The key to patient survival is swift recognition and immediate treatment. Once recognised, high doses of antibiotics are required, but these on their own are insufficient to halt the infection with its severe local and general effects. The most important element of treatment is the surgical removal of the infected dead and dying tissue. If this is not done and done quickly, the infection continues to advance. Many patients who survive the first 48 hours need additional operations during and after this time to remove further infected tissue.
Sometimes it may be necessary to check relatives or others in contact with the patient to see if they are carrying the same strain of Strep. pyogenes. This is normally done by taking nose and throat swabs. Occasionally other swabs may be advised. Contacts found to be carrying a Strep.pyogene strain may be treated with oral antibiotics.
Despite the best treatment, the infection is so severe that the death rate is still around 30-50%. Survivors may need amputation because of extensive areas of tissue being destroyed. NF can be severely disfiguring, and patients may need extensive plastic surgery and skin grafting to achieve the best possible functional and cosmetic result.
Understanding skin grafts
A skin graft is when damaged skin is removed and is replaced with healthy skin taken from another part of your body (or donor area). Split skin grafts are the most common type of skin graft using the epidermis (outer layer of skin) and upper layers of the dermis (second layer).
A donor area is where the skin is harvested or taken from another part of your body and used to cover the affected area. This area heals within 10 – 14 days. The skin is usually taken from the thighs, buttocks or other areas. You will be able to discuss the proposed donor site with the medical staff.
The graft will be secured in different ways for the different patients. It may be stapled, stitched or glued in place, or simply laid onto the area.
The donor area will usually be left for 10 – 14 days, but sometimes may be inspected with your graft. Often the donor area will ooze fluid and may smell this is quite normal. As the healing process of the donor area continues you may experience some pain, and especially itching, when walking, and at other timed also. As time goes on the dressing will dry out, harden and separate from the donor area, it may even fall off. This is also quite normal, as the dressing is designed to fall off when the donor site is healed.
By eating a healthy diet with plenty of protein intake. By avoiding smoking, this slows or stops your healing by slowing oxygen and blood supply to the grafted area.
After skin grafts, scar formation is inevitable. The scar will never look exactly like ordinary skin, but with proper care and medical management during the first 18 months after your burn, the scarring can be reduced to a low level. It takes up to 18 months for a scar to mature, usually leaving only a pale, soft flat and supple scar. During this time there are several important steps that may be taken to treat your possible scars, and your consultant may order special exercises, creams, splints or pressure garments for you. All this will be made clear by the nursing staff prior to your discharge.
The grafted area is usually left dressed for five-seven days after the operation. It will be securely wrapped up with dressings. Some patients may also require a plaster of Paris to prevent additional movements near the joints. It is important that the graft is moved as little as possible in the first 48 hours, giving the skin graft a chance to take. In some cases you will be advised to stay in bed. Sometimes a graft may be left without dressing. If so, the graft will be looked after by nursing and medical staff, and will be cleaned and inspected regularly.
The first dressing change is carried out five – seven days after the operation. If staples were used this is when they are removed. This may be painful, so your usual painkillers will be given. If sutures were used they may be removed, but not always. The Doctor will examine your graft and decide on the final part of your treatment. You will probably be given a lighter dressing, and will not have to have another plaster of Paris applied.
If you have questions about skin grafts which haven’t been answered here, please contact us.