Within days, patients are in the operating room for more removal of dead skin, replacing it with a graft from the patient or, if there's not enough unburned surface, skin from a skin bank or an artificial skin that enables the inner dermis to regrow under a layer of rubber that will eventually be removed. "Typically we take ten-thousandths-of-an-inch-thick outer layer of healthy skin, and that process creates a second-degree burn," Yurt said. "What I usually tell patients is they'll have more pain after than before."
The donor site can take 14 days to heal, he said. The grafted area is immobilized for three to five days. Once it is healed, an intense period of rehabilitation starts to promote flexibility in the grafted area.
Sometimes skin from the donor site is meshed; a machine doubles or triples its original size by cutting holes in it, Yurt said. But the skin that results has an unsightly, diamond-shaped pattern and is usually not used for grafts on the face or hands, he said.
Patients are released from the hospital to a rehabilitation center and then home, with four to five physical therapy sessions a week for about a year. Additional surgeries, including plastic surgeries to improve the look of earlier grafts, also may be offered.
The approach to patient care is interdisciplinary from the start, Yurt said. Physical and occupational therapists, as well as psychologists, are part of the team. Many burn survivors suffer from post-traumatic stress disorder, with flashbacks and intrusive memories.
At the Hearst Burn Center, psychologists are experimenting with a "new exposure" therapy, which uses computer virtual reality to immerse patients in a Sept. 11 scene.
The aim is to let them reexperience that day in a safe, controlled environment so they can reprocess traumatic memories, possibly laying down new memories and becoming desensitized to events of that day.
Unlike other trauma victims, burn survivors cannot avoid reminders of their experience because it is etched into their skin. "When I look at myself in the mirror," Mututanont said, "it's like a patchwork of a not-so-good quilt." She likes working over the phone, she said, because it helps her forget her injuries.