The Emotional and Financial Costs of Skin Graft Surgery
When an individual suffers a serious burn, the injury kills the affected layers of skin. This can not only leave a person profoundly disfigured, but is also medically dangerous since it leaves the burn victim open to infections.
As a result, after a significant burn injury, skin graft surgery may be necessary. Skin grafting involves taking healthy skin from one part of the body and attaching (grafting) it to an area where the skin has been damaged either because of a burn or on account of some other injury. The deeper the wound, the more tissue must be extracted from the undamaged area of the body with healthy skin.
Skin graft surgery can be quite painful, and it will usually involve anesthesia and a hospital stay of a few days. Moreover, even after a skin graft, the area around a burn will not look the same as would uninjured skin. In fact, after a skin graft, a person will have two wounds, the original area of the burn and the area from which the doctor extracted skin.
Like any medical procedure these days, a skin graft costs a lot of money. On average, a skin graft will cost in excess of $15,000; however, the procedure can cost as much as $25,000 - $30,000. That’s roughly an average of $45,000 (without hospital cost). While of course, one would hope that a victim has quality and adequate health insurance that would cover these expenses, it’s a hard fact that many people may find that they will have to bare a large part of these expenses out of pocket.
What Makes Facial Burns Dangerous?
An intense facial burn may leave a permanent disfigurement and other health problems that can last the rest of your life. Not all facial burns are this severe, though. You may only suffer a mild burn that heals up in short order. Still, even a mild facial burn may leave behind a health problem that could become fatal if you are not aware of it.
You may not feel any burns inside your mouth or throat following a sudden encounter with fire. The burn may not have gotten past your lips or mouth, or so you think. The Sepsis Society explains that facial burns may penetrate deeper into your air passages without your knowledge.
Posttraumatic Stress Disorder Risk Factors Associated With Burn Injuries
burn injuries | burn survivors | coping | psychotherapy bulletin | PTSD | risk factors | social support | trauma | trauma-related
Author’s Note: Melissa M. Matos, MA is a graduate student at the California School of Professional Psychology at Alliant International University, Los Angeles.
The skin has been described as the largest organ of the integumentary system (Levenson, 2008). One condition affecting the skin organ is burn injuries. Serious or severe burn injuries have been described as a life-threatening state that challenges all of the integrating systems in the body (Sveen, Dyster-Aas, & Willebrand, 2009). Serious burn injuries are not rare and often occur from everyday circumstances that come unanticipated and without warning (Taal & Faber, 1998).
According to Karter (2011), someone was injured in a fire every 30 minutes and a fire death occurred every 169 minutes in the United States in 2010. In addition, burn injuries appear to be more common among young children between the ages of 2 to 4 years, young adult males between the ages of 17 to 25 years, and older adults over the age of 65 (Flynn, 2010; Yu & Dimsdale, 1999).
The impact of burn injuries extends beyond that of visible difference and appears to be accompanied by a wide host of consequences. Financial burdens experienced by patients with burn injuries may occur from job loss associated with frequent absences due to medical treatment, and costs associated with medical surgery, rehabilitation care, and disability payments (Sadeghi-Bazargani et al., 2011; Yu & Dimsdale, 1999).
Physical impairment is often reported resulting from burn pain which is intense and causes great discomfort and suffering, particularly during hospitalization and the dressing of wounds (Yu & Dimsdale, 1999).
However, it is the psychological reaction to burn injuries, which perhaps may cause the greatest of impairment and distress. Patients suffering from burn injuries may experience depression, anxiety, and delirium associated with the physical experience of burn pain, as well as social withdrawal and negative body image due to visible differences (De Sousa, 2010; Sadeghi-Bazargani, Maghsoudi, Soudmand-Niri, Ranjbar, & Mashadi-Abdollahi, 2011; Yu & Dimsdale, 1999).
In addition, patients with burn injuries appear to be at greater risk for developing symptoms associated with psychological trauma and Posttraumatic Stress Disorder (PTSD) such as re-experiencing of the incident via intrusive recollections, avoidance of reminders of the event, recurrent nightmares, memory and sleep disturbances, and phobic behavior (Lawrence & Fauerbach, 2003; Yu & Dimsdale, 1999).
PTSD and Burn Injuries
Prevalence and Onset
PTSD is a psychiatric condition occurring following exposure to a traumatic event which is characterized by persistent and intrusive re-experiencing of the event, avoidance of stimuli associated with the traumatic event, emotional numbing, dissociation, and hyperarousal (American Psychiatric Association [DSM-IV], 2000*; Lawrence & Fauerbach, 2003).
Among patients with burn injuries, dissociation and a decrease in emotional responsiveness and feelings of detachment have been reported as occurring during the accident (Taal & Faber, 1998). According to the DSM-IV, PTSD has been found to be a common occurrence in patients with burn injuries, with prevalence rates reported as varying between 8% and 45%, while stress disorders in general has been reported as occurring in 18% to 33% of cases (El hamaoui, Yaalaoui, Chihabeddine, Boukind, & Moussaoui, 2002; Sadeghi-Bazargani et al., 2011).
In a sample of 60 patients with burn injuries, 23% met criteria for PTSD, while in a sample of 43 adult inpatients at a regional burn center, 22% were diagnosed with PTSD (El hamaoui et al., 2002; Roca, Spence & Munster, 1992). Despite the high prevalence rates of PTSD among patients with burn injuries, “PTSD remains a neglected entity by practitioners and remains therefore under-diagnosed,” according to El hamaoui and colleagues, who go on to note that “improvement of health and quality of life of these patients necessitates the earliest possible management” (2002, p. 649).
Symptoms must be present for one month to satisfy criteria for PTSD (APA, 2000). For most patients with burn injuries, PTSD-like symptoms may dissipate with time; however, for 5% to 25% of these patients, the symptoms become chronic (Lawrence & Fauerbach, 2003). In fact, evidence suggests that PTSD may have a tendency toward delayed onset in burn survivors, with onset usually occurring 3 to 6 months, and sometimes even a year, after the injury (Sadeghi-Bazarghani, 2011).
Looking at a sample of burn survivors two weeks post-discharge from the hospital, Sadeghi-Bazarghani and colleagues (2011) found that 20% had a positive PTSD screening; after three months, this increased to 31.5%. Similar findings demonstrated a tripled prevalence of PTSD among burn survivors between the times of discharge and the 4-month follow up (Yu & Dimsdale, 1999).
Further complicating the presentation of PTSD among burn survivors is the possibility that a substantial portion of patients may not meet full criteria for the diagnosis; however, the symptoms that are present may still significantly impact their quality of life (De Sousa, 2010). The nature of delayed onset and possible subclinical forms of PTSD among burn survivors illustrates the necessity for increasing awareness of risk factors among medical staff, given that medical professionals are provided opportunities to observe and screen patients during 3- and 6-month follow up examinations.
PTSD Risk Factor: Age
Age has been shown to have an association with the development of PTSD among burn survivors. Sadeghi-Bazarghani and colleagues (2011) found that a younger age at that time of the traumatic event appeared to predict a higher PTSD score after burn injury. Comparatively, El hamaoui and colleagues (2002) found that younger age (M=15.8 years) at the moment of the burn (as well as explosion of gas containers for cooking purposes) also appeared to be related to PTSD.
The element of age as a risk factor for PTSD may be due to the higher incidences of burn injuries among younger age groups, such as children and young adults. Another possible explanation has been the salient role of body image among younger age populations and the role of visible differences and physical appearance (Sadeghi-Bazarghani et al., 2011).
It is then imperative for medical staff to take particular note of younger patients with burn injuries, not only screening for risk of developing PTSD, but also to closely listen to younger patients questions and concerns, and using appropriate and effective communication skills to provide feedback about treatment outcomes (De Sousa, 2010).
PTSD Risk Factor: Gender
The role of gender of burn survivors has been shown to be a potential predictor of risk factors for PTSD. Sadeghi-Bazarghani and colleagues (2011) found an association between PTSD and male gender in their study; however, they explained the higher prevalence of burn injuries among men as possibly accounting for these findings.
Overall, additional findings have indicated that individuals with acquired facial trauma such as burn injuries are more likely to be female, and that most psychological symptoms after facial trauma are experienced more often by women, due to the higher prevalence of concerns associated with physical appearance and disfigurement (De Sousa, 2010).
According to De Sousa (2010), facial trauma may lead to social withdrawal and isolation, and is often accompanied by anger toward the self or others as well as idealizing the pre-injury physical appearance. Previous findings indicated that 27% of patients with facial trauma developed PTSD seven weeks after the burn injury (Yu & Dimsdale, 1999).
Therefore, female gender may function as a risk factor, contingent on the value the individual places on physical appearance and the level of distress resulting from visible differences.
PTSD Risk Factor: Coping Strategies and Social Support
Some models of PTSD postulate that adjustment to trauma is based on a series of factors, including resilience-recovery variables such as coping strategies and social support (Lawrence & Fauerbach, 2003). Coping has been described as behaviors that function to protect individuals from psychological harm from adverse experiences (Lawrence & Fauerbach, 2003).
Coping strategies have been categorized as approach coping, which involves directly resolving the stressor, or avoidance coping, which attempts to avoid thinking about the stressor or associated affect (Lawrence & Fauerbach, 2003). An ambivalent coping style—that is, a coping style that combines both emotion avoidance with emotion approach—has been found to be a predictor of more severe PTSD (De Sousa, 2010; Lawrence & Fauerbach, 2003).
In addition, lack of social support has been shown to function as a risk factor for PTSD among burn survivors (Lawrence & Fauerbach, 2003; Sveen, Dyster-Aas, & Willebrand, 2009; Yu & Dimsdale, 1999). Furthermore, high social support has been associated with both positive mental and physical health outcomes, such as lessening the impact of trauma exposure (Lawrence & Fauerbach, 2003).
Similarly, the nature of the patient’s social support functions as a variable, which influences psychological adjustment to facial trauma such as burn injuries (De Sousa, 2010). Medical staff, therefore, must assess for the presence and role of the patient’s social support system, as well as observing the coping strategies utilized both by the patient and members of that support system, as potential risk factors for PTSD and health-related quality of life indicators.