Burn care

Chippenham Hospital offers Central Virginia’s only state-of-the-art laser treatment for burn and traumatic scars.

We recommend laser scar revision for scars that are:

• Itchy
• Painful
• Red or discolored
• Tight/firm/hard or contracted

Laser treatment is most appropriate for thick, raised scars. These scars — also known as hypertrophic scars — result from abnormal or excessive healing. They are often red or inflamed and frequently cause significant functional impairment. For example, the scar may make it difficult for you to bend a joint. They may also cause emotional distress when they are located on the face, neck or other visible area.

While laser treatment will not completely remove burn scars, it can improve the functional abilities you may have lost due to scarring. You might also experience a softening of your burn scars and less itching. The appearance of scars may improve after laser treatments, but you should not expect a dramatic improvement in how scars look with laser treatment alone.

Laser treatment may also be offered as part of a more comprehensive burn scar reconstructive treatment program tailored for you. Your surgeon will assess whether other treatments, such as surgery, tissue expansion, or medication, would help you reach your goals.

What is the treatment like?

During laser treatments, the surgeon uses a special device called a fractional ablative carbon dioxide (CO2) laser to create microscopic holes in the tissue of a burn scar. This energy is thought to stimulate changes in the scar tissue. Next, a steroid solution is applied to the scar, which is absorbed into the holes. This medication also contributes to scar improvements.

The experience feels like a rubber band snapping against the skin for some people but can be more intense for others. A tingling or burning sensation is expected for up to six hours after treatment. Additionally:

• Patients will wear eye protection because the laser light can potentially harm eyes.
• The physician will test the skin’s reaction to the laser at the first session.
• Subsequent sessions may be longer (up to 30 minutes) to treat a larger area.

Laser treatment procedures typically use general anesthesia, and you should be able to go home the same day with a simple dressing over the treatment area.

What is the treatment plan?

Each patient will require a different number of laser treatments. Patients usually start to see improvement in symptoms around the third treatment. Most people will start with six planned treatments. However, this may vary depending on the location(s), size, thickness of scar(s) and individual response.

We make sure that your care is handled by a multidisciplinary burn treatment team so that you receive the depth and breadth of care that you deserve. Our burn care team includes:

• Burn and trauma surgeons
• Burn care nurses
• Case managers
• Physical therapists
• Plastic surgeons
• Psychologists
• Respiratory therapists
• Social workers

Treating a chemical burn is a race against time. Unlike thermal burns (from fire or steam), chemical burns continue to damage the skin as long as the substance remains on the body.

A Level I Burn Center represents the highest standard of specialized care, offering advanced technology and a multidisciplinary team to manage the most complex injuries. Chippenham Hospital treats chemical burn patients in four phases:

Phase 1: Immediate stabilization and decontamination

The first goal is to stop the burning process. Chemical agents — whether acids, bases, or organic compounds — can react violently with water or air.

• Removal of contaminants: Specialized teams carefully remove all jewelry and clothing, which can trap chemicals against the skin.
• Neutralization vs. irrigation: For most chemicals, the "gold standard" is massive, low-pressure water irrigation. However, for certain substances (like dry powder or elemental metals), water can cause a dangerous reaction. Our team members know when to brush off a powder or when to flush with water.
• Airway protection: If the patient inhaled chemical fumes, the team immediately checks for respiratory damage or swelling that could block breathing.

Phase 2: Advanced assessment and diagnosis

Once the site is "safe," the burn team assesses the severity. This involves more than just a visual check:

• pH monitoring: If a liquid chemical was involved, clinicians use pH paper to ensure the skin has returned to a neutral level (around 7.0) before stopping irrigation.
• Determining dDepth: Burns are categorized by depth — from superficial (first-degree) to full-thickness (third-degree).
• Systemic evaluation: Some chemicals, like hydrofluoric acid or phenols, can enter the bloodstream and damage internal organs (kidneys, liver, or heart). Level I centers have 24/7 access to treat these "hidden" internal threats.

Phase 3: Specialized surgical and medical care

For deep chemical burns, the body cannot heal on its own. Chippenham Hospital provides:

• Debridement: The surgical removal of dead or contaminated tissue to prevent infection and promote healing.
• Skin grafting: Using healthy skin from another part of the body (autograft) or advanced biosynthetic materials to cover the wound.
• Pain management: Chemical burns are notoriously painful. Specialized anesthesiologists manage pain through multi-modal approaches, including nerve blocks and specialized IV medications.

Phase 4: Long-term rehabilitation

Chippenham Hospital can handle the patient's recovery from injury to back to day-to-day life

• Physical and occupational therapy: Chemical burns can cause skin "contractures" (tightening) that limit movement. Therapists begin working with patients within days of the injury to maintain range of motion.
• Scar management: This includes laser treatments, pressure garments, and silicone sheeting to minimize scarring. Chippenham Hospital is the only hospital in central Virginia that offers laser treatment for burn scars.

Why a Level I Burn Center matters

When dealing with chemical agents, the margin for error is slim. Level I centers provide a centralized team — including burn surgeons, toxicologists, specialized nurses, and therapists — who are trained specifically for these rare but devastating injuries.

Safety tip: If you are assisting someone with a chemical burn, always wear protective gear (gloves/goggles) yourself to avoid becoming a second patient.

When a patient arrives, one of the most essential treatments they receive is hydrotherapy. In a clinical setting, it is a sophisticated and medically necessary procedure used to clean wounds, prevent infection, and jumpstart the body's natural healing process.

What is hydrotherapy?

Hydrotherapy is the use of water —controlled, sterile, and temperature-regulated — to treat and clean burn wounds. This takes place on a dedicated hydrotherapy table which allows for a constant flow of clean water to wash away debris without the risk of cross-contamination that can occur in standing water.

How hydrotherapy works

The process is performed by highly trained burn technicians and nurses. Here is the step-by-step approach:

1. Preparation: The patient is made comfortable, often with the help of pain medication or sedation, as the cleaning process can be sensitive.
2. Gentle cleansing: Using mild, antimicrobial soaps and warm water, the team gently washes the wound.
3. Mechanical debridement: This is the most critical part. The water helps soften dead skin (eschar) and old ointments. The team then carefully removes this tissue.
4. Observation: With the wound completely clean, surgeons can clearly see the depth of the burn and check for signs of healing or infection.
5. Dressing application: Once the hydrotherapy session is complete, fresh antimicrobial dressings are applied to protect the clean wound.

Why hydrotherapy is important for recovery

Hydrotherapy is not just about cleanliness; it is a foundational pillar of burn care for several reasons:

• Infection control: Bacteria love to grow in dead tissue and old dressings. By washing these away daily, hydrotherapy significantly lowers the risk of sepsis and other life-threatening infections.
• Promoting new growth: Removing dead tissue "clears the path" for new, healthy skin cells to grow. It also stimulates blood flow to the area, which brings essential oxygen and nutrients to the wound.
• Facilitating movement: The warmth of the water helps relax muscles and soften tight scar tissue. Patients are often encouraged to move their limbs during hydrotherapy to maintain flexibility and prevent joints from "locking" (contractures).
• Accurate assessment: A clean wound is the only way a doctor can accurately determine if a patient needs surgery or if the wound is healing on its own.

• Temperature control: We maintain specific water and room temperatures to prevent hypothermia, as patients with large burns lose body heat very quickly.
• Staff: Our team includes wound care specialists who can identifying the subtle differences between healthy tissue and tissue that needs to be removed.
• Pain management: We have specialized anesthesiology support to ensure that hydrotherapy sessions are as comfortable as possible for the patient.

For patients with severe burns or chronic, non-healing wounds, the body’s natural repair process often needs a powerful boost. Chippenham Hospital offers hyperbaric oxygen therapy (HBOT), a specialized medical treatment used to flood the body with life-saving oxygen, accelerating recovery and saving at-risk tissue.

What is hyperbaric medicine?

Hyperbaric medicine involves breathing 100% pure oxygen while inside a pressurized chamber. Under normal conditions, the air we breathe contains only about 21% oxygen.

In a hyperbaric chamber, the atmospheric pressure is increased to 2 to 3 times higher than normal sea-level pressure. This added pressure does something remarkable: it forces oxygen to dissolve directly into your blood plasma (the liquid part of your blood), allowing it to reach areas where circulation may be blocked or damaged.

How HBOT heals burns and wounds

Oxygen is the "fuel" the body uses to build new tissue and fight off invaders. When a patient is in an HBOT chamber, the benefits include:

• Reducing swelling (edema): The pressurized environment helps constrict small blood vessels, which reduces fluid leakage and swelling without depriving the tissue of oxygen.
• Waking up "stunned" tissue: In severe burns, some tissue isn't dead yet but is starving for air. HBOT delivers the massive dose of oxygen needed to bring these cells back to life, often preventing the burn from getting deeper or wider.
• Killing bacteria: Many harmful bacteria cannot survive in high-oxygen environments. HBOT strengthens the immune system’s white blood cells, making them more effective at destroying infection.
• Building new infrastructure: Oxygen triggers the release of "growth factors" and stem cells, which stimulate the growth of new blood vessels (angiogenesis) and collagen to close the wound.

Why it’s critical

Chippenham Hospital integrates HBOT into a total surgical and medical plan. It is especially vital for:

1. Skin graft survival: If a patient receives a skin graft or "flap," the success of that surgery depends on blood flow. HBOT ensures the new skin has enough oxygen to "take" and survive.
2. Carbon monoxide poisoning: Many burn victims are injured in fires where they inhale toxic smoke. HBOT is the fastest way to scrub carbon monoxide out of the bloodstream.
3. Preventing "reperfusion injury": When blood flow returns to a damaged area, it can sometimes cause a second wave of inflammation. HBOT helps neutralize the harmful molecules that cause this damage.

What a "dive" feels like

HBOT sessions are often called "dives" because the pressure change is like being underwater.

• The chamber: You will be placed in a Monoplace chamber (for one person) where you can lie down and watch TV and be very comfortable during your dive.
• The sensation: As the chamber pressurizes, your ears may "pop," just like on an airplane. Once you reach the treatment pressure, you simply relax and breathe normally.
• The duration: A typical session lasts between 90 and 120 minutes. Most patients require a series of treatments to see the full benefit.

Is hyperbaric therapy right for you?

HBOT is a safe, non-invasive addition to standard burn care. If you or a loved one are struggling with a non-healing wound, diabetic ulcer or a severe burn, our burn and wound center can determine if you are a candidate for "dive" therapy.