Skin grafts following burns?

[orems]

So, every parent's nightmare, my son poured scalding tea water on himself 2 weeks ago. Given the severity of the wound and how it's healing they are recommending he receive a skin graft from his bum to the area on the arm. Does anyone have any experience with this at all? We are scared to death and would love any feedback. Thanks.

[LucyEllensmummy]

oh, poor you and your poor DS. My cousins wee lad did similar with tea on his face - fortunately he only had a couple of days in hospital. But you are right every parents nightmare - and it happens so easily too. My cousin was making the tea and turned her back to get the sugar - he climbed up and pulled the cup over.

I don't have any words of wisdom though - just a very unmumsnetty hug!

[kiltycoldbum]

i can't really offer much help but just wanted to add my story. When i was 3 i pulled a full just boiled kettle on top of myself burning back, stomach and arms. Was in hospital for a little bit and heavily bandaged etc, rather bad burns as you can imagine. i fortunately didnt need grafts. the burn on my back was the worst and was scarred for a good few years, however as i got older the scar eventually disappeared (pretty much at puberty it all disappeared) and i sit here now and you would never have the foggiest i ever had such an injury. The only thing i have to be careful about is not ever sunburning myself as if i do part of the scar does reappear and needs lots of creaming, but you learn that lesson quick and dont do it again.

Am thinking of you all and I hope your son heals well x

[orems]

Thanks for the feedback. It sounds like you had a much worse wound and I continue to doubt whether this is the best course of action or excessive intervention. He would heal eventually without graft but more slowly, with more risk of bad scarring and infection. The dr was pretty adamant about this being the best course of action but left doubting this.

[kiltycoldbum]

im so sorry you're in this position, it must be truly awful, its so vivid still in my mums memory she says it feels like yesterday but obviously i barely remember much about it!
I was in Alder Hay hospital which had a pretty good burns unit but that was over 20years ago now!

Perhaps you could get a second opinion? Every wound is different. I was lucky apparently none of my wounds got infected but they did take many years to heal, eventually getting smaller and smaller. I distinctly remember being on holiday about 9 or 10 and getting burnt on my back and my scar coming right back up on but over than on those occassions where i foolishly burnt in the sun its never come back up! The last time was 2 and half years ago and i badly burnt my back while out on a boat, really burnt it and my scar came up on the top half of my back and took months to go away and my dp had to keep rubbing some cream on it. so while superficially it looks like nothing is there, i suppose some sort of damage sits there underneath the skin? I dont know! Im just sorry youre stuck in what must be a truly agonising place with a difficult decision to make. Sorry i cant help!

[SweetCheeksLovesSweetTalk]

I dont really have any advice but the same thing happened to me when I was 18 months. I pulled a kettle of boiling water on to my stomach. I had to have a skin graft from my thigh onto my stomach.

Where they took the skin from it barley noticeable, however I do have an unsighlty large scar on my stomach which doesnt cause me any physical problems.

[rempy]

Very sorry about your sons accident.

What is scaring you? The anaesthetic? Having to "cause" another wound?

As your doctor has already said, a graft will cover the wound, reducing the chance of infection, and will reduce scarring. The problem with scars are not just cosmetic. Scarred skin can cause contractures - it becomes so tight that it restricts movement, particularly around joints, and can reduce blood flow in a limb, restricting growth and development.

Some burns patients need repeated surgery to release contractures, and have as a result very very poor cosmetic appearances, although usually a more functional limb.

The graft will be so called split skin - so they shave off a relatively small area from the donor site and put it through a meshing machine, which turns it into a sort of skin "net" that is stretchy and can cover a much bigger area. The donor site will heal well, because they only take epidermis, the top layers, not the dermis, the lower level of skin, and very quickly. It is however often quite painful immediately after the procedure, just like an area of gravel rash is. They can put on local anaesthetic soaked bandages to help. Burns units are also very good at pain management usually.

The graft site will still be scarred, but it will be much better than healing by secondary intention - the posh name for just leaving it.

Ask if you can to see pictures of before and after results by your plastic surgeon. They may reassure you about the end result.

PS am anaesthetist, not surgeon.

[lou031205]

Hi orems,

I had an elective placement on a burns unit as part of my nurse training, and saw quite a few grafts.

The area on your son's thigh will be an oblong 'patch', that has literally the very top layer removed. What that means is that his bum will be very sore, and quite itchy for probably about a week, when it will start to feel a lot more comfortable.

The great thing about skin is that it is very stretchable, so they can take quite a small section, and then pass it through what looks a bit like a pasta machine, to gradually make it thinner and longer, and wider. When they have done that, they put it through the 'mesher'. They will either glue or staple the graft to your son's arm, and bandage it.

Skin has a huge blood supply, so the graft should 'take' really quickly, and healing is generally quite fast.

Your son's scars should fade with time, and he will probably be encouraged to rub cream into them to help. His buttock will be reddened for some time, but this too will fade.

It really is a good idea to have the graft, because it is that top layer of skin that protects your body tissues from infection, and the actual scarring will be reduced.

They tend to use the bum because there is a good amount of skin available, and it isn't often on display anyway!

[oremstango]

Mumsnetters come through yet again. Thank you so, so very much as always ladies.

[orems]

Just a follow-on to say thanks again. The surgery appears to have gone quite well though will only be able to tell Tues once bandages are changed. My ds cried a bit after the operation (think the tubing in the throat was the cause of the discomfort) but then slept shortly thereafter, and woke 90 minutes later ready to play. He has been back to himself completely today, and only on Calpol and Calprofen. I have certainly come to appreciate the resilience of little ones and after seeing the severity of the other childrens' injuries and the causes of the burns (iron, Lemsip, kettle, tea) will share his story so that others don't need to go through this.

[lou031205]

Glad to hear that.

Worst I saw was a little boy who had been put in a bath run by his older brother. Scalding water burns. Horribly painful and lots of surgery needed.

[Fruitbatdancer]

Thank you. 11 years later I needed this thread. 6 year old is in for one tomorrow.