It was great to see everyone in Thursday’s Burn Clinic appointment.  Don’s surgeon wasn’t able to make it but Dr. G (rehab) and Nurse Julie were there.  They really couldn’t believe how great Don’s skin looks now.  We talked about how at three months after the fire he was extremely hypertrophic (from http://www.medterms.com/script/main/art.asp?articlekey=4090 — A scar that doesn’t know when to stop. When the skin is injured, cells grow back to fill in the gap. Somehow, they normally “know” when the scar tissue is level with the skin, at which point the cells stop multiplying. When the cells keep on reproducing, the result is a what is called a overgrown (hypertrophic) scar or a keloid. The result is a keloid — a tough heaped-up scar that rises quite abruptly above the rest of the skin. It is irregularly shaped and tends to enlarge progressively.  In other words, keloids are due to an excessive response to trauma such as a cut to the skin. In creating a normal scar, connective tissue in the skin is repaired by the formation of collagen. This occurs in the dermis (the layer of skin just below the epidermis, the outer layer of skin). Keloids arise when there is too much collagen formed in the dermis during the repair of connective tissue. To develop keloids, a person must be susceptible to keloid formation. This susceptibility is clearly genetic.)

What they found remarkable was the smoothness of Don’s skin (particularly on his legs and hands — his shoulders and back donor site are still hypertrophic/lumpy due to the January/February staph infection).  They both said of all the burn patients they have treated, they have never seen someone heal so well.  Dr. G asked me to email him an outline of the treatment protocol I used on Don’s skin to get these results.  I also want to write a booklet for patients to have when they leave the hospital.  Two things to consider however — each burn is different and each burn patient is different, so what worked on Don may not work for everyone — I don’t know – I only know Don’s results using this methodology.

As we were leaving, Julie told us Don has graduated – this was his last appointment at the Burn Clinic (unless we needed them of course).  They said there was nothing more they could do for us because we were already way ahead of normal progress.  Because I hadn’t considered that today would be graduation day, I didn’t think to ask them how we’ll know when Don can stop wearing the custom compression garments — when are they done benefiting Don’s scars?  But maybe because of the uniqueness of each patient there isn’t an answer to that question.  In researching the topic there is very little information — basically I found that when the erythema (redness of the skin) “begins to abate”, then you stop wearing the compression garments.  But that’s pretty subjective and vague….so if there’s the chance that the garments are still helping, even though erythema has begun to abate, then Don will keep wearing them.