press the edge of the implant area with the right thumb.
(2) nose: the patient lies flat, the operator (or family members) is located at the head of the patient’s bed, both hands palm fixed top of the head, middle finger and ring finger simultaneously press the edge of the implant area several times, the tips of both thumbs are inserted into both sides of the nostrils, the index finger is placed on the outside of the nose wing fixed, do outward and forward pulling massage action several times, massage once a day.
(3) mouth: the patient lies flat, the operator (or family members) is located at the head of the patient’s bed, both hands palm fixed jaw, both hands thumb press the edge of the upper lip or lower lip implant area several times, the index finger into the corner of the mouth, thumb placed on the corresponding part of the outer corner of the mouth, thumb and index finger pinch the corner of the mouth to pull outward, the amplitude gradually increased, to the extent that the patient can tolerate, and the patient can cooperate with the opening and closing mouth action, once a day.
(4) neck: patient lying down, the operator (or family members) is located at the head of the patient’s bed, massage in the order of left → right → front. If the left side of the neck is massaged, the head is placed on the left side, the right hand is placed on the lower jaw to play a fixed role, and the small fissure of the left hand is used to massage the edge of the implant area, from top to bottom several times. Massage the posterior side of the neck in the same way. Massage the anterior part of the neck, place the head in the backward position, place the left hand and right hand on the lower jaw after overlapping each other, straighten both forearms, do the backward pulling and kneading action to fully loosen the implant area and make the maximum movement of the neck, once a day.
6.Support production and use
(1) Nose: In order to prevent the nostril from contracture and narrowing after implantation, rubber tubes of suitable size, thickness and soft texture can be chosen as support. The method of placement is to clean the nostril first, then apply oil ointment with cotton swab to ensure smoothness, and then slowly place the selected rubber tube into the nostril, and this method should be adhered to for more than half a year.
(2) Mouth: In order to prevent the contracture of the implant area and the perioral area from becoming smaller, a pull hook of about 1 cm is made of plastic splint and placed in the mouth to play a supporting role. The method is: first measure the width of the patient’s oral cavity and draw it on the plastic splint, then put it into a basin with water temperature of about 70℃, cut and shape it with scissors according to the drawn size after the material becomes soft, with the front end in the shape of hook and the back end in the shape of straight strip, connect the rubber band and fix it to the patient’s ear, in order to make it loose and tight.
(3) Neck brace: It is necessary to wear a neck brace after neck implantation, which can keep the neck in an extended position and maintain the physiological curve of the front of the neck, especially for maintaining the normal shape of the jaw and neck angle, exerting uniform and moderate pressure on the implanted skin piece, and preventing scar growth under the skin piece and around the skin piece. Neck braces can usually be purchased from burn specialists. Neck braces are available in large, medium and small sizes and are chosen according to the patient’s condition. In the early stage, because of the hard texture of the neck brace, the inner layer must be padded with cotton swabs, and assistance is needed to put on and take off the brace to prevent trauma caused by improper fitting.
7.Care of eye burn implant after surgery
(1) Keep the eye clean: remove eye secretions in time to keep the implant area clean.
(2) Medication: use 0.25% chloramphenicol eye drops to dot the eyes twice a day; 0.5% tetracycline eye ointment to coat the eyes once a night.
(3) Covering: Patients with incomplete closure of both eyes should be covered with sterile petroleum jelly gauze every night.
8.Nasal burn implant postoperative care
(1) Keep the nasal cavity clean and unobstructed: clean the nasal cavity with cotton swab dipped in warm water twice a day, moisten the nasal cavity first if there is dry scab in it, and then remove the dry scab with tweezers after a few minutes, then apply tetracycline eye ointment or lubricate with warm water to keep it unobstructed, while clean the implant area with neutral skin cleanser twice a day.
(2) Support the nostril: Use the appropriate thickness of rubber tube to wrap the oil gauze strip and then place it into the nostril for support to prevent the edge of the skin piece from contracting to produce a narrow deformity of the nostril, adhere to it for half a year, remove and clean the nasal cavity every day, replace the oil gauze strip wrapped in the rubber tube and pay attention to keep it clean.
9. Post-operative care of oral burn implant
Make sure the mouth is clean, brush your teeth after each meal, if the perioral area is still small after implantation and you cannot brush your teeth, use warm salt water to rinse your mouth. While cleaning the mouth, you can apply lip balm or glycerin on the lips and corners of the mouth to prevent dryness, cracking and bleeding.
10.Skin rehabilitation care
Skin rehabilitation care is a method of care that integrates cosmetic skin techniques into the post-burn implantation. This method needs to be carried out under the guidance of professionals, and those who are in a position to do so can participate in training and basically master the essentials by operating 2 to 3 times.
(1) Indications: Mostly used for exposed parts of the body, such as the face and neck.
(2) Purpose and function: To promote blood circulation in the implantation area, reduce skin wrinkling, prevent or reduce pigmentation, and make the implantation area close to normal skin color as soon as possible.
(3) Instruments and drugs: herbal ionic spray machine, available at medical equipment stores; herbal mask powder, scar cream
(4) Operation methods.
(1) Fumigation therapy: The herbal ionization spraying machine is filled with appropriate amount of distilled water, powered on, aimed at the skin implantation area and sprayed. The distance between the nozzle and the care area is 40cm～60cm. The fumigation therapy can be carried out 2 weeks after the removal of stitches in the implant area without trauma, and the first time it is fumigated for 30 minutes.
②Fumigation and massage: wash with cleanser after fumigation, remove the dead skin on the implant area with tweezers, cover with sterile gauze, elastic pressure, and wait for no dead skin on the implant area, massage can be performed at the same time of fumigation. Apply scar cream massage on the care area, see this section for the specific massage method of local massage and pulling, the massage time is 30 minutes. Wash after massage, then apply herbal mask, wash and dry after 30 minutes, and apply vitamin e nutritional cream, once every other day.
(3) Mask preparation and use: Add several drops of honey and appropriate amount of distilled water to the herbal mask powder and mix it into a paste to be applied on the implant area.
(5) Precautions: For early healing trauma, massage should be gentle, while the ionic spray should not be too long to prevent skin damage. When small trauma appears, massage should be temporarily stopped and attention should be paid to keep the trauma dry.
11.Functional exercise
Functional exercise is to fully mobilize one’s own potential and achieve the purpose of preventing or reducing contracture in the implant area through planned training. This is the easiest and most economical method.
(1) Eye
①Eye opening and closing exercise training: After the removal of stitches in the implant area, start to do eye opening and closing exercise training, and ask the patient to open and close the eyes as much as possible, several times a day.
② Skin lifting exercise in the implant area: 1 week after the removal of stitches in the implant area, do skin lifting exercise in the implant area by gently lifting the skin in the implant area with the thumb and index finger as much as the patient can tolerate, several times a day. Patients and family members should learn this exercise method.
12.Postoperative review
The main contents include: the appearance of the implant area, such as color and elasticity; whether there is any contracture that affects the function, such as whether the eye can be closed, whether the mouth can be opened to eat, etc.; continue to explain the importance of wearing elastic sleeve and local massage, generally the scar needs 1 to 2 years to be stable; decide whether further surgical treatment is needed, etc.