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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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Local Treatment of Burns with Cell-Based Therapies Tested in Clinical Studies. J Clin Med 2021; 10:jcm10030396. [PMID: 33494318 PMCID: PMC7864524 DOI: 10.3390/jcm10030396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Effective wound management is an important determinant of the survival and prognosis of patients with severe burns. Thus, novel techniques for timely and full closure of full-thickness burn wounds are urgently needed. The purpose of this review is to present the current state of knowledge on the local treatment of burn wounds (distinguishing radiation injury from other types of burns) with the application of cellular therapies conducted in clinical studies. PubMed search engine and ClinicalTrials.gov were used to analyze the available data. The analysis covered 49 articles, assessing the use of keratinocytes (30), keratinocytes and fibroblasts (6), fibroblasts (2), bone marrow-derived cells (8), and adipose tissue cells (3). Studies on the cell-based products that are commercially available (Epicel®, Keraheal™, ReCell®, JACE, Biobrane®) were also included, with the majority of reports found on autologous and allogeneic keratinocytes. Promising data demonstrate the effectiveness of various cell-based therapies; however, there are still scientific and technical issues that need to be solved before cell therapies become standard of care. Further evidence is required to demonstrate the clinical efficacy and safety of cell-based therapies in burns. In particular, comparative studies with long-term follow-up are critical.
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Abstract
Accurately assessing function and disability after hand burns is imperative to improving the management of patients. The biological, social, and psychological impact of these injuries should be considered. The International Classification of Functioning Disability (ICF) and Health Core Sets for Hand Conditions provides a guide to what should be measured and reported. Although many outcomes measures instruments are available to assess patients with hand or burn injuries, few are validated in the subpopulation of hand burns. Further efforts are required to investigate the ability of current assessment instruments to evaluate hand burn outcomes within the ICF framework.
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Affiliation(s)
- Shepard P Johnson
- Department of Surgery, Saint Joseph Mercy Ann Arbor, 5333 McAuley Drive, Suite 2111, Ypsilanti, MI 48197, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Chateau J, Guillot M, Zevounou L, Braye F, Foyatier JL, Comparin JP, Voulliaume D. Is there any place for spontaneous healing in deep palmar burn of the child? ANN CHIR PLAST ESTH 2016; 62:238-244. [PMID: 27777134 DOI: 10.1016/j.anplas.2016.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/18/2016] [Indexed: 11/25/2022]
Abstract
Child palm burns arise by contact and are often deep. The singular difficulty of such a disease comes from the necessity of the child growth and from the potential occurrence of constricted scars. In order to avoid sequelae, the actual gold standard is to practice an early excision of the burn, followed by a skin graft. The aim of this study is to evaluate the results of spontaneous healing combined with rehabilitation versus early skin grafting and rehabilitation concerning the apparition of sequelae. We performed a retrospective study in two burn centers and one rehabilitation hospital between 1995 and 2010. Eighty-seven hands have been included in two groups: one group for spontaneous healing and the other group for excision and skin grafting. Every child benefited from a specific rehabilitation protocol. The two main evaluation criteria were the duration of permanent splint wearing and the number of reconstructive surgery for each child. The median follow-up duration is about four years. The two groups were comparable. For the early skin grafting group, the splint wearing duration was 1/3 longer than for the spontaneous healing group. Concerning the reconstructive surgery, half of the grafted hands needed at least one procedure versus 1/5 of spontaneous healing hands. Our results show the interest of spontaneous healing in palmar burn in child, this observation requires a specific and intense rehabilitation protocol.
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Affiliation(s)
- J Chateau
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - M Guillot
- Centre de rééducation pédiatrique Romans-Ferrari, 01700 Miribel, France
| | - L Zevounou
- Centre de rééducation pédiatrique Romans-Ferrari, 01700 Miribel, France
| | - F Braye
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - J-L Foyatier
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Saint-Joseph-Saint-Luc, 69007 Lyon, France
| | - J-P Comparin
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Saint-Joseph-Saint-Luc, 69007 Lyon, France
| | - D Voulliaume
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Saint-Joseph-Saint-Luc, 69007 Lyon, France
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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: 11] [Impact Index Per Article: 1.4] [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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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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Epidermal healing in burns: autologous keratinocyte transplantation as a standard procedure: update and perspective. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e218. [PMID: 25426401 PMCID: PMC4229277 DOI: 10.1097/gox.0000000000000176] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/11/2014] [Indexed: 01/03/2023]
Abstract
Background: Treatment of burned patients is a tricky clinical problem not only because of the extent of the physiologic abnormalities but also because of the limited area of normal skin available. Methods: Literature indexed in the National Center (PubMed) has been reviewed using combinations of key words (burns, children, skin graft, tissue engineering, and keratinocyte grafts). Articles investigating the association between burns and graft therapeutic modalities have been considered. Further literature has been obtained by analysis of references listed in reviewed articles. Results: Severe burns are conventionally treated with split-thickness skin autografts. However, there are usually not enough skin donor sites. For years, the question of how covering the wound surface became one of the major challenges in clinical research area and several procedures were proposed. The microskin graft is one of the oldest methods to cover extensive burns. This technique of skin expansion is efficient, but results remain inconsistent. An alternative is to graft cultured human epidermal keratinocytes. However, because of several complications and labor-intensive process of preparing grafts, the initial optimism for cultured epithelial autograft has gradually declined. In an effort to solve these drawbacks, isolated epithelial cells from selecting donor site were introduced in skin transplantation. Conclusions: Cell suspensions transplanted directly to the wound is an attractive process, removing the need for attachment to a membrane before transfer and avoiding one potential source of inefficiency. Choosing an optimal donor site containing cells with high proliferative capacity is essential for graft success in burns.
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Patient experiences living with split thickness skin grafts. Burns 2014; 40:1097-105. [DOI: 10.1016/j.burns.2014.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/20/2014] [Accepted: 03/10/2014] [Indexed: 11/19/2022]
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Tyack Z, Wasiak J, Spinks A, Kimble R, Simons M. A guide to choosing a burn scar rating scale for clinical or research use. Burns 2013; 39:1341-50. [PMID: 23768711 DOI: 10.1016/j.burns.2013.04.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/22/2012] [Accepted: 04/23/2013] [Indexed: 12/26/2022]
Abstract
INTRODUCTION A lack of high quality burn scar rating scales underpins the urgent need to introduce a guide for clinicians and researchers to choose the most appropriate scale for their requirements. METHODS An updated electronic search of Medline, CINAHL, and EMBASE databases from 2010 to 2011 of a previous published systematic review were used to identify English articles related to burn scar rating scales. The clinimetric properties, content, purpose, characteristics of the subjects tested and feasibility of each scale were critically reviewed. RESULTS An additional seven papers were identified by the updated search, bringing the total number of papers reviewed to 36. The majority (88%) covered items pertaining to the physical properties of the skin rated by an observer. All of the scales had been tested for the purpose of discriminating between patient groups; however, only preliminary evidence exists for the ability of the scales to measure change in scar properties over time. The majority of testing of scales occurred using Caucasian subjects, males, upper limb sites and adults. CONCLUSIONS This paper provides a guide to selecting the most appropriate burn scar rating scale for research and clinical practice by reviewing the content, purpose, test sample characteristics and feasibility of each scale.
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Affiliation(s)
- Zephanie Tyack
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia.
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Selig HF, Keck M, Lumenta DB, Mittlböck M, Kamolz LP. The use of a polylactide-based copolymer as a temporary skin substitute in deep dermal burns: 1-year follow-up results of a prospective clinical noninferiority trial. Wound Repair Regen 2013; 21:402-9. [DOI: 10.1111/wrr.12050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Maike Keck
- Vienna Burn Center; Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna; Austria
| | - David B. Lumenta
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University Graz; Graz; Austria
| | - Martina Mittlböck
- Informatics and Intelligent Systems; Section for Clinical Biometrics; Medical University Vienna; Vienna; Austria
| | - Lars P. Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University Graz; Graz; Austria
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Lin SY, Chang JK, Chen PC, Mao HF. Hand function measures for burn patients: a literature review. Burns 2012; 39:16-23. [PMID: 22985975 DOI: 10.1016/j.burns.2012.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/12/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
Hand function is one of the most important goals of burn rehabilitation and is a consensually important functional outcome. The purpose of this article is to review the available hand function measures commonly used for burn patients and to summarize their psychometric properties and clinical utilities to serve as guidelines for clinical practice and research. An online-database search of PubMed, MEDLINE, CINAHL and PsychInfo was performed. One hundred and seventeen articles were found and 23 of them met the inclusion and exclusion criteria. The eight identified measurement instruments were then classified into three categories: traditional component measures, performance measures and patient-reported outcome measures. Each type of hand function measure has its unique characteristics and limitations. Traditional component measures only reflect hand impairments, and may not represent hand function status. Performance measures have not been validated in the burn population and do not correlate well with patient-reported outcomes. Patient-reported outcome measures have not been rigorously validated in the burn population. A discussion of how clinicians choose these measures reflecting the purposes of their measurements and goals of intervention is provided. Moreover, future studies are suggested to develop burn-specific hand function measures.
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Affiliation(s)
- Szu-Yen Lin
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan
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