The patient is given pain medication prior to and during the hydrotherapy procedures. Hydrotherapy with the application of wound bandages is done every morning. Antibiotic solutions may be applied to the bandages each evening.

Debridement
The greatest danger to the burn patient is the presence of non-living tissue. Bacterial germs may live in this dead tissue causing a delay in wound healing and may cause a life-threatening infection.

Skin Grafting
After debridement, skin grafting (autografting) may be done if the burn injury is not too extensive. Skin grafting may be postponed until the debrided tissue is healthier. Skin grafting involves taking skin from an unburned part of the patient's body (donor site) and placing it on the burn wound. More than one surgical procedure may be necessary depending upon the extent and location of the burns. If more than one surgery is necessary, temporary skin coverage is needed to protect the wound until final grafting or healing takes place.

Temporary skin coverage may be provided by either Homografts or Xenografts. Homografts and Xenografts are thin grafts resembling autografts that are surgically placed on the burn injured areas. Temporary coverage of the wounds decreases pain and helps protect wounds from bacterial infection. These grafts adhere to the wounds but are removed when the burn wound is ready for autografting.

Most full thickness and sometimes partial thickness burn injuries require debridement and skin grafting. When the skin is ready for skin grafting, the autograft is meshed and stretched to cover a burned area larger than the donor site. The skin is stapled in place and covered with a netting or clear thin dressing.

Bulky, wet bandages soaked with an antibiotic solution are then applied. These bandages are soaked every four to six hours. The bandage is left in place and the graft is left undisturbed. The graft begins to grow and adhere within 48 hours. At the end of four to five days, the graft should be adherent. New skin grafts are fragile and advancement of the dressing will be determined by the medical staff.

Movement, bleeding, infection, and poor nutrition can interfere with the graft taking hold. This is why activity may be limited and splints applied to the grafted area. The donor site will heal in approximately two weeks. The grafted area and donor site may form scars.

If the skin graft is not successful or there is more dead tissue to be debrided, the patient will return to the operating room for further skin grafting until all wounds are covered. The overall number of surgeries is determined by the extent of the injury.

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