ultrasound following split skin grafting

[suzi0802]

Has anyone ever used ultrasound on patients following split skin grafting for burns? if so what are the parameters used and the reasoning?
Also are there are reliable and valid outcome measures for use with these patients?

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[sdkashif]

I don't find any strong recommendations or sufficient references regarding the use of therapeutic ultrasound following the split skin grafting. Other methods for management following the split skin grafting are more effective. Like gentle exercise of the grafted area is commenced once the grafts are stable, usually at 5-7 days. It is essential to restore the range of movement although wounds may still be unhealed in the places. After 14 days, the graft begins to contract and there is a danger that it will become adherent to the inderlying tissues. So the physiotherapy aims will be:

To mobilize the scar tissues
Increase range of movement- passive and active
Prevent further contraction of scar
Reduce redness and flatten raised areas
reduce pain and discomfort
Lenghten soft tissues

These aims are achieved by passive stretching, Massage, splinting and pressure garments.

As the skin matures, it is essential to soften fibrosis and to loosen any contracted soft tissue. Here ultrasound is effective to isolated identified tight areas. You must take special care as the lowest effective dose of ultrasound should be used as heating is contraindicated in grafted areas. This is because heat treatments like hot water and wax baths should be avoided, as the new skin is exceedingly thin and may be insensitive to temperature.

References:

Hand Injuries - A therapeutic Approach By Maureen I. Salter

Tidy's Physiotherapy, Thirteenth Edition, By Stuart B. Porter