Casts for burn injuries
Casts are sometimes applied after grafting for protection of the graft. These casts are usually removed in 1-2 weeks.
If a person is at risk to lose range of motion or has developed a joint contracture (loss of range of motion), serial casts can be worn to maintain or regain range of motion.
The term “serial casting” refers to applying and reapplying a cast over a period of time. The purpose of serial casting is to prevent grafted skin from becoming tight and causing contractures or to correct existing contractures and regain range of motion. Duration of serial casting is from one to four months. Initially, cast changes will occur more frequently (e.g. weekly or every other week) and then transition to every 3-4 weeks. While in a cast with the joint positioned at its maximum excursion, the skin remodels and adjusts to its new length. Each week, range of motion improves until it is within normal limits.
Contact your doctor or burn rehabilitation therapist if you experience any problems with a cast and especially if any of the following signs or symptoms occur:
- Pain unrelieved by the prescribed medication
- Cast feels too snug or tight
- Cast becomes loose, broken or cracked
- Painful rubbing or pressure develops beneath the cast
- Continued coldness or a whitish or bluish discoloration of the casted limb
- Pain, numbness or continued tingling of the casted fingers or toes
- Unusually foul odor
- In infants or young children, crying which cannot be soothed by usual methods
Follow the doctors’ instructions carefully regarding physical activity after a burn injury.
Move fingers or toes frequently to reduce swelling and prevent joint stiffness.
If fitted with a cast walking shoe, wear it at all times except when sleeping or showering.Avoid bumping or knocking the cast against hard surfaces.
Do not use anything to scratch under the cast because it may break the skin and cause an infection. If itching is a problem, tell your doctor.
Never stuff cotton or toilet tissue under the margins of the cast because it may fall into the cast and decrease circulation, causing serious medical problems.
If resting the cast on fine furniture, place a pad under it or wrap a cloth around it to avoid scratching the furniture.Never trim or cut down the length of a cast.
Care of the burned skin under the cast is very important. Cleanse the area surrounding the cast daily with a cloth slightly dampened with water, taking care not to wet the cast. Do not use anything to scratch under the cast because it may break the skin and cause an infection. If itching is a problem, call your doctor.
Before the cast is applied, the skin is padded with a protective layer of cotton called webril. When the cast is removed, a specially designed saw will cut right through the cast but not the protected skin. Cast removal is usually a fast and painless process. However, the cast cutter is attached to a vacuum that removes the particles of plaster from cutting, so cast removal is a noisy process.