How we use casts to treat burn injuries

While you’re recovering from a burn injury, you might need help to keep the injured part of your body as still as possible. In order to help protect your fragile skin while it heals, we might use casts to cover the burn.

We’ve treated patients from all over the country using burn casts. We’re experts in standard cast treatments and serial casting used specifically to help you recover from complex burns.

A cast works like a shell, putting a hard, protective covering around the burn. The outside layer of a burn cast is usually made of plaster or fiberglass. Inside the cast, you’ll wear a protective layer of cotton (Webril) between the outer layer and your skin. This layer of cotton helps make wearing the cast more comfortable and protects the skin during cast removal.

We sometimes recommend using casts to help treat burns. We typically apply a cast after skin graft surgery to keep the skin safe and clean while it heals. These casts are typically removed in 1-2 weeks.

If a burn is over one of your joints and your range of motion is limited, we might recommend serial casting to help you regain joint flexibility.

The term “serial casting” refers to applying and reapplying a cast over a period of time. It’s used to prevent grafted skin from becoming tight and causing contractures (scars that tighten the skin) as it heals. It can also be used to manage existing contractures so you can regain your range of motion.

Serial casting treatment usually lasts from 1-4 months. When you’re first beginning your treatment, we’ll change your burn cast frequently (weekly or every other week). Later in your treatment, we’ll change your cast every 3-4 weeks.

Each time we apply a cast we’ll position your joint to the farthest it can bend (maximum excursion). Doing this helps your healing skin slowly adjust to the new joint position. Each week, your range of motion will improve until it’s within normal limits.

Contact your doctor or burn rehabilitation therapist if you experience any problems with a cast, especially if you notice any of the following signs or symptoms:

• Pain that isn’t controlled by prescribed medicines
• The cast feels too snug or tight
• The 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 from the cast
• In infants or young children, crying which cannot be soothed by usual methods

There are several things you can do to help prevent complications from burn casts.

• Follow your doctor’s instructions carefully about physical activity after a burn injury.
• Move your 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.
• Don’t use anything to scratch under the cast. It may break the skin and cause an infection. If itching is a problem, talk with your doctor.
• Never stuff cotton or toilet paper under the edges of the cast. 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.

Taking care of the burned skin under the cast is a very important part of the healing process. Cleanse the skin around the cast every day with a cloth slightly dampened with water. While you’re cleaning, take care not to get the cast wet.

Don’t 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.

Cast removal is usually a fast and painless process. Before we put on the cast, we’ll pad your skin with a protective layer of cotton called Webril. This provides a cushion between the cast and your skin. When it’s time to remove the cast, we use a specially designed saw to cut through the cast. It won’t cut through the protected skin underneath.

The cast cutter is attached to a vacuum that removes the particles of plaster from the cast. This makes cast removal a noisy process. We’ll talk with you before we remove the cast to make sure you know what to expect and aren’t startled by the noise.