Wound Care and Skin Disorders

Following is an overview of the kinds of wounds we treat. (If you don’t see your child’s condition listed, please search all conditions or contact a Shriners Children’s location for assistance.):

• Burns and pruritus: Itching after a burn
• Surgical wounds: From incisions, pin sites or feeding tube surgeries that have trouble healing
• Chronic or difficult to heal wounds
• Pressure injuries : Pressure ulcer, bedsores
• Trauma wounds: From burns or illness

A pressure injury (pressure ulcer or bedsore) is damaged skin, as well as damaged tissue under the skin. These injuries occur more often over a bony area where the skin is squeezed or rubbed between bones, sometimes on a surface such as a wheelchair seat or bed. The skin doesn’t get enough blood flow to be healthy and it breaks down. Children who don’t have feeling in parts of their body or who can’t reposition themselves are at greater risk. Wounds sometimes also occur under a medical device such as a prosthesis, brace or cast. Doctors will refer to these wounds in stages: 1 to 4, unstageable, or deep tissue injuries. The higher the stage the more severe the wound.

A wound is an opening in the body’s protective layer of skin. Wounds that require specialized treatment to heal, can occur from burns, surgeries or pressure injuries. Doctors talk about wounds by how thick or deep they are in the child's tissue.

Wound Care and Treatment

Our teams evaluate wounds for size, depth, healthy versus unhealthy tissue, and drainage, along with the child’s overall health. Families appreciate how our specialists work together to develop a treatment plan. Your child’s wound care team may include rehabilitation medicine specialists called physiatrists, physical and occupational therapists, dieticians, nurses, care management, infectious disease specialists, plastic surgeons, orthotists, orthopedic surgeons and burn care specialists if needed.

We address all areas of the child's experience to help promote wound healing. Children with poor nutrition, which may occur after injury or illness, have wounds that heal more slowly. Clinical dieticians assess patients and help your child get the vitamins and minerals they need to help skin heal. Physical therapists assess equipment such as wheelchair fit during wheelchair seating clinics, the bed surface at home, or how a brace fits. Some locations offer computerized pressure mapping technology where sensors show how a child sits in a wheelchair.

We offer advanced wound care treatments including:

• Surgery:
  • Surgical removal of dead tissue (surgical debridement)
  • Wound irrigation (pressurized fluid cleans the wound)
• Advanced wound dressings and ointments: Such as collagenase (enzymes that help remove dead skin and tissue)
• Taking weight off the wound: Or "offloading," through frequent turning or specialized mattresses or cushions
• Wound Vac therapy: Negative pressure therapy
• Electrical stimulation

In addition, Shriners Children’s plastic surgeons close some wounds with surgical skin flap procedures (FLAP surgery).

Below are common skin disorders and conditions we treat. (If you do not see your child’s condition, please search all conditions or contact a Shriners Children’s location.):

Skin Conditions

• Nevi/Nevus
• Acne Scars
• Burn Scars
• Skin Tags
• Toxic epidermal necrolysis
• Pupura fulminans
• Stevens-Johnson syndrome
• Skin infections and injuries

Birthmarks and Pigmentation Disorders

• Hemangioma
• Vascular Anomalies and Malformation
• Port Wine Stains
• Pigmented birthmarks 

Birthmarks (nevi) are present in 1 out of every 100 babies. Some also appear soon after birth. We don’t know what causes them. They can be brown/black (congenital melanocytic nevi) or they can be flesh colored (epidermal nevi, sebaceous nevi). Others are red or purple and are related to blood vessels (vascular malformations) like port wine stains or strawberry hemangiomas. Most are small, harmless and painless, and may disappear on their own. But some will keep growing larger, or the skin may itch, bleed or break down.

The pediatric plastic surgeons at Shriners Children’s can help with all types of birthmarks. We provide reconstructive surgery, corrective makeup or laser treatments.

Skin disorders can also affect how children feel about themselves. That’s why we include support services for a child’s emotional and psychological needs.