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Poelchow F, Codde J, Kendell R, Edgar DW, Wood FM. A randomised investigation of film-forming silicone gel in superficial partial thickness face and neck burn patients: Indication of improved early scar pigmentation outcomes. Burns 2024; 50:1605-1613. [PMID: 38614897 DOI: 10.1016/j.burns.2024.03.024] [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: 06/14/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. METHODS This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. RESULTS Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 -10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 - 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 - 4.5 vs control group - Md = 1.5, IQR 0.6 - 3.8, z = -0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. CONCLUSION Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn.
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Affiliation(s)
- Fiona Poelchow
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jim Codde
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Rosemary Kendell
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Armadale Kalamunda Group Health Service, Safety and Quality Unit, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
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Hammer R, Molembi B, Morgenegg M, Mottet L. [Management of patients with facial burns]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2021; 66:52-54. [PMID: 34654517 DOI: 10.1016/j.soin.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
People with severe facial burns face a long process of readjustment to social life. Altered body image challenges their identity and daily interactions. The mirror test, in which nurses help patients to look at their wounds, is a key step in the care given by carers, but also in the transition from the hospital world to the social world.
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Affiliation(s)
- Raphaël Hammer
- Haute École de santé Vaud, avenue de Beaumont 21, 1011 Lausanne, Suisse; Haute École spécialisée de Suisse occidentale, rue de la Jeunesse 1, 2800 Delémont, Suisse.
| | - Brandi Molembi
- Centre hospitalier universitaire vaudois, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Marie Morgenegg
- Centre hospitalier universitaire vaudois, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Louise Mottet
- Centre hospitalier universitaire vaudois, rue du Bugnon 46, 1011 Lausanne, Suisse
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Freysteinson WM, Keele R, Yeatts P, Douglas D, Reeves K, Celia T, Crisp S, Gonzalez K, Du J. Development and validation of the mirror image comfort and avoidance scale (MICAS). Disabil Rehabil 2021; 44:5649-5655. [PMID: 34369240 DOI: 10.1080/09638288.2021.1945691] [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: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to develop an instrument to measure the experience of viewing one's reflection in the mirror for use in rehabilitation, nursing, psychology, and in research studies designed to improve the mirror-viewing experience for those who have suffered psychological or bodily trauma. A secondary purpose was to explore demographic differences in each subscale of the instrument. METHODS The developed items went through content expert validation, exploratory and confirmatory factor analyses, and internal consistency reliability testing. RESULTS Using an exploratory factor analysis (n = 137) and a confirmatory factor analysis (n = 142), we validated a 17-item instrument for two distinct populations: veterans (n = 108) and individuals with upper and lower limb loss (n = 210). The mirror viewing comfort subscale (9 items; α = 0.90) and the mirror avoidance subscale (8 items, α = 0.94) were deemed reliable. Strong, significant correlations between pre-and post-comfort scores (r = 0.81, p < 0.001), as well as pre-and post-avoidance scores (r = 0.94, p < 0.001) provide evidence of test-retest reliability. Demographic differences were noted in the subscales. CONCLUSIONS This instrument contributes to a greater understanding of the experience of mirror-viewing in clinical practice. In interventional research studies to improve the mirror-viewing experience, this instrument can act as a manipulation check or outcome measure.Implications for rehabilitationIndividuals who suffer actual or perceived body disfigurement due to surgery or trauma may suffer mirror discomfort or mirror trauma when viewing their bodies in a mirror. This reaction is due to a pre-frontal cortex neurological disruption and autonomic nervous system fright/flight or faint. Psychological disorders (e.g., devastation, shame, self-revulsion, decreased body image) may ensue.Falls have occurred due to mirror trauma due to an autonomic nervous system disturbance (faint) and may result in ongoing mirror avoidance. When mirrors are needed for incision visualization, mirror avoidance has led to severe surgical site infections.Although there were many scales available in the literature to measure several aspects of the effects of actual or perceived body disfigurement, there were no scales that measured the mirror-viewing experience.Clinicians and researchers can use the Mirror Comfort and Avoidance Scale (MICAS) to assess mirror comfort and avoidance.
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Affiliation(s)
| | - Rebecca Keele
- College of Nursing, Texas Woman's University, Denton, TX, USA
| | - Paul Yeatts
- Center for Research Design & Analysis, Texas Woman's University, Denton, TX, USA
| | - Denika Douglas
- Department of Psychology, Texas Southern University, Houston, TX, USA
| | - Kristin Reeves
- Texas Institute of Research and Rehabilitation, Houston, TX, USA
| | - Tania Celia
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, TX, USA
| | | | - Kimberly Gonzalez
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, TX, USA
| | - Jinlan Du
- Office of Technology, Texas Woman's University, Houston, TX, USA
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Freysteinson WM. Demystifying the mirror taboo: A neurocognitive model of viewing self in the mirror. Nurs Inq 2020; 27:e12351. [PMID: 32220048 PMCID: PMC7685126 DOI: 10.1111/nin.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 01/30/2023]
Abstract
Research has consistently demonstrated that viewing one's body in a mirror after an amputation or other perceived or visible body disfigurements can be a traumatic experience. Mirror viewing or mirroring is a taboo subject, which may be the reason this trauma has not been previously detected or acknowledged. Traumatic mirror viewing may lead to mirror discomfort, mirror avoidance, and a host of psychosocial concerns, including post-traumatic stress. As mirroring is complex, four qualitative mirror viewing studies, embodiment concepts, polyvagal theory, and memory theories were used to develop a model. In this article, foundational knowledge that led to the development of the model is shared. A neurocognitive model of mirror viewing is offered together with implications for nursing research, practice, and education.
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Langlois J, Vincent-Toskin S, Duchesne P, Soares de Vilhena B, Shashoua D, Calva V, de Oliveira A, Nedelec B. Fear avoidance beliefs and behaviors of burn survivors: A mixed methods approach. Burns 2020; 47:175-189. [PMID: 33303261 DOI: 10.1016/j.burns.2020.06.002] [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] [Received: 02/11/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
The Fear-Avoidance Model was developed with patients who had sustained neck and back injuries and describes a cascade of events after pain that is perceived as threatening, which may lead to avoidance of valued and meaningful life activities. The literature examining burn survivors suggests they may experience fear-avoidance, however, their lived experience has yet to be thoroughly explored and the evaluation tool that has been used is four items extracted from the Tampa Scale of Kinesiophobia that were modified for burn survivors, but never formally validated with this population. Therefore, the aim of this study was to explore, through a mixed methods approach, the lived experience of burn survivors with respect to fear-avoidance and determine whether the reduced four question Tampa Scale of Kinesiophobia (4TSK) reflects and accurately measures their experience. Burn survivors (n = 17) who had undergone surgical debridement and grafting were recruited. They completed the reduced 4TSK and participated in an in-depth interview to explore their lived experience regarding fear-avoidance and their opinions on the relevance of the questions. The interviews were analyzed using a thematic-analysis approach. Five major themes that represented the lived experience of fear-avoidance in burn survivors were identified: perceived vulnerability to re-injury, others as fear influencers, difficulties & hardships during recovery, engagement in activity, and active thoughts. Based upon the interviews researchers identified 9 potential fear-avoidant participants, which differed from the screening results from the reduced 4TSK (n = 12). Overall, this study demonstrated the potential uniqueness of the burn survivor population and provided insight into their lived experience of fear of movement or activities.
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Affiliation(s)
- Jade Langlois
- School of Physical and Occupational Therapy, McGill University, Canada
| | | | - Philippe Duchesne
- School of Physical and Occupational Therapy, McGill University, Canada
| | | | | | - Valérie Calva
- Hôpital de réadaptation Villa Medica, Montréal, Québec, Canada
| | - Ana de Oliveira
- Centre de recherche, Center hospitalier de l'Université de Montréal (CRCHUM), Canada
| | - Bernadette Nedelec
- School of Physical and Occupational Therapy, McGill University, Canada; Hôpital de réadaptation Villa Medica, Montréal, Québec, Canada; Centre de recherche, Center hospitalier de l'Université de Montréal (CRCHUM), Canada.
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Herring B, Paraskeva N, Tollow P, Harcourt D. Women's initial experiences of their appearance after mastectomy and/or breast reconstruction: A qualitative study. Psychooncology 2019; 28:2076-2082. [PMID: 31386237 DOI: 10.1002/pon.5196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/03/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Beth Herring
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Nicole Paraskeva
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Philippa Tollow
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied SciencesUniversity of the West of England Bristol UK
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Kil M, Lee Y. [A Qualitative Study on Interpersonal Relationships of Patients with Facial Burn Injuries: Phenomenological Study]. J Korean Acad Nurs 2019; 49:263-273. [PMID: 31266923 DOI: 10.4040/jkan.2019.49.3.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of the study was to explore the experience of patients with facial burn injuries regarding their interpersonal relationships. METHODS The phenomenological research method was used. Participants of the study consisted of five males and three females. Data were collected through individual in-depth interviews from November, 2014 to February, 2015 and analyzed using Colaizzi's method. RESULTS Five theme clusters were extracted that described patients' experiences. They are "being a lonely foreigner," "closing my mind toward the world," "hiding hurt feelings," "companion of my face," and "communicating with the world". CONCLUSION The results of this study provide a deep understanding and insight into the experience of interpersonal relationships among facial burn patients. The development of a comprehensive program including physical, psychological, and social aspects is recommended to address the problems facial burn patients encounter in interpersonal relationships and to facilitate interaction.
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Affiliation(s)
- Myungsook Kil
- Department of Nursing, Gangneung Yeongdong University, Gangneung, Korea
| | - Yongmi Lee
- College of Nursing, Kangwon National University, Chuncheon, Korea.
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Paraskeva N, Herring B, Tollow P, Harcourt D. First look: A mixed-methods study exploring women's initial experiences of their appearance after mastectomy and/or breast reconstruction✰. J Plast Reconstr Aesthet Surg 2019; 72:539-547. [DOI: 10.1016/j.bjps.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/30/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
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A comparison of two psychological screening methods currently used for inpatients in a UK burns service. Burns 2017; 43:1802-1808. [DOI: 10.1016/j.burns.2017.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022]
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Management of Head and Neck Burns-A 15-Year Review. J Oral Maxillofac Surg 2017; 76:375-379. [PMID: 28963867 DOI: 10.1016/j.joms.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this project was to characterize patients with isolated head and neck burns admitted to the Grady Memorial Hospital (GMH) Burn Center (Atlanta, GA). MATERIALS AND METHODS This was a retrospective case series of patients admitted to the GMH Burn Center with the primary diagnosis of head and neck burns from 2000 through 2015. Demographic data (gender and age) were recorded. Burn details (etiology, mechanism, percentage of burned total body surface area, depth, and associated injuries) were summarized. Patient management and hospital course were documented. Data were collected using a standardized collection form. Descriptive statistics were computed. RESULTS There were 5,938 patients admitted to the burn unit at the GMH Burn Center during the study period. Of these, 2,547 patients had head and neck burns and 205 patients met the inclusion criteria. Most (n = 136; 66%) were male, with a mean age of 40 years. The most common burn depth was superficial partial thickness. Flame burns were the most likely mechanism related to full-thickness injury. Approximately one fourth of patients had an associated injury, such as inhalation or ocular injury. Surgical interventions consisted of tangential excision and split-thickness skin grafting, contracture release, excision of hypertrophic scars, and rotational flaps. Mean length of hospital stay for isolated head and neck burns was 4.4 days. Overall mortality was 2%. CONCLUSION The results of this study show that superficial partial-thickness head and neck burns are more likely to occur from accidental exposure to flames in men older than 55 years. Owing to an increase in risk and mortality of inhalation injury associated with head and neck burns, airway protection and respiratory management are critical considerations of head and neck burn management.
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McLean LM, Rogers V, Kornhaber R, Proctor MT, Kwiet J, Streimer J, Vandervord J. The patient-body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment. J Multidiscip Healthc 2015; 8:377-87. [PMID: 26347401 PMCID: PMC4551300 DOI: 10.2147/jmdh.s89375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Throughout development and into adulthood, a person’s face is the central focus for interpersonal communication, providing an important insight into one’s identity, age, sociocultural background, and emotional state. The face facilitates important social, including nonverbal, communication. Therefore, sustaining a severe burn, and in particular a facial burn, is a devastating and traumatizing injury. Burn survivors may encounter unique psychosocial problems and experience higher rates of psychosocial maladjustment, although there may be a number of potentially mediating factors. Objectives The purpose of this phenomenological study was to examine the early recovery experience of patients with a facial burn. In particular, this study focused on how the injury impacted on the participants’ relationship with their own body and the challenges of early psychosocial adjustment within the first 4 months of sustaining the injury. Methods In 2011, six adult participants encompassing two females and four males ranging from 29 to 55 years of age with superficial to deep dermal facial burns (with background burns of 0.8%–55% total body surface area) were recruited from a severe burn injury unit in Australia for participation in a Burns Modified Adult Attachment Interview. Narrative data were analyzed thematically and informed by Colaizzi’s method of data analysis. Results Three overarching themes emerged: relationship to self/other, coping, and meaning-making. Themes identified related to how the experience affected the participants’ sense of relationship with their own bodies and with others, as well as other challenges of early psychosocial adjustment. All participants indicated that they had experienced some early changes in their relationship with their body following their burn injury. Conclusion These findings highlight the struggle burn survivors experienced with postburn adjustment, but expressed altruism and optimism around their recovery. Past trauma was observed to be a significant finding in this sample. Understanding the “lived experience” supports the way clinical and family systems can foster positive adjustment and coping. Consequently, multidisciplinary burn teams and health care professionals need to understand the principles of trauma-informed care and translate these into practice in the treatment of this group of patients.
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Affiliation(s)
- Loyola M McLean
- Brain and Mind Centre and Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney and Western Sydney Local Health District, Parramatta, NSW, Australia ; Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Vanessa Rogers
- Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia ; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Rachel Kornhaber
- School of Health Sciences, Faculty of Health, University of Tasmania, Alexandria, NSW, Australia ; Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia ; School of Nursing, University of Adelaide, SA, Australia
| | | | - Julia Kwiet
- Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia ; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jeffrey Streimer
- Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia ; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John Vandervord
- Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
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