Pressure gradient garments are specifically measured, engineered, and designed for each individual patient and burn site. The dacron fabric has a tri-dimensional quality which allows full body mobility and comfort while applying direct pressure. The custom-made garment should be used whenever feasible

and indicated .

Silastic-Elastomer molds are used in conjunction with pressure garments and splints. They are definitive molds specifically poured into, around or over "hard to reach" concavities of the body in order to apply a direct pressure over the burn scar to prevent, retard, and smooth scar hypertrophy build-up and contracture.

UVEX® face molds are made of semi-rigid plastic which are fabricated over individual plaster positive molds of the face to form a face mask which applies definitive observable pressure to the scarred soft tissue areas of the face.

Midriff VestWhen the burn involves the arm, including the cap of the shoulder, a separate sleeve will not supply adequate pressure, a vest with full sleeves should be ordered. Without the continuation of pressure supplied by the vest, all pressure over the cap of the shoulder will be lost. If the patient desires, the vest can be constructed to a midriff level for comfort when the pressure is not required over the trunk.

Short Sleeve VestWhen the burn includes the trunk and only the portion of the arms proximal to the elbow, a vest with short sleeves is used. For this type of garment to be most effective, the burn should not extend beyond the area that is 2" to 3" proximal to the elbow joint. a short sleeve should be incorporated in the design of the garment. This short sleeve will help to counterbalance the pull from the opposite side.

Vest With Different Sleeve LengthsWhen the distal margin of the burn of one arm extends beyond the distal margin of the opposite arm, the vest can be

constructed with different sleeve lengths..

Forearm SleeveWhen the burn involves the forearm but does not include the elbow or the area just distal to the elbow, a separate forearm sleeve extending from the wrist to the elbow can be used to apply pressure. If the burn extends beyond the distal 1/3 of the

forearm the addition of a gauntlet is required to assure adequate pressure to the scar and prevent any gaps in the line of pressure to the wrist. A short zipper can be incorporated into this style of garment.

Full sleeveWhen the burn involves only the arm without extending beyond the upper 1/3 of the biceps, a separate full sleeve can be utilized to supply the required pressure. For this style of garment to be effective, the burn should not

extend beyond the distal 1/3 of the forearm without the addition of a gauntlet or glove. A full length zipper can be incorporated into this style of garment to ease donning.

Simple Chin StrapIf the burn scar involves only the chin and mandibular line, and does not extend above the ear, only a simple chin strap is required.

This garment will apply pressure to the chin and middle portion of the mandibular line only.

Modified Chin StrapWhen the burn extends around the ear and onto the chin, a modified chin strap should be used. The head strap is widened to extend behind the ears. For optimal pressure around the ears, an open face mask should be used. This type of support can also be utilized if there are anterior neck burns. When used in conjunction with a soft foam collar, an unbroken like of pressure is achieved along the full length of the scar.

Unlike the full face mask, the chin strap (simple or modified) is open at the back of the head, with an elastic band ending with a Velcro closure at the ne

Open Face MaskWhen the burn extends to the area above the ears, or across the forehead, without including the eyes, nose, or mouth, an open face mask should be used. This type of mask will apply pressure to the side of the face, chin, and forehead.

When the burn area includes the mouth, a modified version of the open face mask should be used. This mask is constructed with a lip strap which forms a separate opening for the mouth apart from the opening for the eyes and nose. The lip strap maintains pressure around the mouth.

Full Face MaskWhen the burn involves the area round the eyes and nose, a full face mask should be used. Because of the many hollows in the face, the full face mask will not apply adequate pressure alone, but acts as the vehicle to supply pressure to the interface of choice. In this style of mask, separate openings are provided for the eyes, nose, ears, and mouth.Option:

When pressure is required over the ears, an ear cover or closed ear can be constructed.

GauntletWhen the burn involves only the wrist area, or the body of the hand (not extending to the MCP joints) a simple gauntlet can be used. The gauntlet should also be used if the burn is located on the forearm and extends to the wrist area. When used in conjunction with a sleeve, the gauntlet will provide uninterrupted pressure to the wrist and prevent the development of a rigid band of scar tissue at the wrist

Glove with Open Fingertips at the PIP LevelIf the burn extends to the level of the MCP joint, a glove with the fingertips open to the PIP joint should be ordered. If the burn extends beyond the distal portion of the metacarpal head, this style will not apply adequate pressure. Zippers can also be considered with this style.

Glove with OPEN FingertipsWhen the burn extends to the level of the proximal portion of the middle phalanx, the glove can be constructed to end at the DIP joint level.

This style is preferred over the full glove, because the open fingertips provide for better tactile sensation and use of the hand.

Full Glove with CLOSED FingertipsWhen the burn extends to the DIP joint, the fingertips should be enclosed. Later, as the scar begins to mature, the glove can be revised with open fingertips.

Body SuitWhen the burns involve the trunk and abdomen, a one piece body suit can be used. This style of garment is often more comfortable for the patient as there is a continuous line of pressure with no gaps at the waist. It is particularly good for use with active children, rather than using a separate vest and panty brief. The body suit can be constructed with legs to the knees or end at the groin. All body suits are constructed with a front zipper closure. The crotch can be ordered either open or closed. A snap gusset crotch can also be ordered. A sleeveless body suit should only be used if the burn is located below the breasts. This is because the arm openings decrease the pressure over the upper chest, back and shoulders.

Panty BriefWhen the burns involve only the buttocks or pelvic area, a panty brief is all that is necessary. This type of garment should not be used if the burn extends beyond the hip joint or the fold of the buttocks

Panty GirdleWhen the burn involves the hip joint or the upper thigh, a panty girdle should be ordered. This type of garment will assure the proper pressure over the hip and upper thigh that would be lacking in the panty brief. To achieve adequate pressure, the burn should not extend any further than 3" above the knee.

Garment with One Full Leg SupportWhen the burn primarily involves one leg without including the lower abdomen, a support with one leg can be used. This type of support will not apply pressure to the upper inner thigh or the lower abdomen. The leg portion of the support is attached to a wide waist band.

Leotard - Different LengthsThe leotard with one full length leg and the other a brief or panty girdle to knee should be used when either pressure is required over the lower abdomen in addition to one entire leg or if the burn is restricted to the thigh of one leg and the entire length of the opposite leg

Bilateral Full Length GarmentIf the burn covers both entire lower extremities, or if they have been used as donor sites, a garment with bilateral full length legs is suggested. Because scar tissue will mature at a different rate in different areas of the body, this style of garment will probably require revision before the entire leg is mature. In a few months time it is possible to eliminate or shorten one or both legs of the garment.

Knee-high and Anklet SupportsWhen the burn and/or donor site is restricted to the lower leg without any involvement about the knee joint, a short stocking in the form of an anklet or knee-hi stocking should be considered. These types of supports are more comfortable for the patient but should only be used providing pressure is not sacrificed to an area of burn or donor site on the thigh. These supports can be constructed with open or soft enclosed toe (for patient comfort). To prolong the life of the garment or provide for additional patient comfort, the heels of the garment can be reinforced with a soft material. The knee-hi support can also be constructed with a zipper.

Knee-hi Support•Providing the burn does not extend beyond the upper 1/3 of the

lower leg to include the patella or popliteal fossa, a knee-hi support can be used. If the burn extends to the area just distal to the patella, adequate pressure will not be applied. When the burn extends into this region, a knee-hi support should only be used if the patient totally rejects the use of a full length leg support