Timing of Pressure Garment Measurement and Use: Key Considerations for Burn Rehabilitation Therapists
- Yu-Li SUNG
- Oct 4
- 4 min read
Yu-Li SUNG, Physical Therapist and Director
Medical Device Center, Sunshine Social Welfare Foundation
When is the right time to measure pressure garments in burn patients? I always worry I am either too early or too late…
There are still wounds. If I wait for all of the wounds to heal before taking measurements, won’t the scars have already developed by then?
Effective pressure therapy is vital for managing hypertrophic scars in burn patients, but its success depends on carefully timing the measurement and use of pressure garments. Burn rehabilitation therapists are not just confronted to the risk of hypertrophic scar growth, but they must also balance other considerations, like unstable skin surface that breaks and blisters easily, wounds that haven’t healed or that can even be infected, lingering edema, multiple healing areas with varying wound healing statuses, etc. This post explores key considerations to help burn rehabilitation therapists optimize outcomes by addressing the timing of pressure garment measurement and use.
When to Measure for Pressure Garments
The timing of pressure garment measurement hinges on two key factors: wound healing and the presence of edema.
Wound Healing
Do I need to wait until all wounds across the body are healed before taking measurements for pressure garments?
Criteria for Measurement: Size, Location and Status of Wounds: Measurement can be taken when most wounds have healed, and the few remaining wounds are no larger than 2.5 cm. However, in the case of children, special consideration must be given to the size of the wound in relation to the body size. Pay special attention to wounds located on joints, because the friction from the fabric of pressure garments can exacerbate the wound. For grafted areas, measurements are possible if the grafted skin is healing as expected, with no signs of infection or delayed closure. The grafted area should not have cracks in the sutures, discharge, odor, or inflammation. The donor site also needs to be assessed to ensure it is healing properly without complications that might affect measurements or garment use.
Evaluating Remaining Wounds: If the remaining wounds exceed 2.5 cm, therapists should delay measurement for 7–10 days or until the wounds shrink sufficiently. However, it’s unnecessary to wait for all wounds across the body to heal. Since pressure garments are specific pieces tailored for specific body parts, measurements can proceed for healed areas, while other pressure therapy interventions, like elastic bandages, can be used on unhealed regions.
Edema Management
What should I do if a patient has significant edema in areas where pressure garments are needed?
Edema, particularly in the hands and feet, can skew measurements, leading to ill-fitting garments once the swelling subsides. To address this, reduce edema first. Encourage the patient to use elastic bandages or self-adherent elastic bandage like Coban to reduce edema before taking measurements. Taking measurements while the limbs are still swollen from edema can result in garments that become too loose once the swelling goes down. This often leads to delays in the start of the pressure therapy intervention, as adjustments or, in some cases, entirely new garments may need to be made.
By assessing both wound healing and edema, therapists can determine the right time to measure pressure garments.
When to Begin Using Pressure Garments
After receiving the pressure garments, therapists must re-evaluate the patient’s skin to decide if they can start wearing them.
Wound Size and Location
Can pressure garments be used on areas with small open wounds or blisters?
What are acceptable wound conditions? Wounds must be no larger than 2.5 cm in diameter and should not be located on joints, because pressure and friction from fabric on joints can aggravate the wound and delay healing. Also, use of pressure garments should be delayed for infected wounds. Extensive blistering makes wearing and removing pressure garment problematic, as friction can break the skin. For a small number of blisters, therapists can manage them aseptically and cover them before using pressure garments. However, if the skin appears weak and is prone to tearing, delaying use of pressure garments until the skin can better tolerate friction is preferable.
After a skin graft, both the grafted and donor areas should be evaluated for signs of infection or delayed healing, such as cracked suture edges, discharge, odor, or inflammation. For unhealed grafts, delay pressure garment use until infections are resolved and wounds are stable. For healed grafts, start pressure therapy promptly to minimize the risk of hypertrophic scar formation.
Clinical Example: Wound Evaluation for Pressure Therapy
A wound with small, healed areas (e.g., ≤2.5 cm) indicates readiness for measurement (photo on the left). These small wounds can be protected with non-woven gauze or other dressing before putting on the pressure garments. Larger, open wounds (photo on the right) or unhealed skin grafts signal the need for additional healing time before taking measurements or using pressure garments.
Key Takeaways for Timing of Pressure Garment Measurement and Use
Start Early, But Be Cautious: Timely wound evaluation is critical to avoid delays in pressure therapy. Measure as soon as healing criteria are met.
Assess Edema Before Measurement: Manage swelling with elastic bandages first to ensure accurate fitting.
Individualize Timing: Consider each body part separately by starting measurement and use of garments for healed regions, to avoid delaying pressure garment use unnecessarily.
Evaluate Skin Before Use: Reassess wounds, infection risks, and skin fragility before allowing patients to wear garments.
By balancing these factors, therapists can optimize the timing of pressure garment measurement and use, ensuring effective scar management and better outcomes for burn patients.
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