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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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Lumsden E, Kimble R, McMillan C, Storey K, Ware RS, Griffin B. The feasibility of negative pressure wound therapy versus standard dressings in paediatric hand and foot burns protocol: a pilot, single-centre, randomised control trial. Pilot Feasibility Stud 2023; 9:90. [PMID: 37237316 DOI: 10.1186/s40814-023-01308-z] [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: 12/06/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The goal of paediatric hand and foot burn management is hypertrophic scar and/or contracture prevention. The risk of scar formation may be minimised by integrating negative pressure wound therapy (NPWT) as an acute care adjunct as it decreases the time to re-epithelialisation. NPWT has known associated therapeutic burden; however, this burden is hypothesised to be outweighed by an increased likelihood of hypertrophic scar prevention. This study will assess the feasibility, acceptability and safety of NPWT in paediatric hand and foot burns with secondary outcomes of time to re-epithelialisation, pain, itch, cost and scar formation. METHODS AND ANALYSIS This is a single-site, pilot randomised control trial. Participants must be aged ≤ 16 years, otherwise well and managed within 24 h of sustaining either a hand or foot burn. Thirty participants will be randomised to either standard care (Mepitel®-a silicone wound interface contact dressing-and ACTICOAT™-a nanocrystalline silver-impregnated dressing) or standard care plus NPWT. Patients will be reviewed until 3 months post-burn wound re-epithelialisation, with measurements taken at dressing changes to assess primary and secondary outcomes. Surveys, randomisation and data storage will be done via online platforms and physical data storage collated at the Centre for Children's Health Research, Brisbane, Australia. Analysis will be performed using the Stata statistical software. ETHICS AND DISSEMINATION Queensland Health and Griffith University Human Research ethics approval including a site-specific assessment was obtained. The findings of this study will be disseminated through clinical meetings, conference presentations and peer reviewed journals. TRIAL REGISTRATION Registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622000044729, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381890&isReview=true , registered 17/01/2022).
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Affiliation(s)
- Emma Lumsden
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia.
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia.
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Roy Kimble
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - Catherine McMillan
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Kristen Storey
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
| | - Bronwyn Griffin
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
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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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Shi JJ, Sun Y, Pan SS, Xu TT, Hua JJ. Manufacture and clinical application of the forearm pronation's assistant tableware in the severely burned. Burns 2020; 47:684-691. [PMID: 32917474 DOI: 10.1016/j.burns.2020.08.007] [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: 12/04/2019] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Even after reconstructive surgery, it is still difficult for patients with severe burns to achieve independent eating activity. In this project, we customized the forearm pronation's assistant tableware to assist in improvement with eating activities. METHODS From January 2017 to December 2018, 28 patients with severe burns including the hands were recruited. For the patient's independent eating activities, we customized forearm pronation's tableware (forks and spoons). We compared modified Barthel index (MBI) and Visual analogue scale (VAS) of satisfaction under three conditions: no auxiliary tableware, ADL universal cuff, or forearm pronation tableware; to compare the duration and the weight of food spilled during lunch when the patients wore the ADL universal cuff or the forearm pronation's tableware. Differences in MBI (rank data) were tested by the Friedman test, differences in VAS (normal distribution) were tested with One-way ANOVA (Bonferroni), differences in the duration and the weight (normal distribution data) were tested by paired sample t test. RESULTS After wearing the forearm pronation's assistant tableware, MBI VAS both increased more than when the patients did not wear the auxiliary tableware (all p<0.05). When the subjects wore forearm pronation tableware, the duration of lunch significantly decreased and the quality of eating activity significantly improved compared to the ADL universal cuff in eating activity (all p<0.05). CONCLUSION After wearing the forearm pronation's assistant tableware, the patients with severe burns completely or almost completely accomplished independent eating, the duration was decreased, and during eating activity the quality and the satisfaction were improved. CLINICAL TRIAL REGISTRATION Chinese Clinical trial registry, ChiCTR1800019963.
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Affiliation(s)
- Jia-Jia Shi
- Department of Physical Medicine and Rehabilitation Medicine, Kunshan Rehabilitation Hospital, Suzhou, Jiangsu, PR China
| | - Ying Sun
- Department of Physical Medicine and Rehabilitation Medicine, Kunshan Rehabilitation Hospital, Suzhou, Jiangsu, PR China
| | - Shan-Shan Pan
- Department of Burn Medicine, Kunshan Rehabilitation Hospital, Suzhou, Jiangsu, PR China
| | - Ting-Ting Xu
- Research Laboratory, Kunshan Rehabilitation Hospital, Suzhou, Jiangsu, PR China
| | - Jia-Jia Hua
- Department of Rehabilitation Medicine, The Sixth People's Hospital of Nantong, Nantong, Jiangsu, PR China.
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Dargan D, Adjei B, Shokrollahi K. A Rule of Thumb for Hand Burns: Categorization and Mapping of Proportional Surface Area Involvement. J Burn Care Res 2020; 41:1092-1096. [DOI: 10.1093/jbcr/iraa054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Hand burns are common and often complex injuries, requiring referral to specialist centers. The patient’s thumbprint is a rapid means of accurately assessing hand burn surface area. This study aimed to establish categories and evaluate sites of hand burn surface area in order to facilitate comparison of hand burns. Sixteen burns involving the hand and wrist among 14 patients referred to a burns center were retrospectively categorized by burn mechanism, burn thickness, and hand burn surface area. The burn surface area in the clinical record was compared with that calculated by the thumbprint method and the rule of thumb diagram. Burn surface area in the clinical record was either “1%” or “<1%” in 9 of 16 cases. In contrast, the surface area was <1 thumbprint (T) in six burns, two were between 1 and 5T, three were 5 to 10T, two were 10 to 20T, two were 20 to 50T, and one was greater than 50T. The median thumbprint burn surface area was 1.5T (range 0.20–80T), which corresponds to 0.05% TBSA. The hand areas with the highest burn frequency per unit area were the dorsum of the hand and dorsum of the index finger, with relative sparing of the palm and palmar surface of the digits. Hand burns surface area varies widely, and thumbprint evaluation with categories and mapping allows finer distinction between the surface area proportions and specific sites involved, even in a small series of hand burns.
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Affiliation(s)
- Dallan Dargan
- Mersey Regional Burns and Plastic Surgery Centre and St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
| | - Bismark Adjei
- Mersey Regional Burns and Plastic Surgery Centre and St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
| | - Kayvan Shokrollahi
- Mersey Regional Burns and Plastic Surgery Centre and St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
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Bache SE, Fitzgerald O’Connor E, Drake PJ, Philp B, Dziewulski P. Development and validation of the Burnt Hand Outcome Tool (BHOT): A patient-led questionnaire for adults with hand burns. Burns 2018; 44:2087-2098. [DOI: 10.1016/j.burns.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/11/2018] [Accepted: 07/26/2018] [Indexed: 01/08/2023]
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