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Olutoye OO, Eriksson E, Menchaca AD, Kirsner RS, Tanaka R, Schultz G, Weir D, Wagner TL, Fabia RB, Naik-Mathuria B, Liu PY, Ead JK, Adebayo T, Armstrong DG, McMullin N, Samora JB, Akingba AG. Management of Acute Wounds-Expert Panel Consensus Statement. Adv Wound Care (New Rochelle) 2024. [PMID: 38618741 DOI: 10.1089/wound.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Significance: The Wound Healing Foundation recognized the need for consensus-based unbiased recommendations for the treatment of wounds. As a first step, a consensus on the treatment of chronic wounds was developed and published in 2022. The current publication on acute wounds represents the second step in this process. Acute wounds may result from any number of conditions, including burns, military and combat operations, and trauma to specific areas of the body. The management of acute wounds requires timely and evidence-driven intervention to achieve optimal clinical outcomes. This consensus statement provides the clinician with the necessary foundational approaches to the causes, diagnosis, and therapeutic management of acute wounds. Presented in a structured format, this is a useful guide for clinicians and learners in all patient care settings. Recent Advances: Recent advances in the management of acute wounds have centered on stabilization and treatment in the military and combat environment. Specifically, advancements in hemostasis, resuscitation, and the mitigation of infection risk through timely initiation of antibiotics and avoidance of high-pressure irrigation in contaminated soft tissue injury. Critical Issues: Critical issues include infection control, pain management, and the unique considerations for the management of acute wounds in pediatric patients. Future Directions: Future directions include new approaches to preventing the progression and conversion of burns through the use of specific gel formulations. Additionally, the use of three-dimensional bioprinting and photo-modulation for reconstruction is a promising area for continued discovery.
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Affiliation(s)
- Oluyinka O Olutoye
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Elof Eriksson
- Harvard Medical School, Cambridge, Massachusetts, USA
| | - Alicia D Menchaca
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert S Kirsner
- University of Miami Hospital and Clinics Wound Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rica Tanaka
- Juntendo University Graduate School of Medicine, Division of Regenerative Therapy, Department of Plastic & Reconstructive Surgery, Juntendo University Hospital Podiatry Center, Tokyo, Japan
| | - Greg Schultz
- University of Florida, Gainesville, Florida, USA
| | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, USA
| | - Tracey L Wagner
- Department of Pediatrics, Section of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Renata B Fabia
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Paul Y Liu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - J Karim Ead
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Temitope Adebayo
- Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - David G Armstrong
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Neil McMullin
- Plastic Surgery Consultant to the Surgeon General of the Army, Evans Army Community Hospital, Fort Carson, Colorado, USA
| | - Julie Balch Samora
- Department of Orthopedics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - A George Akingba
- Department of Vascular Surgery, VA Medical Center, Washington, District of Columbia, USA
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Watzinger N, Hecker A, Petschnig D, Tran J, Glantschnig C, Moshammer M, Pignet AL, Ellersdorfer AM, Kamolz LP. Long-Term Functional Outcomes after Hand Burns: A Monocentric Controlled Cohort Study. J Clin Med 2024; 13:3509. [PMID: 38930038 PMCID: PMC11204761 DOI: 10.3390/jcm13123509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Hand burns are involved in 80-90% of severe burn injuries. Even though hands correspond to a small total burn surface area (TBSA) of less than 5%, the loss of their functionality has a significant impact on the patient's life. Studies that provide long-term results regarding hand functionality after hand burns are scarce. Therefore, this study aimed to investigate functional long-term results in a patient-centric approach regarding burn depth, unilateral and bilateral hand involvement, and (non-)isolated hand burns as potential influencing factors in patients with hand burns. Methods: We conducted a controlled cohort study of patients with burned hands treated at our department between 2005 and 2022. Healthy age-, sex-, and handedness-matched participants were used as controls. Data on the demographics, burn-related injuries, and treatments were collected. For a patient-centric approach, we used the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick-DASH) and the Michigan Hand Questionnaire (MHQ) as patient-reported outcome measures for functional long-term evaluation, and the Patient and Observer Scar Assessment Scale (patient scale) for assessing long-term scar quality. Results: We enrolled 61 patients with 88 affected hands and 63 matched control participants. Up to 77.1% of the participants were male, with a mean age of 50.7 (±15.5) years and a follow-up of 8.1 (±4.7) years. The mean TBSA was 13.9% (±15.8), with 72.4% of the hands presenting with deep partial-thickness and full-thickness burns and most of the patients had only one hand affected (55.7%). The hand burn patients perceived significantly worse long-term functional scores in every domain of the MHQ as well as in the "overall function" and "work" of the Quick-DASH. Superficial hand burns negatively affected the two-handed activities of daily living (p = 0.013) and aesthetic appearance (p = 0.005) when both hands were involved. Isolated hand burns were associated with more difficulties in work performance (p = 0.03), whereas patients with bilateral hand involvement perceived more pain (p = 0.025). Conclusions: The patients with hand burns can achieve satisfactory long-term functional outcomes over time, but they do not reach the same long-term hand functionality as the healthy matched control group. Our study revealed that factors such as burn depth, unilateral or bilateral hand involvement, and (non-)isolated hand burns indeed have an impact on certain aspects of perceived long-term hand functionality.
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Affiliation(s)
- Nikolaus Watzinger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - David Petschnig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Jana Tran
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Caroline Glantschnig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Maximilian Moshammer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Anna-Maria Ellersdorfer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
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Itakussu EY, Morita AA, Kakitsuka EE, Kuwahara RM, Anami EHT, Pitta F, Hernandes NA. The Brazilian-Portuguese version of the Upper Extremity Functional Index (UEFI): Translation, cross-cultural adaptation and measurement properties for Brazilian adults after a burn injury. Burns 2024; 50:219-225. [PMID: 37690965 DOI: 10.1016/j.burns.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES To translate, cross-culturally adapt, validate, verify the reliability and estimate the minimal detectable change (MDC) of the UEFI to Brazilian Portuguese (UEFI-Br) for burns. METHODS The study was carried out with 131 Brazilian burn cases at two time points, at discharge and at the first outpatient follow-up (15-21 days after discharge) in a Burn Treatment Center. The adaptation process of the UEFI was based on international recommendations. The Burn Specific Health Scale-Brief-Br (BSHS-B-Br) was also applied in order to analyze construct validity of the UEFI-Br and distribution-based methods were used to estimate its MDC. RESULTS Intra- and inter-rater reliability were good with ICC of 0.986 (CI 95 %: 0.98-0.99) and 0.969 (CI 95 %: 0.955-0.979), respectively, at discharge and 0.997 (CI 95 %: 0.996-0.998) and 0.987 (CI 95 %: 0.981-0.991), respectively, at the first outpatient follow-up appointment. We found good internal consistency with Cronbach's α values of 0.987 and 0.996, respectively, at the two times. The SEM was 4.42 and 2.31 at the first and second time points, respectively. The UEFI-Br scores demonstrated strong correlation with the Burn Specific Health Scale-Brief-Br (BSHS-B-Br) function domain scores (r = 0.87-0.90). No significant correlation was found between UEFI-Br scores and participants' characteristics. The MDC of the UEFI-Br lies between 11 and 13 points. CONCLUSION The Brazilian version of the UEFI-Br, a useful tool to assess upper limb function and disability, is a valid and reliable tool for use with Brazilian burn survivors. The MDC for the instrument was determined to be 11-13 points.
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Affiliation(s)
- Edna Yukimi Itakussu
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil; Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Paraná, Brazil.
| | - Andrea Akemi Morita
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
| | - Emely Emi Kakitsuka
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
| | - Reinaldo Minoru Kuwahara
- Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Paraná, Brazil
| | - Elza Hiromi Tokushima Anami
- Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Paraná, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
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Murtaugh B, Warthman R, Boulter T. Rehabilitation Management of the Burned Hand. Phys Med Rehabil Clin N Am 2023; 34:767-782. [PMID: 37806696 DOI: 10.1016/j.pmr.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Burns to the hands constitute a small total surface area burn, but can result in significant functional challenges and disability. The complexity of multiple anatomical structures and intricate interplay of bones, muscles, and connective tissues requires specialized knowledge of how burns of the hand can affect function and independence. This article will provide an evidence-based overview of rehabilitation of the burned hand across the burn care continuum including a focus on evaluation, pain management, treatment interventions, and outcome assessment. Additionally, various deficits that can put the hand at significant risk for loss of function will be discussed. Finally, the authors will address the special considerations and treatment caveats of addressing the pediatric hand burn.
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Affiliation(s)
- Brooke Murtaugh
- Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, USA.
| | - Renee Warthman
- Arizona Burn Center, Valleywise Health Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Trudy Boulter
- Children's Hospital Colorado Burn Center, 13123 East 16th Avenue, Aurora, CO 80045, USA
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Cook AB, Donoso Brown E, Hambrose M, Schreiber J. Occupational Therapy Practitioners' Implementation of Home Programs for Individuals Post Burn: An Initial Cross-Sectional Survey. Occup Ther Health Care 2023:1-17. [PMID: 37497627 DOI: 10.1080/07380577.2023.2240395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
Occupational therapy practitioners who care for individuals post burn often prescribe home programs to facilitate continued progress toward occupational therapy goals. This study identified the components included in home programs, how practitioners create and prescribe home programs, and perceived supports and barriers to adherence in this population. Thirty-nine practitioners employed at American Burn Association-verified centers completed an online survey. Results suggest that home programs are primarily designed to address range of motion with less emphasis on function. The highest-ranked barriers to adherence were pain and lack of motivation while the highest-ranked supports were client motivation and family/caregiver support. Practitioners reported using handouts and demonstration frequently for delivery, with infrequent use of technology. Recommendations for incorporating evidence-based strategies into home program creation and administration are included.
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Affiliation(s)
- Ann B Cook
- Occupational Therapy Department, Slippery Rock University, Slippery Rock, USA
| | - E Donoso Brown
- Occupational Therapy Department, Duquesne University, Pittsburgh, USA
| | - M Hambrose
- Sunnyview Rehabilitation Hospital, Schenectady, USA
| | - J Schreiber
- School of Nursing, Duquesne University, Pittsburgh, USA
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Dargan D, Himmi G, Anwar U, Jivan S, Muthayya P. A comparison of the epidemiology of isolated and non-isolated hand burns. Burns 2023; 49:951-960. [PMID: 35760611 DOI: 10.1016/j.burns.2022.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 11/02/2022]
Abstract
Hand burns are common and treatment individualized, however given large volumes in some centers, pattern recognition may help optimize service provision. We performed a single center retrospective review from 2014 to 2018 of hand burns in patients aged 16 and over. Burns confined to the hands were considered isolated. We found 1163 patients (790 male, 68%), with 853 isolated (9% bilateral) and 310 non-isolated (35% bilateral) hand burns, and 12% were sustained in industrial workplaces. Most isolated burns received first aid (72%) and were scalds (41%) or contact (23%). Many presented to hospital by car (73%) and most were treated as outpatients (92%). Non-isolated burns were mainly flash (38%) or flame burns (25%, p < 0.01), with 66% given first aid, 49% used ambulances (p < 0.01) and 54% underwent hospital admission (p < 0.01). Non-isolated injuries had more full thickness involvement (p < 0.01), 13% were resuscitation burns and 10% received intensive care. Isolated and non-isolated burns are distinct clinical entities, as are unilateral and bilateral injuries. Isolated burns are usually unilateral scalds or contact burns, suited to outpatient treatment. Non-isolated burns are often flash or flame, bilateral, often needing ambulances, admission, and interventions. First aid can be improved, and consideration given to inpatient rehabilitation of bilateral hand burns.
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Affiliation(s)
- Dallan Dargan
- Regional Burns Centre, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom.
| | - Ghita Himmi
- Hull York Medical School, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Umair Anwar
- Regional Burns Centre, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom
| | - Sharmila Jivan
- Regional Burns Centre, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom
| | - Preetha Muthayya
- Regional Burns Centre, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, United Kingdom
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Mc Kittrick A, Gustafsson L, Hodson T, Di Tommaso A. Exploration of individuals perspectives of recovery following severe hand burn injuries. Burns 2023; 49:467-475. [PMID: 35570111 DOI: 10.1016/j.burns.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/21/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Burns to one or both hands can impact how a person interacts with the world around them. Research regarding the specific impact of hand burn injuries and the experiences of individuals who have sustained hand burn injuries remains limited. OBJECTIVE The aim of this study was to explore the lived experiences of people with severe hand burn injuries, including their return to daily activities. METHODS This study used an interpretive description approach, incorporating 23 semi-structured interviews with people who had sustained severe hand burn injuries. RESULTS A major theme, "changes over time ", was identified and reflected the progressive nature of the experience over time. This was present in all three sub-themes: physical recovery, activities of daily living recovery, and psychosocial impact. Participants described a dual process of managing the recovery of the burn injury and burn rehabilitation interventions, whilst simultaneously learning to live with their injury and finding ways to engage in their occupations to the best of their abilities. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The findings of the study suggest that burns recovery could be described in terms of performance rather than impairment and needs to be continuously monitored overtime.
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Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, 4029 QLD, Australia; Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia.
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia; Honorary Associate Professor School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072 QLD Australia
| | - Tenelle Hodson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia
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Liu C, Xie H, Wei P, Gong T, Wu G, Xu Z, Chen S. Clinical study of early rehabilitation training combined with negative pressure wound therapy for the treatment of deep partial-thickness hand burns. Front Surg 2023; 10:1040407. [PMID: 36843993 PMCID: PMC9952234 DOI: 10.3389/fsurg.2023.1040407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/04/2023] [Indexed: 02/10/2023] Open
Abstract
Objective This study aims to explore the clinical effect of early rehabilitation training combined with negative pressure wound therapy (NPWT) for treating deep partial-thickness hand burns. Methods Twenty patients with deep partial-thickness hand burns were randomly divided into an experimental group (n = 10) and a control group (n = 10). In the experimental group, early rehabilitation training combined with NPWT was performed, including the proper sealing of the negative pressure device, intraoperative plastic brace, early postoperative exercise therapy during negative pressure treatment, and intraoperative and postoperative body positioning. Routine NPWT was conducted in the control group. Both groups received 4 weeks of rehabilitation after wounds healed by NPWT with or without skin grafts. Hand function was evaluated after wound healing and 4 weeks after rehabilitation, including hand joint total active motion (TAM) and the brief Michigan Hand Questionnaire (bMHQ). Results Twenty patients were involved in this study, including 16 men and 4 women, aged 18-70 years, and the hand burn area ranged from 0.5% to 2% of the total body surface area (TBSA). There was no significant difference in TAM and bMHQ scores between the two groups after negative pressure removal. After 4 weeks of rehabilitation training, the TAM scores and bMHQ scores were significantly improved in both groups (p < 0.05); among them, those of the experimental group were both significantly better than those of the control group (p < 0.05). Conclusion The application of early rehabilitation training combined with NPWT to treat deep partial-thickness hand burns can effectively improve hand function.
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Affiliation(s)
- Canbin Liu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hongteng Xie
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pei Wei
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Teng Gong
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guohua Wu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhaorong Xu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China,Correspondence: Shun Chen Zhaorong Xu
| | - Shun Chen
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China,Correspondence: Shun Chen Zhaorong Xu
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Alsaif A, Karam M, Hayre A, Abul A, Aldubaikhi A, Kahlar N. Full Thickness Skin Graft versus Split Thickness Skin Graft in Paediatric Patients with Hand Burns: Systematic Review and Meta-Analysis. Burns 2022:S0305-4179(22)00249-2. [DOI: 10.1016/j.burns.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/02/2022]
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10
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Zhou YQ, Zhou JY, Luo GX, Tan JL. Effects of early rehabilitation in improvement of paediatric burnt hands function. World J Clin Cases 2021; 9:9741-9751. [PMID: 34877313 PMCID: PMC8610915 DOI: 10.12998/wjcc.v9.i32.9741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/07/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hands are one of the most common burn sites in children. Hypertrophic scar contractures in hands after wound healing result in further reductions in their range of motion (ROM), motility, and fine motor activities. Rehabilitation can improve the function of hands. But the optimal time of rehabilitation intervention is still unclear. Therefore, this study was designed to investigate the effects of early rehabilitation management of paediatric burnt hands and to compare the efficacy between early and later rehabilitation intervention.
AIM To investigate the effects of early rehabilitation management of paediatric burnt hands.
METHODS A total of 52 children with burnt hands were allocated into the early intervention group (≤ 1 mo from onset) and a late intervention group (> 1 mo from onset) between January 2016 and December 2017. The children received the same rehabilitation programme including skin care, scar massage, passive ROM exercises, active ROM exercises, compression therapy, orthotic devices wearing and game or music therapy. Rehabilitation assessments were performed before and after the rehabilitation treatment.
RESULTS In the early intervention group, the ROM of the hands was significantly improved after rehabilitation (P = 0.001). But in the late group the effect was not significant statistically (P = 0.142). In the early group, 38.5% of the patients showed significant improvement, while in the late group, 69.2% of the patients showed no significant improvement. The time from onset to posttraumatic rehabilitation (P = 0.0007) and length of hospital stay (P = 0.003) were negatively correlated with the hand function improvement. The length of rehabilitation stay was positively correlated with the hand function improvement (P = 0.005).
CONCLUSION These findings suggest that early rehabilitation might show better results in terms of ROM.
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Affiliation(s)
- Ya-Qin Zhou
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jun-Yi Zhou
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Gao-Xing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jiang-Lin Tan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
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Corrales-Benítez C, González-Peinado D, González-Miranda Á, Martínez-Méndez JR. Evaluation of burned hand function after enzymatic debridement. J Plast Reconstr Aesthet Surg 2021; 75:1048-1056. [PMID: 34848129 DOI: 10.1016/j.bjps.2021.09.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 07/09/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
Hand burns are common injuries that can result in long-term impairment of hand function. Enzymatic debridement (ED) prevents damage to the viable dermis due to the procedure's selectivity and has become an option for obtaining an accurate depth assessment and enabling wound re-epithelialization with less skin graft use. We conducted a prospective study from July 2015 to July 2018, which enrolled patients with deep partial-thickness hand burns and treated them with ED using bromelain. After a specified period, we assessed the patients' hand function, using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHOQ) to assess their disabilities and activities of daily life, respectively. We assessed the hand joint range of motion using a goniometer and assessed scar quality with the Vancouver Scar Scale (VSS). We analyzed 72 patients with 90 burned hands at 3 months and, at the final assessment, 69 patients with 86 burned hands. Fire was the most common cause of the burns. Bromelain allowed for early debridement (73.6% during the first 24 h). At the 3-month evaluation, the mean DASH and MHOQ scores were 2.35 and 97.9%, respectively, with a high inverse correlation between the 2 types of scores (Spearman's rho, -0.78; p < .001). The mean wrist flexion and extension were 85.7 and 80°, respectively, the mean metacarpophalangeal flexion was 88.3°, the proximal interphalangeal (PIP) flexion was 112.9°, and the thumb opposition was 77°. The mean VSS score was 2.87. At the final evaluation, with a minimum follow-up of 391 days, the mean DASH and MHOQ scores were 0.18 and 99.71%, respectively. ED with bromelain in deep partial-thickness hand burns resulted in normal values at 3 months and at over 1 year of follow-up, with complete restoration of function and quality of life and good scar results.
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Affiliation(s)
- Carlos Corrales-Benítez
- Burn Unit, Plastic and Reconstructive Surgery Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain.
| | - David González-Peinado
- Burn Unit, Plastic and Reconstructive Surgery Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Álvaro González-Miranda
- Burn Unit, Plastic and Reconstructive Surgery Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - José Ramón Martínez-Méndez
- Burn Unit, Plastic and Reconstructive Surgery Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
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Butts CC, Holmes JH, Carter JE. Surgical Escharotomy and Decompressive Therapies in Burns. J Burn Care Res 2021; 41:263-269. [PMID: 31504609 DOI: 10.1093/jbcr/irz152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Early recognition of the need for escharotomy and other decompressive therapies is imperative for experienced burn providers, as to avoid reversible tissue ischemia and necrosis. With full-thickness burns, the eschar that develops is largely noncompliant. The predictable edema that develops during resuscitation of larger burns increases the likelihood ischemia-inducing pressure, as the underlying tissues swell within noncompliant skin, resulting in burn-induced compartment syndrome. Conventionally, this has been treated with decompressive therapies, such as escharotomy. The most recent surveys have identified that the United States and Canada both face a shortage of practicing burn surgeons. In the event of a burn disaster, many nonburn surgeons would need to provide burn care, including decompressive therapies. We reviewed the literature to provide accurate, accessible, and applicable recommendations regarding this practice following burn injury for both the practicing burn surgeon and those that would provide care in the burn disaster.
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Affiliation(s)
- C Caleb Butts
- Division of Acute Care Surgery, Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - James H Holmes
- Division of Acute Care Surgery, Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Jeffrey E Carter
- UMC Burn Center, University Medical Center, New Orleans, Los Angeles
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Rahimi F, Rezayatmand R. Use of a biosynthetic wound dressing to treat burns: a systematic review. J Wound Care 2021; 29:S16-S22. [PMID: 33320760 DOI: 10.12968/jowc.2020.29.sup12.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Accelerating the process of wound healing, reducing infection risks, and decreasing pain and discomfort in the burn area are important goals of burn treatment. To achieve these goals, the use of biosynthetic wound dressings has increased in recent years. Suprathel (PolyMedics Innovations, Germany) is a biosynthetic wound dressing used to treat both partial-thickness burns and split-thickness skin graft (STSG) donor sites, full-thickness wounds, large-scale abrasions, and scar revisions. METHOD This study is a systematic review of empirical evidence reported on the application of the biosynthetic wound dressing in burns up to 2017. Keywords such as 'Suprathel', 'effectiveness', 'safety', and 'cost' were searched in PubMed, Cochrane, Scopus and Embase databases. RESULTS A total of 14 publications were identified, based on the inclusion and exclusion criteria. The findings reported in the literature reviewed were classified in terms of safety, effectiveness and cost-effectiveness of use of the biosynthetic wound dressing. Regarding safety and effectiveness, the dressing was found to yield desirable results, particularly for partial thickness burns and STSG donor sites. As of 2017 no health economics assessments have been carried out. CONCLUSION Despite the desirable advantages of the biosynthetic wound dressing with respect to its effectiveness, safety and ease of use, its major limitation was found to be its cost. However, in the absence of comprehensive studies on the quantification of all factors, there is scant scientific evidence for making reliable conclusions from this systematic review.
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Affiliation(s)
- Farimah Rahimi
- Health Management and Economics Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Reza Rezayatmand
- Health Management and Economics Research Center, Isfahan University of Medical Science, Isfahan, Iran
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14
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Barış Cartı E, Deniz Uçar A, Yıldırım M. Is carpal tunnel release safe in electrical burn decompressive therapy: Six-years experience. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.4379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Upper extremity electrical burn can create severe sequela and debilitation if not treated properly. Immediate decompression with fasci- otomy and carpal tunnel release seem to be the most promising choice of treatment. Neurologic functional loss can be avoided if median nerve is liberated.
Material and Methods: During 6-year time interval, 50 out of 1158 burn patients underwent upper extremity decompressive fasciotomy with carpal tunnel release. Their hand motor function based on nerve innervation and daily usage questionnaire were followed in 12-month intervals.
Results: Average score rose markedly after 18th month and reached nearly normal at the end of 66th month. Median, ulnar and radial nerve function tests were all positive, and no irreversible nerve function loss observed.
Conclusion: All compartments of the forearm should be explored and carpal tunnel release should be added into upper extremity decompressive fasciotomy after electrical burns.
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Dargan D, Kazzazi D, Limnatitou D, Cochrane E, Stubbington Y, Shokrollahi K, Ralston D. Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature. Ann Plast Surg 2021; 86:517-531. [PMID: 33675628 DOI: 10.1097/sap.0000000000002755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. RESULTS An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. DISCUSSION The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. CONCLUSIONS More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.
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Affiliation(s)
| | - Diana Kazzazi
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Elliott Cochrane
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Kayvan Shokrollahi
- Mersey Regional Burns Centre, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Merseyside, Prescot, United Kingdom
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Itakussu EY, Morita AA, Kakitsuka EE, Pitta F, Cavalheri V, Hernandes NA. Instruments to assess function or functionality in adults after a burn injury: A systematic review. Burns 2021; 47:999-1011. [PMID: 33896659 DOI: 10.1016/j.burns.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area. OBJECTIVES To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility. METHODS We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts. RESULTS Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments' measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility. CONCLUSION This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.
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Affiliation(s)
- Edna Yukimi Itakussu
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil; Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Brazil.
| | - Andrea Akemi Morita
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Emely Emi Kakitsuka
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Fabio Pitta
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Australia; Allied Health, South Metropolitan Health Service, Perth, Australia.
| | - Nidia Aparecida Hernandes
- Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
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17
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Smolle C, Nischwitz SP, Kamolz LP. Defining a meaningful reduction of donor sites-Not as easy as it seems. Burns 2021; 47:976-977. [PMID: 33750603 DOI: 10.1016/j.burns.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Christian Smolle
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Sebastian P Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria; COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
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Abstract
This study aims to present the outcomes from current alternative treatment modalities combined with the conventional techniques used in the treatment of burn contractures. Twenty-nine patients were included in the study. Patients were divided into three groups according to the severity of contractures: 1- mild, 2- moderate, and 3- severe. Skin defects that occurred following the incision and scar contracture release were closed with a collagen-elastin acellular dermal matrix (ADM). The split-thickness skin graft was evenly placed on the ADM and fixed with absorbable sutures. The grafts were closed with NPWT (negative pressure wound therapy system) dressings. In platelet-rich plasma (PRP) mild cases as well as moderate and severe PRP cases, stem cell and fat injection were applied. PRP injection was applied to the scar base before the contracture; fat injection and stem cells were applied at the 3rd and 6th months. Preoperative and postoperative range of motion (ROM), Patient and Observer Scars Evaluation Scale (POSAS), and histopathological scores were evaluated. There was a statistically significant decrease in postoperative POSAS scores (p < .05) and a significant increase in the ROM score (p < .05). Histopathological examination revealed an increased postoperative collagen accumulation and organization, increased vascularization, decreased scar tissue thickness and increased subcutaneous tissue thickness. There was no difference in treatment outcomes between the groups.Based on the current findings, we conclude that ADM, stem cell-rich fat grafting, and PRP therapies combined with conventional methods could satisfactorily improve functional outcomes in the repair of burn contractures.
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Affiliation(s)
- Percin Karakol
- Department of Plastic, Reconstructive and Aesthetic Surgery, Health Science University Bağcılar Education and Training Hospital, Istanbul, Turkey
| | - Mehmet Bozkurt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Health Science University Bağcılar Education and Training Hospital, Istanbul, Turkey
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Vyrva O, Smock E, Pessa J, Thirkannad SM. Outcomes of the glove-gauze regimen for managing burn injuries of the hand. J Hand Surg Eur Vol 2020; 45:737-741. [PMID: 32178564 DOI: 10.1177/1753193420910054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied the efficacy of the glove-gauze regimen in treating superficial, partial-thickness and small full-thickness hand burns. Outcome measures included healing time, need for surgical intervention, need for formal physical therapy, restoration of range of motion, return to function and incidence of infection. All patients (n = 123) successfully completed the regimen with an average healing time of 3.7 weeks. None required surgical debridement and seven (6%) required formal physical therapy. One hundred and eighteen patients (96%) regained full range of motion and 122 (99%) returned to their previous level of work. We believe that the glove-gauze regimen provides a simplified and effective means of managing hand burns. We conclude from our patients that the glove-gauze regimen is an effective treatment that can ensure uneventful healing of superficial, partial-thickness and small full-thickness burns. A majority of our patients healed with full range of motion and function without formal physical therapy.Level of evidence: IV.
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Affiliation(s)
- Oleksandra Vyrva
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Elliott Smock
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Joel Pessa
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Sunil M Thirkannad
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
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20
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Mc Kittrick A, Gustafsson L, Marshall K. A systematic review to investigate outcome tools currently in use for those with hand burns, and mapping psychometric properties of outcome measures. Burns 2020; 47:295-314. [PMID: 32826095 DOI: 10.1016/j.burns.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/18/2020] [Accepted: 07/10/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Severe burn injuries to the hand impact multiple domains of function and participation. Measurement of outcomes after hand burn injuries is multifaceted and is influenced by several variables. OBJECTIVE The aim of this systematic review was to review outcome measures reported in studies used to measure outcomes after severe hand burn injuries; and to critically evaluate the reliability, validity and clinical utility of each hand assessment tool identified from the literature to determine suitability for use with the burn's population. DATA SOURCES A search of the published literature using electronic data bases MEDLINE, CINAHL, PEDro, OT seeker and PubMed was undertaken. Studies were included if they reported assessment tools and outcome measures used to determine hand function after severe burn injuries; were published in English and available in their full-length. Studies were excluded if they were related to a group under 18 years of age. RESULTS Thirty-four papers were included in this systematic review. A total of 25 outcome measures were confirmed for inclusion in this paper and each underwent further evaluation to identify their psychometric properties. LIMITATIONS A factor which could cause bias in this systematic review was the search was restricted to English language journals therefore excluding any primary papers in other languages. Mapping of the outcome measures to the ICF was conducted by the primary author which may give rise to bias however a member checking was conducted in order to remove this bias. CONCLUSIONS This review established that no one outcome measure meets all the psychometric properties of validity, reliability and responsiveness SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42018085059.
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Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, 4029, QLD, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD Australia.
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Nathan, QLD, 4111, Australia; Honorary Associate Professor School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD Australia
| | - Kathryn Marshall
- Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, 4102, QLD, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD Australia
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21
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Lotfi M, Mirza Aghazadeh A, Davami B, Khajehgoodari M, Aziz karkan H, Khalilzad MA. Development of nursing care guideline for burned hands. Nurs Open 2020; 7:907-927. [PMID: 32587709 PMCID: PMC7308693 DOI: 10.1002/nop2.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022] Open
Abstract
Aim To develop an evidence-based guideline to care for hand-burned patients. Design An integrative review. Method The search was conducted of EMBASE, PubMed, Web of Science, SCOPUS, Clinical Key, Iranmedex, Magiran, Scientific Information Database (SID), Cochran, CINAHL and Google Scholar databases from January 2000-August 2019. Following the formation of the research team, two researchers independently selected the eligible studies. The initial search resulted in 2,230 records; ultimately, 40 articles were identified to be the review after screening the records based on the study's inclusion and exclusion criteria. Quality of selected studies was evaluated with the MMAT method. Results Data syntheses of selected studies, coded by highlighting the relevant parts of the text, and assigning code words to these areas were done. Following this, a constant comparison was used to develop categories by combining codes. Finally, hand burns nursing care guideline was developed by categorizing descriptive themes in two main phases. Conclusion This review results have shown that evidence-based guidelines present high-quality recommendations for the healthcare team, which improves the quality of clinical care. Due to a lack of established guidelines in our context, it seems to be helpful to use evidence-based guidelines in managing burned hands.
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Affiliation(s)
- Mojgan Lotfi
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
| | - Ahmad Mirza Aghazadeh
- Department of Basic sciencesParamedical FacultyTabriz University of Medical SciencesTabrizIran
| | - Babak Davami
- Faculty of MedicineSina HospitalTabriz University of Medical SciencesTabrizIran
| | - Mohammad Khajehgoodari
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Hanieh Aziz karkan
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
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22
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Randomized Controlled Trial of Compression Interventions for Managing Hand Burn Edema, as Measured by Bioimpedance Spectroscopy. J Burn Care Res 2020; 41:992-999. [DOI: 10.1093/jbcr/iraa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Compression, a common treatment of choice for the management of edema, is one intervention that is applied with little objective understanding of the optimal parameters of application or efficacy in acute burn wounds. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The primary hypothesis tested was that in acute hand burn injury, the application of cohesive bandage will reduce edema faster than a generic compression glove. It is a randomized controlled study of 100 patients presenting with hand burn injury. Compression was randomized to one of the three methods of application: 1) spiral application of Coban to fingers, figure of eight to hand and wrist; 2) pinch application of Coban to fingers, spiral application to hand and wrist; or 3) a generic compression glove (control condition). Bioimpedance spectroscopy was used to measure hand volumes. Hand and wrist range of movement, pain scores, and QuickDASH were recorded. One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods. Both methods of applying Coban resulted in significantly greater reductions in edema compared to the generic compression glove. Notwithstanding compression method, all range of movement measures improved, with significant improvement in thumb opposition (P = .046), hand span (P = .020), and wrist flexion (P = .020). QuickDASH decreased between sessions (P < .001). Different methods of applying Coban are superior to generic compression gloves for managing acute hand burn edema.
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Affiliation(s)
- Dale O Edwick
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia
| | - Dana A Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia
| | - Jeremy M Rawlins
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Department of Plastic and Maxillofacial Surgery, Royal Perth Hospital, Western Australia
| | - Fiona M Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Unit, University of Western Australia, Perth
| | - Dale W Edgar
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia
- Burn Injury Research Unit, University of Western Australia, Perth
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Liu M, Zhu H, Yan R, Yang J, Zhan R, Yu X, Hu X, Zhang X, Luo G, Qian W. Epidemiology and Outcome Analysis of 470 Patients with Hand Burns: A Five-Year Retrospective Study in a Major Burn Center in Southwest China. Med Sci Monit 2020; 26:e918881. [PMID: 32417848 PMCID: PMC7222659 DOI: 10.12659/msm.918881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background This retrospective study aimed to investigate the epidemiology of burns to the hand, including the causes, demographic data, management, and outcome in a single center in Southwest China between 2012 and 2017. Material/Methods A retrospective study included 470 patients with hand burns who were treated at a single hospital in Southwest China between 2012 and 2017. Demographic, injury-related, and clinical data were obtained from the clinical electronic data collection system. Results In 470 patients, men were more commonly admitted to hospital with hand burns (73.62%). Children under 10 years (29.57%) were the main patient group. Hospital admissions occurred in the coldest months, from December to March (55.11%). In 60.21% of cases, hand burns occurred outside the workplace. Fire (40.42%), electricity (30.85%), and hot liquids (20.21%) were the main causes of hand burns. Data from 428 patients showed that burns with a larger total body surface area and deeper burns were associated with surgery and amputation. Burn depth was a risk factor for skin grafting, and lack of burn cooling before hospital admission increased the risk of amputation. Data from 117 patients with localized burns showed that full-thickness burns and lack of cooling before admission were associated with an increased hospital stay. Conclusions The findings suggest that in Southwest China, prevention programs for children aged 0–9 years, injuries occurring in winter and non-workplace sites, and fire burns were imperative.
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Affiliation(s)
- Mian Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Haijie Zhu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Rongshuai Yan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Jiacai Yang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Rixing Zhan
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Xunzhou Yu
- Department of Burn and Plastic Surgery, 80th Group Military Hospital, Weifang, Shandong, China (mainland)
| | - Xiaohong Hu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Xiaorong Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
| | - Wei Qian
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), People's Liberation Army (PLA), Chongqing, China (mainland)
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Fischer S, Kotsougiani D, Kneser U, Hirche C. Response to: Re: Feasibility and safety of enzymatic debridement for the prevention of operative escharotomy in circumferential deep burns of the distal upper extremity. Surgery 2019; 167:512-513. [PMID: 31378481 DOI: 10.1016/j.surg.2019.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Sebastian Fischer
- BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
| | - Dimitra Kotsougiani
- BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Christoph Hirche
- BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Feasibility and safety of enzymatic debridement for the prevention of operative escharotomy in circumferential deep burns of the distal upper extremity. Surgery 2019; 165:1100-1105. [DOI: 10.1016/j.surg.2018.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022]
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Ayaz M, Karami MY, Deilami I, Moradzadeh Z. Effects of Early Versus Delayed Excision and Grafting on Restoring the Functionality of Deep Burn-Injured Hands: A Double-Blind, Randomized Parallel Clinical Trial. J Burn Care Res 2019; 40:451-456. [DOI: 10.1093/jbcr/irz033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mehdi Ayaz
- Division of Burn and Reconstructive Surgery, Department of Surgery, Shiraz, Iran
| | | | - Iman Deilami
- Division of Burn and Reconstructive Surgery, Department of Surgery, Shiraz, Iran
| | - Zahra Moradzadeh
- Physiotherapy and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Billner M, Hofmann N, Jaehn T, Püski T, Reichert B. [Enzymatic débridement as a treatment option for deep dermal burns of the hand]. Unfallchirurg 2018; 122:323-327. [PMID: 30498896 DOI: 10.1007/s00113-018-0583-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Burns and thermal injuries from other causes often affect exposed body regions such as the hands. Besides aesthetic aspects, deep dermal burns of the skin are often critical from a functional point of view, especially for important subcutaneous structures. This article reports the course of two patients who received enzymatic debridement with bromelain-based salve as a treatment for deep grade burns of the hands.
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Affiliation(s)
- M Billner
- Universitätsklinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Breslauer Straße 201, 90471, Nürnberg, Deutschland.
| | - N Hofmann
- Universitätsklinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Breslauer Straße 201, 90471, Nürnberg, Deutschland
| | - T Jaehn
- Universitätsklinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Breslauer Straße 201, 90471, Nürnberg, Deutschland
| | - T Püski
- Universitätsklinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Breslauer Straße 201, 90471, Nürnberg, Deutschland
| | - B Reichert
- Universitätsklinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Breslauer Straße 201, 90471, Nürnberg, Deutschland
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Ciprandi G, Ramsay S, Budkevich L, Strack A, van Capellen P, Marathovouniotis N. A retrospective systematic data review on the use of a polihexanide-containing product on burns in children. J Tissue Viability 2018; 27:244-248. [DOI: 10.1016/j.jtv.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022]
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Ghalayini G, O'Brien L, Bourke‐Taylor HM. Recovery in the first six months after hand and upper limb burns: A prospective cohort study. Aust Occup Ther J 2018; 66:201-209. [DOI: 10.1111/1440-1630.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Grace Ghalayini
- Department of Occupational Therapy Eastern HealthVictoria Australia
- School of Allied Health Australian Catholic University (Melbourne Campus) Fitzroy VictoriaAustralia
| | - Lisa O'Brien
- Department of Occupational Therapy Eastern HealthVictoria Australia
- Department of Occupational Therapy School of Allied and Primary Health Care Monash University – Peninsula Campus Frankston Victoria Australia
- Department of Occupational Therapy Alfred Health MelbourneVictoriaAustralia
| | - Helen M. Bourke‐Taylor
- School of Allied Health Australian Catholic University (Melbourne Campus) Fitzroy VictoriaAustralia
- Department of Occupational Therapy School of Allied and Primary Health Care Monash University – Peninsula Campus Frankston Victoria Australia
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Abstract
Escharotomy incisions must be made in the inelastic skin eschar that is typical of circumferential third-degree burns. Later, the necrotic tissue must be debrided and substituted with a skin graft. Many reports on this topic have revealed that concepts and techniques vary widely. This study aims to present a critical review of the literature about escharotomy in burns and to highlight a different strategy to perform escharotomy in patients with burned extremities. We conducted a critical review in Pubmed/MEDLINE using the keywords "escharotomy" and "burns." In the present study, we included 22 articles published from 1955 to 2015 (60 years) that contain the aforementioned keywords. With respect to the extremities, most of the publications recommend that medial and lateral longitudinal incisions be performed and that care must be taken to avoid deep structures, particularly nerves. Moreover, the publications mention that escharotomy might result in thick, hypertrophic, retracting, and painful scars. We advocate that incisions performed only on the lateral and medial borders of the extremities are usually unnecessary, and that they contribute to the creation of misconceptions about burns. In addition, these incisions can somehow trigger complications that can be avoided by using the concept of escharotomy in multiple directions, as highlighted in this review.
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Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement. Burns 2017; 43:1233-1243. [DOI: 10.1016/j.burns.2017.02.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
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Development of an integrative algorithm for the treatment of various stages of full-thickness burns of the first commissure of the hand. Burns 2017; 43:812-818. [DOI: 10.1016/j.burns.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/14/2016] [Accepted: 01/06/2017] [Indexed: 11/24/2022]
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Li L, Dai JX, Xu L, Huang ZX, Pan Q, Zhang X, Jiang MY, Chen ZH. The effect of a rehabilitation nursing intervention model on improving the comprehensive health status of patients with hand burns. Burns 2017; 43:877-885. [DOI: 10.1016/j.burns.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/04/2016] [Accepted: 11/04/2016] [Indexed: 12/23/2022]
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Abstract
Thermal injuries of the hand can have a great impact on function. Initial treatment should focus on the prevention of contracture through the use of tissue-sparing techniques and optimized occupational therapy. Surgical intervention should follow the standard reconstructive ladder and can involve several techniques from simple to complex including minimally invasive techniques, such as laser and steroid injection, contracture release and skin grafting, and local tissue rearrangement and regional flaps as well as distant pedicled and free flaps. Reconstructive surgery of the hand, when performed well, can lead to meaningful functional improvement in severe burns.
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Affiliation(s)
- Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Lydia A Helliwell
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Matthias B Donelan
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Plastic and Reconstructive Surgery, Shriner's Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
| | - Kyle R Eberlin
- Plastic and Reconstructive Surgery, Shriner's Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA; MGH Hand Surgery Fellowship, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Abstract
Hypertrophic scar and contracture in burn patients is a complex process. Contributing factors include critical injury depth and activation of key cell subpopulations, including deep dermal fibroblasts, myofibroblasts, fibrocytes, and T-helper cells, which cause scarring rather than regeneration. These cells influence each other via cellular profibrotic and antifibrotic signals, which help to determine the outcome. These cells also both modify and interact with extracellular matrix of the wound, ultimately forming hypertrophic scar. Current treatments reduce hypertrophic scar formation or improve remodeling by targeting these pathways and signals.
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Affiliation(s)
- Peter O Kwan
- 2A Plastic Surgery, Kaye Edmonton Clinic, University of Alberta, 11400 University Avenue, Edmonton, Alberta T6G 1Z1, Canada
| | - Edward E Tredget
- Department of Surgery, University of Alberta, 2D2.28 WMHSC, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada.
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van der Vlies CH, de Waard S, Hop J, Nieuwenhuis MK, Middelkoop E, van Baar ME, van Zuijlen PPM. Indications and Predictors for Reconstructive Surgery After Hand Burns. J Hand Surg Am 2017; 42:351-358. [PMID: 28359638 DOI: 10.1016/j.jhsa.2017.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 02/01/2017] [Accepted: 02/13/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to analyze the prevalence, indications, and type of reconstructive surgery and predictors of the outcomes of reconstructive surgery after hand burns. METHODS A retrospective cohort study was conducted that included all patients admitted with acute hand burns in the Dutch burn centers from January 1998 through December 2002. The details of reconstruction including frequency, timing, indication, and techniques were collected over a 10-year follow-up period. RESULTS Hand burns were seen in 42% (n = 562 of 1,334) of all patients admitted with acute burns. Reconstructive surgery during the 10-year follow-up period was required in 15%. Contractures, especially of the first web space and little finger, were the most frequent indications for reconstructive surgery. Web spaces 1 to 3 and the little finger were the location most frequently operated on. The most frequently performed surgical technique was release of the contractures and the use of a random flap. Eighty percent of the reconstructive surgery patients required more than 1 reconstructive procedure, most often within 2 years of the initial injury. Secondary operations at the same location were required in 12%. In 40% of the patients, the first reconstructive surgery was performed within the first postburn year. Significant independent factors related to the need for reconstructive hand surgery were a larger area of full-thickness burns and surgical treatment of the hand during the acute phase. CONCLUSIONS Reconstructive surgery was required in 15% of patients who sustained hand burns. The majority of the patients requiring reconstructive surgery of the hand needed 2 or more operations to correct the contractures of the hand. Contractures of the little finger and first web space were the locations most frequently operated on. Patients with more extensive burns and who required hand surgery during the acute phase were more likely to need reconstructive surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- C H van der Vlies
- Department of Surgery, Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands.
| | - S de Waard
- Department of Surgery, Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - J Hop
- Department of Plastic Surgery, Medical Centre, Leeuwarden, the Netherlands
| | - M K Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands
| | - E Middelkoop
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University, Amsterdam, the Netherlands
| | - M E van Baar
- Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - P P M van Zuijlen
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands
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Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Centre for Burn Treatment between 2009 and 2015. Int Wound J 2017; 14:849-855. [PMID: 28220597 DOI: 10.1111/iwj.12720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022] Open
Abstract
Nearly 80% of all burns include the hands of affected individuals. Skin grafting is the gold standard in burns treatment, but in the case of the burn wound bed, it may require the necessity of utilising skin substitutes to facilitate closure. The aim of this study is to assess the impact of a porcine-derived wound dressing (Oasis™) for application to hand burns compared to a synthetic dressing (Suprathel™). Comparative assessments were made, including the time to heal, quality of healing and pain intensity. A retrospective, unblinded, matching pair case-control of hand burns was performed. A control group of 24 patients was treated with Suprathel dressing, and a study group of six patients underwent application of the Oasis dressing. The wound healing process was evaluated by taking histopathological specimens and also utilising the Bates-Jensen Wound Assessment Tool. A 10-cm Visual Analogue Scale (VAS) was used for pain assessment. Other parameters measured included dressing loss because of infection and the need of rehabilitation. The progress of wound healing on the fourth day in the study group was 30%. A decrease in the level of pain was recorded on the fourth day after surgery. There was a decrease of 5% in the risk of rehabilitation in the treatment group.
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Affiliation(s)
- Justyna Glik
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Chronic Wounds Management Organization, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marek Kawecki
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Health Sciences, Technical-Humanistic Academy, Bielsko-Biała, Poland
| | - Diana Kitala
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | | | - Wojciech Łabuś
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marek Grabowski
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Agata Durdzińska
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Mariusz Nowak
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marcelina Misiuga
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Aleksandra Kasperczyk
- Department of Biochemistry, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Zabrze, Poland
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Bache SE, Fitzgerald O’Connor E, Theodorakopoulou E, Frew Q, Philp B, Dziewulski P. The Hand Burn Severity (HABS) score: A simple tool for stratifying severity of hand burns. Burns 2017; 43:93-99. [DOI: 10.1016/j.burns.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/24/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Knight A, Wasiak J, Salway J, O'Brien L. Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge. Burns 2016; 43:100-106. [PMID: 27608528 DOI: 10.1016/j.burns.2016.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/17/2016] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hands are the most commonly burnt body part given humans' innate response to guard their face from injury, and are known to have detrimental functional and psychological consequences. Conflicting evidence exists regarding the impact of hand burns on long-term health status and global functioning. The objective of this study was to identify patient and clinical characteristics that predict health status and hand function of people at 12-24 months after hand burn. METHODS The Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ) were administered to community-dwelling adults who were between one and two years after admission to a statewide burns service for burns including one or both hands. Demographic, injury, and treatment data were collected to identify which factors predict health status and hand function in the second year after admission. Linear regression analyses adjusted for total burn surface area and burn depth were conducted to identify important predictors or outcomes. RESULTS The sample (n=41) was 80.5% male, with a mean age of 44.5 years and total body surface area (TBSA) of 8.4%. Psychiatric illness (regression coefficient -56.6, confidence interval (95% CI) -76.70, -36.49) and female gender (-20.3; 95% CI -0.77, -40.29) were key predictors of poorer global health status on the BSHS-B. Females also scored worse on body image (-5.35; 95% CI -1.83, -8.87) and work (-4.13; 95% CI -0.64, -7.62) domains of BSHS-B. The need for reconstructive or secondary surgery (-38.84; 95% CI -58.04, -19.65) and female gender (-16.30; 95% CI -4.03, -28.57) were important predictors of poorer hand function. CONCLUSION Women and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function after burns, and may benefit from more intensive rehabilitation support and long-term follow-up.
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Affiliation(s)
- Amber Knight
- Monash University, Peninsula Campus, McMahons Rd, Frankston, Victoria 3199, Australia.
| | - Jason Wasiak
- Epworth Radiation Oncology, Epworth HealthCare, Melbourne, Australia; The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Jacqueline Salway
- Victorian Adult Burns Service, Alfred Health, 55 Commercial Rd, Prahran, Victoria 3181, Australia.
| | - Lisa O'Brien
- Monash University, Peninsula Campus, McMahons Rd, Frankston, Victoria 3199, Australia.
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Feng J, Yong C, Bin Kasmin MR, Tan KC, Tan BK, Chong SJ. A preliminary report: The new protocol of managing acute partial-thickness hand burns. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816632540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Optimal hand function recovery is the key to the successful management of hand burns. It starts with a timely burns coverage in the acute setting. A new hand burns protocol has been introduced to cover hand burn wounds within 24 hours after admission. BiobraneTM and split skin graft (SSG) are the coverage methods for partial-thickness burns. A three-year prospective study is being carried out to evaluate the short- and long-term clinical and functional outcomes of the two treatment modalities. This paper reports the preliminary short-term results of the first 34 hand burns of the study. Methodology: This report includes consecutive hand burns patients admitted between September 2014 and May 2015. The recruited hand burns patients underwent clinical and functional assessments seven days after the coverage with either SSG or BiobraneTM. Statistical analysis was performed to evaluate the outcomes. Results and discussion: Eleven burnt hands were treated with SSG and 23 with BiobraneTM. The clinical and functional outcomes, including range of motion, power and sensitivity, were similar in both treatment groups. Further study to recruit more patients is necessary to ascertain the significance of the above findings. More importantly, long-term functional outcomes have to be assessed to conclude the treatment efficacy of early hand burns coverage with BiobraneTM or SSG.
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Affiliation(s)
- Jiajun Feng
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Cheryl Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Kok Chai Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Bien-Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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Kubota Y, Mitsukawa N, Chuma K, Akita S, Sasahara Y, Rikihisa N, Satoh K. Hyperpigmentation after surgery for a deep dermal burn of the dorsum of the hand: partial-thickness debridement followed by medium split-thickness skin grafting vs full-thickness debridement followed by thick split-thickness skin grafting. BURNS & TRAUMA 2016; 4:9. [PMID: 27574679 PMCID: PMC4964008 DOI: 10.1186/s41038-016-0039-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Early excision and skin grafting are commonly used to treat deep dermal burns (DDBs) of the dorsum of the hand. Partial-thickness debridement (PTD) is one of the most commonly used procedures for the excision of burned tissue of the dorsum of the hand. In contrast, full-thickness debridement (FTD) has also been reported. However, it is unclear whether PTD or FTD is better. METHODS In this hospital-based retrospective study, we compared the outcomes of PTD followed by a medium split-thickness skin graft (STSG) with FTD followed by a thick STSG to treat a DDB of the dorsum of the hand in Japanese patients. To evaluate postoperative pigmentation of the skin graft, quantitative analyses were performed using the red, green, and blue (RGB) and the hue, saturation, and brightness (HSB) color spaces. We have organized the manuscript in a manner compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS Data from 11 patients were analyzed. Six hands (five patients) received grafts in the PTD group and eight hands (six patients) received grafts in the FTD group. Graft take was significantly better in the FTD group (median 98 %, interquartile range 95-99) than in the PTD group (median 90 %, interquartile range 85-90) (P < 0.01). Quantitative skin color analyses in both the RGB and HSB color spaces showed that postoperative grafted skin was significantly darker than the adjacent control area in the PTD group, but not in the FTD group. CONCLUSIONS There is a possibility that FTD followed by a thick STSG is an option that can reduce the risk of hyperpigmentation after surgery for DDB of the dorsum of the hand in Japanese patients. Further investigation is needed to clarify whether the FTD or the thick STSG or both are the factor for the control of hyperpigmentation.
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Affiliation(s)
- Yoshitaka Kubota
- Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan
| | - Kumiko Chuma
- Department of Plastic Surgery, Tokyo Rosai Hospital, 4-13-21, Omoriminami, Ota-ku, Tokyo 143-0013 Japan
| | - Shinsuke Akita
- Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan
| | - Yoshitaro Sasahara
- Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan
| | - Naoaki Rikihisa
- Department of Plastic Surgery, Chiba Rosai Hospital, 2-16, Tatsumidaihigashi, Ichihara, Chiba 290-0003 Japan
| | - Kaneshige Satoh
- Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan
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Dunpath T, Chetty V, Van Der Reyden D. Acute burns of the hands - physiotherapy perspective. Afr Health Sci 2016; 16:266-75. [PMID: 27358641 DOI: 10.4314/ahs.v16i1.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Acute burns of the hands are complex and may impact on various aspects of a person's life. Physiotherapy rehabilitation and restoration of hand function is critical for the patient's independence and re-integration into society. PURPOSE This study aimed to explore the perceptions and experiences of physiotherapists in the management of patients with their hand burn injuries. METHOD Five focus groups consisting of physiotherapists and physiotherapy assistants working with burn injured patients from each of the five selected public hospitals in KwaZulu-Natal were recruited. An explorative qualitative approach was adopted. RESULTS Physiotherapists emphasised that the acute management of the hand was trivialised due to a primary focus on the survival of the burn sufferer. Therapists identified several factors that determined the patients' level of participation and motivation in therapy one of which was the procedural pain experienced. The role of the therapists' within the rehabilitation framework was found to be critical to their recovery however there appeared to be a breakdown in the collaboration and communication among health care professionals to the detriment of effective intervention. CONCLUSION A multidisciplinary team approach is the foundation in the management of acute burn injuries and during the trajectory of the trauma care continuum.
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Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up. Burns 2015; 42:e1-e7. [PMID: 26652220 DOI: 10.1016/j.burns.2015.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/12/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis. PATIENTS AND METHODS In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire. RESULTS No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14. DISCUSSION The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring.
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Cen Y, Chai J, Chen H, Chen J, Guo G, Han C, Hu D, Huan J, Huang X, Jia C, Li-Tsang CW, Li J, Li Z, Liu Q, Liu Y, Luo G, Lv G, Niu X, Peng D, Peng Y, Qi H, Qi S, Sheng Z, Tang D, Wang Y, Wu J, Xia Z, Xie W, Yang H, Yi X, Yu L, Zhang G. Guidelines for burn rehabilitation in China. BURNS & TRAUMA 2015; 3:20. [PMID: 27574666 PMCID: PMC4964028 DOI: 10.1186/s41038-015-0019-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 02/05/2023]
Abstract
Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.
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Affiliation(s)
| | | | - Ying Cen
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Jiake Chai
- Department of Burn & Plastic Surgery, the First Hospital Affiliated to General Hospital of PLA, Beijing, China
| | - Huade Chen
- Department of Burns, General Hospital of Guangdong Province, Guangzhou, Guangdong China
| | - Jian Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Guanghua Guo
- Department of Burns, the First Affiliated Hospital of Nanchang Univerisity, Research Center of Technology of Wound Repair Engineering in Jiangxi Province, Nanchang, Jiangxi China
| | - Chunmao Han
- Department of Burns and Wound Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi China
| | - Jingning Huan
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyuan Huang
- Department of Burns and Plastic Surgery, Central South University, Changsha, Hunan China
| | - Chiyu Jia
- Plastic Beauty and Burn Repair Center, the 309th Hospital of the Chinese PLA, Beijing, China
| | - Cecilia Wp Li-Tsang
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Jianan Li
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu China
| | - Zongyu Li
- Department of Burns and Plastic Surgery, the Fifth Hospital of Harbin, Harbin, Heilongjiang Province China
| | - Qun Liu
- Department of Burn and Plastic Surgery, the Fourth Hospital of Tianjin, Burn Institution of Tianjin, Tianjin, China
| | - Yi Liu
- Burns and Plastic Surgery Center, PLA Lanzhou General Hospital of Lanzhou Command, Lanzhou, Gansu China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Guozhong Lv
- Department of Burn Surgery, the Third People's Hospital of Wuxi, Jiangsu, China
| | - Xihua Niu
- Department of Burn Surgery, the First People's Hospital of ZhengZhou, Zhengzhou, Henan China
| | - Daizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Hongyan Qi
- Department of Burn Surgery, Beijing Children's Hospital, Beijing, China
| | - Shunzhen Qi
- The Center of Burn and Plastic of Hebei Province, Bethune International Peace Hospital, Shijiazhuang, Hebei China
| | - Zhiyong Sheng
- Department of Burn & Plastic Surgery, the First Hospital Affiliated to General Hospital of PLA, Beijing, China
| | - Dan Tang
- Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, Guangdong China
| | - Yibing Wang
- Department of Burns and Plastic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong China
| | - Jun Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Zhaofan Xia
- Department of Burn Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weiguo Xie
- Institute of Burns, Wuhan City Hospital No. 3 & Tongren Hospital of Wuhan University, Wuhan, Hubei China
| | - Hongming Yang
- Department of Burn & Plastic Surgery, the First Hospital Affiliated to General Hospital of PLA, Beijing, China
| | - Xianfeng Yi
- Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, Guangdong China
| | - Lehua Yu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoan Zhang
- Department of Burns, Beijing Jishuitan Hospital, Forth Medical College of Peking University, Beijing, China
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Abstract
PURPOSE Hand burns are common in the pediatric population. Optimal hand function is a crucial component of a high-quality survival after burn injury. This can only be achieved with a coordinated approach to the injuries. The aim of this study was to review the management algorithm and outcomes of pediatric hand burns at our institution. METHODS In total, 70 children fulfilling our study criteria were treated for a burn hand injury in our Burn Care Center between January 2008 and May 2013. RESULTS 14 of the 70 pediatric patients underwent surgery because of the depth of the hand burns. The management algorithm depending on the depth of the burn is described. Two patients underwent correction surgery due to burn contractures later. CONCLUSION For a successful outcome of the burned hand, the interdisciplinary involvement and cooperation of the plastic and pediatric surgeon, hand therapist, burn team, patient and their parents are crucial.
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Abstract
Glass fronted gas fireplaces (GFGFs) have exterior surfaces that can reach extremely high temperatures. Burn injuries from contact with the glass front can be severe with long-term sequelae. The Consumer Product Safety Commission reported that these injuries are uncommon, whereas single-center studies indicate a much higher frequency. The purpose of this multi-institutional study was to determine the magnitude and severity of GFGF injuries in North America. Seventeen burn centers elected to participate in this retrospective chart review. Chart review identified 402 children ≤10 years of age who sustained contact burns from contact with GFGF, who were seen or admitted to the study hospitals from January 2006 to December 2010. Demographic, burn, treatment, and financial data were collected. The mean age of the study group was 16.8 ± 13.3 months. The majority suffered burns to their hands (396, 98.5%), with burns to the face being the second, much less common site (14, 3.5%). Two hundred and sixty-nine required rehabilitation therapy (66.9%). The number of GFGF injuries reported was 20 times greater than the approximately 30 injuries estimated by the Consumer Product Safety Commission's 10-year review. For the affected children, these injuries are painful, often costly and occasionally can lead to long-term sequelae. Given that less than a quarter of burn centers contributed data, the injury numbers reported herein support a need for broader safety guidelines for gas fireplaces in order to have a significant impact on future injuries.
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Fufa DT, Chuang SS, Yang JY. Postburn contractures of the hand. J Hand Surg Am 2014; 39:1869-76. [PMID: 25154575 DOI: 10.1016/j.jhsa.2014.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 02/02/2023]
Abstract
Several functionally limiting sequelae can follow deep thermal injury to the hand. Despite appropriate initial management, contractures are common. Whereas acute burn care is often managed by multidisciplinary, specialized burn units, postburn contractures may be referred to hand surgeons, who should be familiar with the patterns of burn contracture and nonsurgical and operative options to improve function and expected outcomes. The most common and functionally limiting sequelae are contractures of the webspace, hand, and digits. Webspace contractures and postburn syndactyly are managed with scar excision and local soft tissue rearrangement or skin grafting. The burn claw hand presents as extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstays of management of these contractures include complete surgical excision of scar tissue and resurfacing of the resultant soft tissue defect, most commonly with full-thickness skin grafts. If scar contracture release results in major exposure of the tendons or joints, distant tissue transfer may be required. Early motion and rehabilitative modalities are essential to prevent initial contracture formation and recontracture after surgical release.
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Affiliation(s)
- Duretti T Fufa
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Shiow-Shuh Chuang
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jui-Yung Yang
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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