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Vakili Ojarood M, Yaghoubi T, Mohsenizadeh SM, Torabi H, Farzan R. The future of burn management: How can machine learning lead to a revolution in improving the rehabilitation of burn patients? Burns 2024; 50:1704-1706. [PMID: 38637259 DOI: 10.1016/j.burns.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Tahereh Yaghoubi
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Mostafa Mohsenizadeh
- Department of Nursing, Qaen School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Hossein Torabi
- Department of General Surgery, Poursina Medical and Educational Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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2
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Blome-Eberwein SA, Schwartz A, Ferdock M, Starner S, Gogal C. Minimally invasive burn reconstruction with subcutaneous scar contracture release. Burns 2024; 50:1597-1604. [PMID: 38609745 DOI: 10.1016/j.burns.2024.03.023] [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: 03/13/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Scar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. METHODS Patients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. RESULTS Forty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6-68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were "satisfied" or "very satisfied". 95% reported improved mobility. No significant adverse events occurred. CONCLUSION This MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury.
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Affiliation(s)
- Sigrid A Blome-Eberwein
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Adam Schwartz
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | | | - Sophia Starner
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Christina Gogal
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, PA, USA
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3
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Liu T, Qu Y, Chai J, Liu X, Hu F, Zhang D, Duan H, Chi Y. Epidemiology and first aid measures in pediatric burn patients in northern China during 2016-2020: A single-center retrospective study. Health Sci Rep 2024; 7:e2218. [PMID: 39072351 PMCID: PMC11273291 DOI: 10.1002/hsr2.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 07/30/2024] Open
Abstract
Background and Aims Burn and scald injuries are the fourth most common type of trauma. Pediatric burns account for a high proportion of the total number of burn patients and impose a high burden on public health. Understanding the epidemiology of pediatric burns can help improve science education and reduce the incidence of burn injuries. Methods This study is a single-center retrospective study. One thousand five hundred and twenty-seven pediatric burn patients admitted to our burn center from January 2016 to December 2020 were included. Demographic and epidemiological data of included patients were extracted and analyzed. The correlations of categorical data were tested by the Chi-square tests, and differences of continuous data were tested by the Kruskal-Wallis tests. A p-value of less than 0.05 was considered to be statistically significant. Results The results showed that children under 3 years of age were most susceptible to burn and scald injuries. Burn injuries were most likely to occur in the season of winter and at the place of home. 56.6% of included patients did receive first aid measures, while 1.8% received gold-standard first aid. Clinical variables related to the severity of injuries were statistically different between patients with and without cooling measures in first aid. Linear regression models showed that emergency treatment of burns in children and adolescents was associated with outcome indicators, including number of operations, total operation duration per total burn surface area (TBSA), cost per TBSA, and length of stay per TBSA. Conclusions This study summarized the epidemiology and outcomes of pediatric burn patients admitted to a burn center in northern China. Adopting cooling measures in first aid can reduce the severity of injuries and reduce the burden on the medical system. Education on burn prevention and first aid measures to caregivers of children, especially preschool children, should be strengthened.
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Affiliation(s)
- Tian Liu
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
- Department of Burn and Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouChina
| | - Yirui Qu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Jiake Chai
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Xiangyu Liu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Fangchao Hu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Dongliang Zhang
- Department of Burns and Cutaneous Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Hongjie Duan
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Yunfei Chi
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
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4
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Fanstone R, Price P. Global perspectives on risk factors for major joint burn contractures: A literature review. Burns 2024; 50:537-549. [PMID: 37977897 DOI: 10.1016/j.burns.2023.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
Contractures are a frequent consequence of burn injuries, yet our knowledge of associated risk factors is limited. This paper provides an extensive review of relevant literature from both High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). Ninety-four papers (up to June 2019) and eight subsequent publications (up to March 2022) were included, 76% of which were from HICs. The majority of publications were either descriptive studies (4 from HICs, 9 from LMICs) or papers citing putative risk factors (37 from HICs, 10 from LMICs). Seventeen publications (all from HICs) reported on the effects of individual non-surgical therapeutic interventions, often with conflicting results. Two published systematic reviews emphasised the poor quality of evidence available. Only fifteen studies (3 from LMICs) examined potential contracture risk factors with statistical comparisons of outcomes; significant findings from these included demographic, burn, comorbidities, and treatment risk factors. LMIC papers included socioeconomic and healthcare system factors as potential risks for contracture; these were rarely considered in HIC publications. Methodological issues identified from this review of literature included differences in contracture definitions, populations studied, standards of care, joints included and the timing and nature of contracture assessments.This review is the first to collate existing knowledge on risk factors for burn contractures from both HIC and LMIC settings, revealing a surprising lack of robust evidence for many accepted risk factors. In LMICs, where burns are particularly common, universal health provision is lacking and specialist burn care is both scarce and difficult to access; consequently, socioeconomic factors may have more immediate impact on contracture outcomes than specific burn treatments or therapies. Much more work is indicated to fully understand the relative impacts of risk factors in different settings so that context-appropriate contracture prevention strategies can be developed.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Fanstone R, Price P, Bodger O, Potokar T, Khan MRK. Risk factors for burn contractures: A cross-sectional study in a lower income country. Burns 2024; 50:454-465. [PMID: 37980272 DOI: 10.1016/j.burns.2023.09.003] [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: 05/02/2023] [Revised: 07/31/2023] [Accepted: 09/09/2023] [Indexed: 11/20/2023]
Abstract
Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n = 104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant's included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
| | - Owen Bodger
- Faculty of Medicine, Health and Life Sciences, Swansea University, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Fanstone R, Price P. Burn contracture risk factors and measurement in low-middle income countries: A clinical perspective. Burns 2024; 50:466-473. [PMID: 37985269 DOI: 10.1016/j.burns.2023.09.007] [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: 04/20/2023] [Revised: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023]
Abstract
We find a lack of high-quality published evidence on risk factors for burn contracture formation. The vast majority of research is from High Income Countries (HICs), where many potential risk factors are controlled for by standardised and high-quality healthcare systems. To augment the published literature, burn care professionals with Low Middle Income Countries (LMICs) experience were interviewed for their opinion on risk factors for burn contracture formation. Participants were also asked for their views on identification and measurement of contracture. Seventeen semi-structured interviews were conducted (13 burn surgeons and 4 therapists). The average length of experience in burn-care was 13 years. Participants represented Ghana, Ethiopia, Malawi, Nigeria, South Africa, Nepal, and India. Participants reported ninety risk factors. Risk factors were later collated according to topic: Non burn individual factors (n = 13), Burn injury factors (n = 14), Family and community factors (n = 9), Treatment factors (n = 18), Complications (n = 2), Healthcare capacity factors (n = 19) and Societal and environmental factors (n = 12). The top five most frequently cited risk factors were lack of splinting, lack of physiotherapy, lack of early excision and skin grafting, low socioeconomic status and presence of infection. Although participants had no doubts that they could recognise a contracture, none provided a standardised system of measurement or an operational definition of contracture. Burn care professionals have a wealth of experience and untapped knowledge of risk factors for burn contracture formation in their own population base, but many of the risk factors highlighted by participants have not yet been explored in the literature. Variations in clinicians' diagnosis and measurement of a burn contracture underscores the need for an agreed, standardised, simple and easily reproducible method of diagnosing and classifying burn contractures.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Chen L, Xie L, Tan J, Li N, Luo Y, Li M, Zhang S, Wang Z. The gut microbiota regulates the depressive-type behaviors and inflammatory processes after severe burn injuries in mice. Heliyon 2024; 10:e25617. [PMID: 38380023 PMCID: PMC10877245 DOI: 10.1016/j.heliyon.2024.e25617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
An emerging number of studies have recently revealed the correlation between burn injuries and psychological disorders. Gut microbiota and inflammatory factors may play a vital role in this process. Nevertheless, there are few studies conducted to disclose the potential mechanism of the gut microbiota between depression and burn injuries. In this study, we constructed a burn model of C57BL/6 mice, which showed that the symptom of depression became more and more severe with the burn of mice lasted longer. Meanwhile, there are significant differences of composition of gut microbiota among mice before and after burn. Then, we tested the inflammatory factors in the brain and peripheral blood, which showed an increased expression of Iba1, VWF, TNF-α and IL-6, and a decreased expression of IL-10 in burn mice. In addition, the expression of zonula occludens-1 (ZO-1) in cecum showed a down-regulation in burn mice, which indicated impaired intestinal barrier function. Lastly, the crossing fecal microbiota transplantation (FMT) and cohousing experiment were conducted to determine the functions of cross-transplantation of fecal microbiota on the depressive-type behaviours in burned mice. According to the score of Tail suspension test (TST), the burn mice were divided into two groups: Resilient mice (no-depressed mice) and Abnormal mice (depressed mice). After abnormal mice were transplanted with fecal microbiota of resilient mice, the symptom of depression was improved, and the expression of TNF-α, IL-6 and IL-10 return to normal levels (P < 0.05). On the contrary, after resilient mice were transplanted with fecal microbiota of abnormal mice both the TST scores and inflammatory factor developed depressive-type changes. In conclusion, our study demonstrated the changes of gut microbiota and inflammatory factors in depressed burn mice and non-depressed burn mice. The gut microbiota dysbiosis could impaired intestinal barrier function and lead to neuroinflammation, and this phenomenon could be significantly mitigated by FMT.
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Affiliation(s)
- Ling Chen
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Army Medical University, Chongqing, China
| | - Langlang Xie
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Army Medical University, Chongqing, China
| | - Jing Tan
- Department of Nursing Management, School of Nursing, Army Medical University, Chongqing, China
| | - Ning Li
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yue Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Maojun Li
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shi Zhang
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Army Medical University, Chongqing, China
| | - Zonghua Wang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
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8
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Kivi MK, Jafarzadeh A, Hosseini-Baharanchi FS, Salehi S, Goodarzi A. The efficacy, satisfaction, and safety of carbon dioxide (CO2) fractional laser in combination with pulsed dye laser (PDL) versus each one alone in the treatment of hypertrophic burn scars: a single-blinded randomized controlled trial. Lasers Med Sci 2024; 39:69. [PMID: 38376542 DOI: 10.1007/s10103-024-03976-6] [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: 07/08/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
The tendency to use less-invasive laser-based methods with far more obvious effectiveness has been taken into consideration today for improvement of burning scars. The present study thus aimed to assess the efficacy of two laser-based techniques including pulsed dye laser (PDL) and ablative fractional CO2 laser (AFCL) and its combination on improving different aspects of burning scars regardless of the types of scar as hypertrophic or keloid scars. This randomized single-blinded clinical trial was performed on patients suffering hypertrophic or keloid burning scars. The patients were randomly assigned into three groups scheduling for treatment with PDL alone, AFCL alone, or its combination. All patients were visited before and 40 days after the last treatment session, and their scars were assessed. In all groups, significant improvement was revealed in the Vancouver scar scale (VSS) score, the color of scar, vascular bed in the scar, the and height of scar and its pliability; however, the improvement in each item was more highlighted in the group receiving a combination therapy with PDL and AFCL techniques. In this regard, the highest improvement was found in vascular bed and pliability in the combination therapy group as compared to other groups. Although the superiority of the combined group was not statistically significant, due to the high percentage of improvement in total VSS and most of its indicators, it can be clinically significant. The efficacy of the treatment protocols was different considering subgroups of mature and immature scars (less than 1 year), so that more improvement in pliability of scar, vascularity, and color of scar was found in the group scheduling for PDL + AFCL as compared to those who were treated with PDL alone in immature scar group but not in mature scar group. Combined treatment can be much more effective in improving the appearance and pathological characteristics of scars than each individual treatment. This effectiveness can be seen mainly in immature scars.
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Affiliation(s)
- Maedeh Karimi Kivi
- Medical Students Association, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemeh Sadat Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center & Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sadaf Salehi
- Medical Students Association, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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9
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Abstract
Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients' lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.
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Affiliation(s)
- Marc G Jeschke
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Fiona M Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Children's Hospital, Perth, Western Australia, Australia
- Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, Netherlands
- Association of Dutch Burn Centers (ADBC), Beverwijk, Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Ardeshir Bayat
- Medical Research Council Wound Healing Unit, Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Luc Teot
- Department of Plastic Surgery, Burns, Wound Healing, Montpellier University Hospital, Montpellier, France
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig-Maximilian University Munich, Munich, Germany
- Haut- und Laserzentrum Glockenbach, Munich, Germany
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10
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Deng H, Genovese TJ, Schneider JC. A Narrative Review of Outcomes in Burn Rehabilitation Based on the International Classification of Functioning, Disability, and Health. Phys Med Rehabil Clin N Am 2023; 34:867-881. [PMID: 37806703 PMCID: PMC10560762 DOI: 10.1016/j.pmr.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Burn injury commonly causes long-term physical impairments and psychosocial limitations that impact survivorship. This article uses the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) framework to summarize burn rehabilitation outcomes related to body functions and structures and how they relate to activities and participation within the social context. This article will contribute to a better understanding of burn recovery, facilitate the identification of specific and meaningful issues common to burn survivorship that may be under-reported in prior investigations and guide future rehabilitation to advance long-term burn outcomes.
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Affiliation(s)
- Huan Deng
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1st Avenue, Boston, MA 02129, USA
| | - Timothy J Genovese
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1st Avenue, Boston, MA 02129, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 300 1st Avenue, Boston, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Twichell M. Inpatient Rehabilitation Following Burn Injury. Phys Med Rehabil Clin N Am 2023; 34:755-765. [PMID: 37806695 DOI: 10.1016/j.pmr.2023.06.002] [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
Inpatient rehabilitation confers excellent benefit to burn survivors and should be considered as a potential destination during discharge planning. Consulting physiatrists identify and manage complications within the inpatient rehabilitation setting. Interventions can be taken to address medical sequelae of injury, including pain, itch, neuropathy, psychological coping and mood, and nutritional needs. Physiatrists also oversee and direct a rehabilitation program focusing on scar management, contracture prevention, dysphagia treatment, and evaluation and treatment of cognitive impairments. Aerobic and resistive exercise are key components of an inpatient rehabilitation program to reduce the systemic impact of a burn injury and improve quality of life.
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Affiliation(s)
- Maria Twichell
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA.
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12
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Li R, Zheng Y, Fan X, Cao Z, Yue Q, Fan J, Gan C, Jiao H, Liu L. Establishment and validation of a nomogram to predict the neck contracture after skin grafting in burn patients: A multicentre cohort study. Int Wound J 2023; 20:3648-3656. [PMID: 37245866 PMCID: PMC10588345 DOI: 10.1111/iwj.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023] Open
Abstract
Cervical burn contracture is one of the burn contractures with the highest incidence and severity, and there is no effective method to predict the risk of neck contracture. This study aimed to investigate the effect of combined cervicothoracic skin grafting on the risk of neck contracture in burn patients and to develop a nomogram to predict the risk of neck contracture after skin grafting in burn patients. Data from 212 patients with burns who underwent neck skin grafting were collected from three hospitals, and the patients were randomly divided into training and validation sets. Independent predictors were identified through univariate and multivariate logistic regression analyses and incorporated into a prognostic nomogram. Its performance was assessed using the receiver operating characteristic area under the curve, calibration curve, and decision curve analysis. Burn depth, combined cervicothoracic skin grafting, graft thickness, and neck graft size were significantly associated with neck contractures. In the training cohort, the nomogram had an area under the curve of 0.894. The calibration curve and decision curve analysis indicated good clinical applicability of the nomogram. The results were tested using a validation dataset. Combined cervicothoracic skin grafting is an independent risk factor for neck contracture. Our nomogram demonstrated excellent performance in predicting neck contracture risk.
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Affiliation(s)
- Rui Li
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yangyang Zheng
- Department of General Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Xijuan Fan
- Department of Plastic SurgeryBeijing Ever Care Medical and Beauty HospitalBeijingChina
| | - Zilong Cao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Qiang Yue
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Jincai Fan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Cheng Gan
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Hu Jiao
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Liqiang Liu
- Scar and Wound Treatment CenterPlastic Surgery Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
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Abdulrazzak M, Shehnah G, Mohamad A, Shehada S, Etr A. Massive scar contractures in unique presentation: Case report. Int J Surg Case Rep 2023; 112:108960. [PMID: 37839255 PMCID: PMC10667866 DOI: 10.1016/j.ijscr.2023.108960] [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: 09/14/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Scar contractures are a common complication of burn injuries, especially in the head and neck region. This paper presents a case of a middle-aged female who suffered severe scar contracture after a burn injury during the war in Syria. PRESENTATION OF CASE A 33-year-old woman with a severe neck scar contracture resulting from a neglected burn injury presented to a plastic surgery department. The contractures extended to the chin, mandible, chest, and upper limbs. The patient underwent contracture release and reconstruction surgery, which involved the removal of the platysma and the placement of split-thickness skin grafts. The patient was discharged after one month of hospitalization. However, burn injuries require immediate and deliberate treatment, which may include reconstructive surgery. DISCUSSION Despite various efforts have been made to prevent the development of contractures, the contraction ratio of burn scars is still a badly controlled process, and reconstructive surgery is often indicated. There are many options to achieving the surgery, which vary in complexity. However, there is no preferable strategy and each option has advantages and disadvantages. CONCLUSION Reconstructive is complete and technically demanded surgery, which needs special centers and professionals, this leads to poor results, especially in development countries like Syria.
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Affiliation(s)
- Mohammed Abdulrazzak
- Faculty of Medicine, University of Aleppo, Aleppo, Syria; CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Ghina Shehnah
- Faculty of Medicine, University of Aleppo, Aleppo, Syria; CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Anwar Mohamad
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Sounar Shehada
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Aladdin Etr
- Department of Plastic Surgery, Faculty of Medicine, Aleppo University, Aleppo, Syria
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14
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Schetzsle S, Lin WWC, Purushothaman P, Ding J, Kwan P, Tredget EE. Serial Casting as an Effective Method for Burn Scar Contracture Rehabilitation: A Case Series. J Burn Care Res 2023; 44:1062-1072. [PMID: 37254900 DOI: 10.1093/jbcr/irad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Indexed: 06/01/2023]
Abstract
Guidelines and protocols for orthoses in burn scar contracture rehabilitation are limited. The current study aims to determine the optimal frequency of casting, potentially facilitating the development of a serial casting protocol. Previous literature supporting casting has low generalizability due to methodology limitations. Seven patients with burn scar contracted joints, who did not respond to traditional therapy, were recruited in this study. Patients were serially casted once, three times, or five times a week. Joint range of motion was maximized with stretching and exercise techniques before every new cast application. Across all patients, active range of motion increased from 65.8 ± 27.8° to 108.1 ± 23.3° with casting; or from 57.8 ± 16.2% to 96.7 ± 2.9% of normal. Similarly, scars improved from 9.5 ± 1.5 to 4.9 ± 1.4 on the Modified Vancouver Scar Scale score. This therapeutic effect was achieved within an average of 8.5 ± 3.7 d and 4.0 ± 2.2 new cast applications. Given the study findings, the procedures outlined could be used to develop a standardized serial casting protocol for burn scar contracture rehabilitation.
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Affiliation(s)
- Stephanie Schetzsle
- Department of Surgery, Firefighters Burn Treatment Unit, University of Alberta Hospital, Edmonton, AB, CanadaT6G 2B7
| | - Weber Wei Chiang Lin
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Prabhu Purushothaman
- Department of Surgery, Firefighters Burn Treatment Unit, University of Alberta Hospital, Edmonton, AB, CanadaT6G 2B7
| | - Jie Ding
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Peter Kwan
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Edward E Tredget
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
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15
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Li R, Zheng Y, Fan X, Cao Z, Yue Q, Fan J, Gan C, Jiao H, Liu L. Epidemiology and Predictors for Cervical Burn Scar Contractures: A Multicenter Cohort Study. J Craniofac Surg 2023; 34:1795-1798. [PMID: 37184463 DOI: 10.1097/scs.0000000000009344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 05/16/2023] Open
Abstract
Cervical burn scar contracture (BSC) affects many important neck functions and the patients' quality of life. However, it remains unclear which patients have a higher risk of neck BSCs. This study aimed to describe the epidemiology and identify the independent risks of cervical BSC formation and severity. Clinical and demographic data of 106 patients with burn scars were retrospectively collated and analyzed from 3 different Chinese hospitals between December 2016 and December 2020. Both univariate and multivariate logistic regression analyses were performed to identify the independent risks for BSC formation and severity at 12 months postburn. Lateral flexion was the most common plane of motion (POM) limited by contractures (29.4%), whereas the POM most commonly limited by severe contractures was the extension (24.6%). Most patients with contractures had those in 3 to 4 POMs (72.1%). Neck skin grafting was an independent risk factor for BSC formation, and cervical and cervicothoracic skin grafting were independent risk factors for BSC severity. These results may help to identify high-risk patients with contractures in the early stages of burns to carry out individualized early prevention and treatment.
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Affiliation(s)
- Rui Li
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangyang Zheng
- Department of General Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xijuan Fan
- Department of Plastic Surgery, Beijing Ever Care Medical and Beauty Hospital, Beijing, China
| | - Zilong Cao
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Yue
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jincai Fan
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Gan
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hu Jiao
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liqiang Liu
- 9th Department, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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16
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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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17
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Thomas R, Wicks S, Toose C, Dale M, Pacey V. Reliability, Validity, and Predictive Validity of Cutaneous Functional Units Predicted to Scar Following Palmar Burn Injury in Young Children. J Burn Care Res 2023; 44:918-924. [PMID: 36478206 DOI: 10.1093/jbcr/irac179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Identification of children at risk of palmar burn scar is important for early initiation of scar management. This study determined the interrater reliability of face-to-face and photographic assessments of 29 palmar cutaneous functional units (CFUs) predicted to scar following palmar burn. The validity of photographic compared to face-to-face assessment, and the predictive validity of both assessment types to identify scarring at 3 to 6 months following burn, was also established. Thirty-nine children (40 hands) post burn injury were assessed face-to-face in the clinical setting, following healing of their palmar burn, by three burn therapists. Photographs of the children's hands at initial assessment were assessed by the same therapists a minimum of 6 months later. To determine which CFUs scarred, children were reassessed face-to-face in the clinical setting 3 to 6 months following their burn. For analysis, 29 CFUs were merged into eight separate groups to determine the number of CFUs predicted to scar per CFU group for face-to-face and photographic assessments. The range of agreement for individual CFUs within CFU groups was also calculated for both assessment types. Excellent interrater reliability was established for face-to-face assessment in all eight CFU groups (ICC2,1 0.83-0.96). Photographic assessment demonstrated good to excellent interrater reliability in six CFU groups (ICC2,1 0.69-0.90) and validity in seven CFU groups (ICC2,1 0.66-0.87). Good to excellent predictive validity was established for both assessment types in seven CFU groups (face-to-face ICC2,1 0.60-0.95, photographic ICC2,1 0.69-0.89). Experienced therapists can reliably assess CFUs face-to-face or via photographs and predict future scar development.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Claire Toose
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Marita Dale
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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18
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Cancio JM, Dewey WS. Critical Care Rehabilitation of the Burn Patient. Surg Clin North Am 2023; 103:483-494. [PMID: 37149384 DOI: 10.1016/j.suc.2023.01.010] [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: 05/08/2023]
Abstract
Despite the fact that modern burn care has significantly reduced the mortality associated with severe burn injuries, the rehabilitation and community reintegration of survivors continues to be a challenge. An interprofessional team approach is essential for optimal outcomes. This includes early occupational and physical therapy, beginning in the intensive care unit (ICU). Burn-specific techniques (edema management, wound healing, and contracture prevention) are successfully integrated into the burn ICU. Research demonstrates that early intensive rehabilitation of critically ill burn patients is safe and effective. Further work on the physiologic, functional, and long-term impact of this care is needed.
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Affiliation(s)
- Jill M Cancio
- US Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767, USA.
| | - William S Dewey
- US Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767, USA
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19
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Bryarly J, Kowalske K. Long-Term Outcomes in Burn Patients. Surg Clin North Am 2023; 103:505-513. [PMID: 37149386 DOI: 10.1016/j.suc.2023.02.004] [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: 05/08/2023]
Abstract
Better understanding of long-term outcomes after burn injury is essential for the burn clinician. Contractures are present in almost half of patients at discharge. Although less common, neuropathy and heterotopic ossification may be missed or go unaddressed. Close attention to psychological distress and to challenges with community reentry is essential. Obviously long-term problems with skin issues occur but other issues must be attended to maximize health and quality of life after injury. Facilitating access to community resources and providing long-term medical follow-up should be the standard of care.
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Affiliation(s)
- Julia Bryarly
- Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9055, USA
| | - Karen Kowalske
- Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9055, USA.
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20
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Abdelhakim M, Dohi T, Ogawa R. Congress Report on the Second World Congress of Global Scar Society with Scar Academy and Japan Scar Workshop. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4921. [PMID: 37073255 PMCID: PMC10106224 DOI: 10.1097/gox.0000000000004921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023]
Abstract
Pathological scars (including keloids, hypertrophic scars, and scar contractures) are present with high severity among certain populations, particularly in Asians and Africans who are highly prone to develop scars. Understanding the patho-mechanism that underlies scarring, such as mechanosignaling, systemic, and genetic factors, as well as optimal surgical techniques and integrated noninvasive therapeutic methods can guide clinicians to develop treatment protocols that can overcome these issues. This report summarizes a congress at Pacifico Yokohama (Conference Center) on December 19, 2021 involving researchers and clinicians from diverse disciplines who convened to discuss current clinical, preclinical, and most recent research advances in understanding pathological scarring, keloid and hypertrophic scar management, and research progress in wound healing. Presenters described the advances in scar therapies, understanding scarring mechanisms, and scar prevention and assessments tools. Moreover, presenters addressed the challenges during the COVID-19 pandemic and using telemedicine in management of scar patients.
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Affiliation(s)
- Mohamed Abdelhakim
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Teruyuki Dohi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Rei Ogawa
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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21
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Rodriguez-Menocal L, Davis SC, Guzman W, Gil J, Valdes J, Solis M, Higa A, Natesan S, Schulman CI, Christy RJ, Badiavas EV. Model to Inhibit Contraction in Third-Degree Burns Employing Split-Thickness Skin Graft and Administered Bone Marrow-Derived Stem Cells. J Burn Care Res 2023; 44:302-310. [PMID: 36048023 DOI: 10.1093/jbcr/irac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 11/14/2022]
Abstract
Third-degree burns typically result in pronounced scarring and contraction in superficial and deep tissues. Established techniques such as debridement and grafting provide benefit in the acute phase of burn therapy, nevertheless, scar and contraction remain a challenge in deep burns management. Our ambition is to evaluate the effectiveness of novel cell-based therapies, which can be implemented into the standard of care debridement and grafting procedures. Twenty-seven third-degree burn wounds were created on the dorsal area of Red Duroc pig. After 72 h, burns are surgically debrided using a Weck knife. Split-thickness skin grafts (STSGs) were then taken after debridement and placed on burn scars combined with bone marrow stem cells (BM-MSCs). Biopsy samples were taken on days 17, 21, and 45 posttreatment for evaluation. Histological analysis revealed that untreated control scars at 17 days are more raised than burns treated with STSGs alone and/or STSGs with BM-MSCs. Wounds treated with skin grafts plus BM-MSCs appeared thinner and longer, indicative of reduced contraction. qPCR revealed some elevation of α-SMA expression at day 21 and Collagen Iα2 in cells derived from wounds treated with skin grafts alone compared to wounds treated with STSGs + BM-MSCs. We observed a reduction level of TGFβ-1 expression at days 17, 21, and 45 in cells derived from wounds treated compared to controls. These results, where the combined use of stem cells and skin grafts stimulate healing and reduce contraction following third-degree burn injury, have a potential as a novel therapy in the clinic.
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Affiliation(s)
- Luis Rodriguez-Menocal
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery/Interdisciplinary/Stem Cell Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Stephen C Davis
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Wellington Guzman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery/Interdisciplinary/Stem Cell Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Joel Gil
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Jose Valdes
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Michael Solis
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Alexander Higa
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Shanmugasundaram Natesan
- Extremity Trauma and Regenerative Medicine Program, US Army Institute of Surgical Research, Texas, USA
| | - Carl I Schulman
- Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Robert J Christy
- Extremity Trauma and Regenerative Medicine Program, US Army Institute of Surgical Research, Texas, USA
| | - Evangelos V Badiavas
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery/Interdisciplinary/Stem Cell Institute, University of Miami School of Medicine, Miami, Florida, USA
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22
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Ge X, Sun Y, Tang Y, Zhou F, Yao G, Su X. Flexible application of scar tissue flaps in scar contracture release surgery: A retrospective study. J Cosmet Dermatol 2023; 22:907-912. [PMID: 36374624 DOI: 10.1111/jocd.15505] [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: 08/24/2022] [Revised: 10/03/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Complete release of scar contracture often relies on surgery, but if the surgery injures normal skin tissue triggers new wounds and scarring, which adds insult to injury for the patient. OBJECTIVE To explore a method that uses scar tissue to repair the defect after the release of scars and try to avoid damage to normal skin tissue. MATERIALS AND METHODS Forty-eight scar contracture patients admitted to our hospital from October 2014 to October 2019 were treated with scar tissue flaps (including Subcutaneous pedicle rhomboid flap, Z-plasty flap, 5-flap, and their combination model) and minor defects in combination with little scattered skin grafts. Medical and demographic data were collected on each patient. Assessed the joint range of motion (ROM) preoperatively and postoperatively, and complication was recorded. The rate of scar contracture recurrence was recorded at a follow-up of 6-24 months. RESULTS Twenty-eight cases of scar contracture located in the joint sites, 20 in the trunk. All the surgical outcomes were satisfied, with significant improvement in contracture scarring and joint status. Postoperative joint range of motion (ROM) showed a significant improvement in comparison with preoperative mobility, whereas the difference was statistically significant (p < 0.05). After 24 months of follow-up, five joints showed recontraction, with a recurrence rate of 10.42%. CONCLUSION Scar contracture could be efficiently treated by properly designing incisions and making the most of the scar tissue flap, to minimize and avoid damage to the normal skin.
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Affiliation(s)
- Xiaojing Ge
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yute Sun
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Youzhi Tang
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang Zhou
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yao
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Su
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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23
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Lan X, Tan Z, Zhou T, Huang Z, Huang Z, Wang C, Chen Z, Ma Y, Kang T, Gu Y, Wang D, Huang Y. Use of Virtual Reality in Burn Rehabilitation: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023; 104:502-513. [PMID: 36030891 DOI: 10.1016/j.apmr.2022.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We systematically reviewed published clinical trials to evaluate the effectiveness of virtual reality (VR) technology on functional improvement, pain relief, and reduction of mental distress among burn patients undergoing rehabilitation. DATA SOURCES Systematic searches were conducted in 4 databases, including PubMed, the Cochrane Library, Embase, and Web of Science, from inception to August 2021. STUDY SELECTION Randomized controlled trials (RCTs) evaluating any type of VR for the rehabilitation in burn patients with dysfunction were included. DATA EXTRACTION Two reviewers evaluated the eligibility, and another 2 reviewers used the Cochrane risk of bias assessment tool to assess the risk of bias. The extracted data included the main results of rehabilitation evaluation (quality of life [QOL], work performance, range of motion [ROM] of joints, hand grip and pinch strength, pain, fun, anxiety), the application performance of VR (realness and presence), adverse effects (fatigue and nausea), and characteristics of the included studies. Heterogeneity was evaluated using the chi-square tests and I2 statistics. Random- or fixed-effects models were conducted to pool the effect sizes expressed as standardized mean differences (SMDs). DATA SYNTHESIS Sixteen RCTs with 535 burn patients were included. VR-based interventions were superior to usual rehabilitation in QOL and work performance of burn patients and produced positive effect on the average gain of ROM (SMD=0.72) as well. VR was not associated with improved hand grip and pinch strength (SMD=0.50, 1.22, respectively) but was associated with reduced intensity, affective, and cognitive components of pain (SMD=-1.26, -0.71, -1.01, respectively) compared with control conditions. Ratings of fun in rehabilitation therapy were higher (SMD=2.38), and anxiety scores were lower (SMD=-0.73) than in control conditions. CONCLUSIONS VR-based burn rehabilitation significantly improves the QOL and work performance of burn patients, increases the ROM gain in the joints, reduces the intensity and unpleasantness of pain and the time spent thinking about pain, increases the fun in the rehabilitation therapy, reduces the anxiety caused by the treatment, and has no obvious adverse effects. However, it did not significantly improve hand grip or pinch strength.
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Affiliation(s)
- Xiaodong Lan
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Ziming Tan
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Tao Zhou
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Zhenjia Huang
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Zhiyong Huang
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Chao Wang
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Zhenwei Chen
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Yan Ma
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Tao Kang
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Yan Gu
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Dehuai Wang
- Department of Burn and Plastic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Yuesheng Huang
- Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology School of Medicine; Department of Wound Repair, Southern University of Science and Technology Hospital, Shenzhen, China.
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24
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Mason SA, Pham TN. Use of Dermal Regenerative Templates for Burns. J Burn Care Res 2023; 44:S19-S25. [PMID: 36567477 DOI: 10.1093/jbcr/irac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autologous skin grafting has permitted survival and restoration of function in burn injuries of ever larger total body surface area (TBSA) sizes. However, the goal of replacing "like with like" skin structures is often impossible because full-thickness donor harvesting requires primary closure at the donor site for it to heal. Split-thickness skin grafting (STSG), on the other hand, only harvests part of the dermis at the donor site, allowing it to re-epithelialize on its own. The development of the first dermal regenerative template (DRT) in the late 1970s represented a major advance in tissue engineering that addresses the issue of insufficient dermal replacement when STSGs are applied to the full-thickness defect. This review aims to provide an overview of currently available DRTs in burn management from a clinician's perspective. It focuses on the main strengths and pitfalls of each product and provides clinical pearls based on clinical experience and evidence.
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Affiliation(s)
| | - Tam N Pham
- University of Washington, Regional Burn Center at Harborview, USA
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25
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Challita R, Bazzi N, Fazaa E, Maassarani D, Habib T, Bazzi M, Ghanime G, Sleiman Z. Management of Burn Scars: A Five-Year Retrospective Study. Cureus 2022; 14:e31448. [DOI: 10.7759/cureus.31448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/14/2022] Open
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Shupp JW, Holmes JH, Moffatt LT, Phelan HA, Sousse L, Romanowski KS, Jeschke M, Kowalske KJ, Badger K, Allely R, Cartotto R, Burmeister DM, Kubasiak JC, Wolf SE, Wallace KF, Gillenwater J, Schneider DM, Hultman CS, Wiechman SA, Bailey JK, Powell HM, Travis TE, Supp DM, Carney BC, Johnson LS, Johnson LS, Chung KK, Chung KK, Kahn SA, Gibson ALF, Christy RJ, Carter JE, Carson JS, Palmieri TL, Kopari NM, Blome-Eberwein SA, Hickerson WL, Parry I, Cancio JM, Suman O, Schulman CI, Lamendella R, Hill DM, Wibbenmeyer LA, Nygaard RM, Wagner AL, Carter ADW, Greenhalgh DG, Lawless MB, Carlson DL, Harrington DT. Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting. J Burn Care Res 2022; 43:1241-1259. [PMID: 35988021 DOI: 10.1093/jbcr/irac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA's Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA's Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.
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Ashouri S. An Introduction to Burns. Phys Med Rehabil Clin N Am 2022; 33:871-883. [DOI: 10.1016/j.pmr.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lahdenperä NI, Lindford A, Kautiainen H, Paloneva J, Hietanen K, Vuola J, Repo JP. Translation and psychometric validation of the Finnish version of the Patient Scar Assessment Scale for use in patients with burn scars. Burns 2022:S0305-4179(22)00232-7. [PMID: 36137884 DOI: 10.1016/j.burns.2022.08.025] [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: 01/01/2022] [Revised: 08/15/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to create a Finnish scar assessment scale by translating and evaluating the psychometric properties of the Patient Scar Assessment Scale (PSAS), a part of the Patient and Observer Scar Assessment Scale (POSAS), with burn patients to enable its use in burn care. METHODS The translation process followed international guidelines with forward and backward translations and cognitive debriefing with patients. Psychometric validation was performed with adult patients with burns who had been treated at the Helsinki Burn Centre between 2006 and 2017 with skin grafting following the excision of deep second- or third-degree burns. To ensure reproducibility, the PSAS was sent to the study participants twice. The correlation between the PSAS and health-related quality of life (HRQL) was also tested. RESULTS In total, 192 patients, of whom 71 % were male, participated in this study. The mean (SD) age of the participants was 57 (17) years. The internal consistency of the PSAS was good, Cronbach's α 0.89 (95 % CI: 0.86-0.91). The reproducibility was also good concerning all items and the total score, ICC from 0.77 to 0.89. As expected, the total PSAS score correlated negatively with HRQL. CONCLUSION The PSAS was successfully translated and culturally adapted into Finnish and the newly translated version has good validity and reproducibility for assessing mature burn scars.
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Affiliation(s)
- Noora-Ilona Lahdenperä
- Department of Surgery, Hyvinkää Hospital, the Hospital District of Helsinki and Uusimaa, Sairaalankatu 1, FI-05850 Hyvinkää, Finland.
| | - Andrew Lindford
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
| | | | - Juha Paloneva
- Department of Surgery, Central Finland Healthcare District, Keskussairaalantie 19, FI-40620 Jyväskylä, Finland
| | - Kristiina Hietanen
- Department of Surgery, Central Finland Healthcare District, Keskussairaalantie 19, FI-40620 Jyväskylä, Finland
| | - Jyrki Vuola
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Hatanpäänkatu 24, FI-33900 Tampere, Finland
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Self-reported health measures in burn survivors undergoing burn surgery following acute hospitalization: A burn model system national database investigation. Burns 2022; 49:688-700. [PMID: 35718573 DOI: 10.1016/j.burns.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Health Related Quality of Life (HRQoL) surveys such as PROMIS-29 may facilitate shared decision-making regarding surgery after burn injury. We aimed to examine whether scar revision and contracture release surgery after index hospitalization was associated with differences in HRQoL. METHODS Patient and PROMIS-29 Profile v2.0 data were extracted from the Burn Model System (BMS) at 6-, 12-, and 24-months after burn. PROMIS-29 measures 7 health-related domains. Linear regression was performed to identify associations between independent burn patient variables (e.g. scar-related surgery) and PROMIS-29 scores. Socio-demographic and injury variables were analyzed using logistic regression to determine the likelihood of undergoing burn-related surgery. RESULTS Of 727 participants, 201 (27.6%) underwent ≥ 1 scar/contracture operation within 24 months of injury. Number of operations at index hospital admission and range of motion (ROM) deficit at discharge were correlated with an increased likelihood of undergoing subsequent scar/contracture surgery (p < 0.05). Participants undergoing scar/contracture surgery and those that were Medicaid insured reported significantly worse HRQoL for PROMIS domains: anxiety, depression, and fatigue (p < 0.05). CONCLUSIONS After adjusting for burn severity and available confounders, participants who underwent scar-related burn reconstructive surgery after index hospitalization reported overall worse Health-Related Quality of Life (HRQoL) in multiple domains.
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Edger-Lacoursière Z, Deziel E, Nedelec B. Rehabilitation interventions after hand burn injury in adults: A systematic review. Burns 2022; 49:516-553. [PMID: 35662480 DOI: 10.1016/j.burns.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
The aim of this review was to summarise the current evidence regarding the effectiveness of rehabilitation interventions in improving hand function, range of motion (ROM), hand strength, scar outcome, return to work, level of impairment/disability, level of burn knowledge and decreasing edema following hand burns in adult burn survivors. This review provides evidence-based support for the use of rehabilitation interventions for burn rehabilitation professionals. The following data sources were searched: MEDLINE, EMBASE and CINAHL from their inception up to February 2021, reference lists from all the included full-text articles were screened for additional relevant publications and monthly Google Scholar searches until December 23rd 2021 to make sure all new pertinent published articles after February 2021 would be included. Thirty-five studies were included in this review including 14 RCTs. Most of the included studies were Level 4 (46%; 16/35) and Level 2 (40%; 14/35) evidence. Only four studies were classified as Level 3 (14%; 5/35) evidence and none were considered Level 1. Most studies received a score of 5-9 (54%; 19/35) (Moderate quality). Fourteen studies received a score of ≥ 10 (40%; 14/35) (High quality) and only 2 studies received a score of< 5 (6%; 2/35) (Low quality). Articles were categorized according to the primary outcome targeted by the intervention. Clinical recommendations on higher-level evidence interventions are presented. This review supports the clinical practice of the following interventions: 1) The use of adhesive compression wraps for patients who have increased edema to increase hand function and ROM; 2) The use of compression (adhesive compressive wrap, compression bandage or intermittent compression pump) to decrease hand edema following burn injury; 3) Participating in general rehabilitation to increase hand function and patient perceived level of disability; 4) The use of an orthosis to increase ROM and a dynamic MCP orthosis to increase hand function; 5) If available, incorporate the use of VR based rehabilitation to increase hand function and hand strength; 6) The use of paraffin to increase hand PROM; 7) The use of gels to reduce hand scar thickness; 8) The use of an education component in rehabilitation to increase the level of burn knowledge. The limitations of this study are also discussed. Further research with robust methodology is needed to investigate the potential benefits of treatment interventions included in this review.
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Affiliation(s)
- Zoë Edger-Lacoursière
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3A 0G4, Canada; Hôpital de Réadaptation Villa Medica, Montreal, QC H2X 1C9, Canada; Centre Professionnel d'Ergothérapie, Montreal, QC H1N 1E5, Canada
| | - Erika Deziel
- Centre Professionnel d'Ergothérapie, Montreal, QC H1N 1E5, Canada
| | - Bernadette Nedelec
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3A 0G4, Canada; Hôpital de Réadaptation Villa Medica, Montreal, QC H2X 1C9, Canada.
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Aguilera-Sáez J, Dos Santos BP, Serracanta J, Monte-Soldado A, Bosacoma P, Rivas-Nicolls D, Barret JP. The effect of Extracorporeal Shock Wave Therapy in the treatment of burn scars: A prospective, randomized, controlled trial. Burns 2022; 48:577-584. [PMID: 34844816 DOI: 10.1016/j.burns.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/24/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current scientific evidence on the effect of Extracorporeal Shock Wave Therapy (ESWT) as adjunctive treatment for burn scars is scarce. However preliminary evidence, indicates it might prove a useful tool. MATERIALS AND METHODS A prospective, randomized, controlled study was conducted from February 2017 to February 2019. Patients with burn scars were divided into two groups with twenty patients per group. The control group received the standard treatment for burn scars. The ESWT group received the standard treatment and treatment of burn scars with ESWT 512 impulses of 0.15mJ/mm2 in each session, twice per week for 4 weeks. We assessed the appearance of scar with the Vancouver Scar Scale (VSS), pruritus and pain with Visual Analog Scale (VAS) before the start of the treatment and at 2 weeks and 5 months after the treatment. RESULTS Both groups showed improvements in all variables through the study. However, these improvements were only statistically significant for the VSS at the 6th month for the control group and VSS and VAS pain and pruritus for the ESWT group. Nonetheless the results failed to show statistically significant differences between the ESWT and the control group neither at two weeks after treatment nor at 5 months after treatment. CONCLUSION Our study questions the relevance of ESWT as adjunctive treatment for burn scars as far as outward appearance, pain and pruritus as end-results are concern. Nonetheless, further studies are required to accurately assess the potential benefits of ESWT as an adjunctive treatment for burn scars.
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Affiliation(s)
- Jorge Aguilera-Sáez
- Department of Plastic Surgery and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Bruce P Dos Santos
- Department of Plastic Surgery and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Serracanta
- Department of Plastic Surgery and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Alejandra Monte-Soldado
- Department of Plastic Surgery and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Pau Bosacoma
- Department of Plastic Surgery and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Danilo Rivas-Nicolls
- Department of Plastic Surgery and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Juan P Barret
- Department of Plastic Surgery and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Iyer C, Soletti AB. Lived Experiences of Adult Burn Survivors with Post-Burn Contractures. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:209-223. [PMID: 34797206 DOI: 10.1080/19371918.2021.1997862] [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
The article documents the life changes and challenges that are experienced by individuals who suffer from burns with long-lasting injury, and what are the available support mechanisms for these individuals. The experiences are drawn from a qualitative phenomenological inquiry conducted at a leading facility for burns treatment in Navi Mumbai, where people from across the country can access free non-cosmetic corrective surgery for burn-related contracture. In-depth interviews have been conducted with nine participants and three key informants. Burns are commonly experienced as a disabling phenomenon, with the repercussions being experienced in the activities of daily living, finances, social roles, and social participation. We have noted, not only the changes in physical and emotional self but also the difficulty in accepting the changed self. Traversing and negotiating the fragmented healthcare system has been a baffling experience that is riddled with expensive, complex, and protracted treatment procedures. The uncertainty around the prognosis and treatment are sources of distress for the participants and their families. The paper concludes by indicating the need and scope for social work interventions in the lived experiences of adult burn survivors.
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Affiliation(s)
- Chetana Iyer
- Center for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences, Mumbai, India
| | - Asha Banu Soletti
- Center for Health and Mental Health, School of Social Work, Tata Institute of Social Sciences, Mumbai, India
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Schouten HJ, Nieuwenhuis MK, van Baar ME, van der Schans CP, Niemeijer AS, van Zuijlen PPM. The degree of joint range of motion limitations after burn injuries during recovery. Burns 2022; 48:309-318. [PMID: 34955294 DOI: 10.1016/j.burns.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to determine the degree of ROM limitations of extremities, joints and planes of motion after burns and its prevalence over time. METHOD The database of a longitudinal multicenter cohort study in the Netherlands (2011-2012) was used. From patients with acute burns involving the neck, shoulder, elbow, wrist, hip, knee and ankle joints that had surgery, ROM of 17 planes of motion was assessed by goniometry at 3, 6 weeks, 3-6-9 and 12 months after burns and at discharge. RESULTS At 12 months after injury, 12 out of 17 planes of motion demonstrated persistent joint limitations. The five unlimited planes of motion were all of the lower extremity. The most severely limited joints at 12 months were the neck, ankle, wrist and shoulder. The lower extremity was more severely limited in the early phase of recovery whereas at 12 months the upper extremity was more severely limited. CONCLUSION The degree of ROM limitations and prevalence varied over time between extremities, joints and planes of motion. This study showed which joints and planes of motion should be watched specifically concerning the development of scar contracture.
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Affiliation(s)
- H J Schouten
- Association of Dutch Burn Centers, Burn Centre, Red Cross Hospital Beverwijk, The Netherlands; Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Physiotherapy, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands.
| | - M K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands
| | - M E van Baar
- Association of Dutch Burn Centers, Burn Centre, Maasstad Hospital Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - C P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, The Netherlands; Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, The Netherlands; Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - A S Niemeijer
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Research Institute, Martini Hospital Groningen, The Netherlands
| | - P P M van Zuijlen
- Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Korkmaz HI, Niessen FB, Pijpe A, Sheraton VM, Vermolen FJ, Krijnen PA, Niessen HW, Sloot PM, Middelkoop E, Gibbs S, van Zuijlen PP. Scar formation from the perspective of complexity science: a new look at the biological system as a whole. J Wound Care 2022; 31:178-184. [PMID: 35148632 DOI: 10.12968/jowc.2022.31.2.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A burn wound is a complex systemic disease at multiple levels. Current knowledge of scar formation after burn injury has come from traditional biological and clinical studies. These are normally focused on just a small part of the entire process, which has limited our ability to sufficiently understand the underlying mechanisms and to predict systems behaviour. Scar formation after burn injury is a result of a complex biological system-wound healing. It is a part of a larger whole. In this self-organising system, many components form networks of interactions with each other. These networks of interactions are typically non-linear and change their states dynamically, responding to the environment and showing emergent long-term behaviour. How molecular and cellular data relate to clinical phenomena, especially regarding effective therapies of burn wounds to achieve minimal scarring, is difficult to unravel and comprehend. Complexity science can help bridge this gap by integrating small parts into a larger whole, such that relevant biological mechanisms and data are combined in a computational model to better understand the complexity of the entire biological system. A better understanding of the complex biological system of post-burn scar formation could bring research and treatment regimens to the next level. The aim of this review/position paper is to create more awareness of complexity in scar formation after burn injury by describing the basic principles of complexity science and its potential for burn care professionals.
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Affiliation(s)
- H Ibrahim Korkmaz
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands
| | - Frank B Niessen
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Anouk Pijpe
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Vivek M Sheraton
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Fred J Vermolen
- Delft Institute of Applied Mathematics, Delft University of Technology, Delft, The Netherlands.,Computational Mathematics, Hasselt University, Diepenbeek, Belgium
| | - Paul Aj Krijnen
- Department of Pathology and Cardiac Surgery, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Hans Wm Niessen
- Department of Pathology and Cardiac Surgery, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Peter Ma Sloot
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.,Complexity Institute, Nanyang Technological University, Singapore.,ITMO University, Saint Petersburg, Russian Federation
| | - Esther Middelkoop
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Pm van Zuijlen
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Xue M, Zhao R, March L, Jackson C. Dermal Fibroblast Heterogeneity and Its Contribution to the Skin Repair and Regeneration. Adv Wound Care (New Rochelle) 2022; 11:87-107. [PMID: 33607934 DOI: 10.1089/wound.2020.1287] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Significance: Dermal fibroblasts are the major cell type in the skin's dermal layer. These cells originate from distinct locations of the embryo and reside in unique niches in the dermis. Different dermal fibroblasts exhibit distinct roles in skin development, homeostasis, and wound healing. Therefore, these cells are becoming attractive candidates for cell-based therapies in wound healing. Recent Advances: Human skin dermis comprises multiple fibroblast subtypes, including papillary, reticular, and hair follicle-associated fibroblasts, and myofibroblasts after wounding. Recent studies reveal that these cells play distinct roles in wound healing and contribute to diverse healing outcomes, including nonhealing chronic wound or excessive scar formation, such as hypertrophic scars (HTS) and keloids, with papillary fibroblasts having antiscarring and reticular fibroblast scar-forming properties. Critical Issues: The identities and functions of dermal fibroblast subpopulations in many respects remain unknown. In this review, we summarize the current understanding of dermal fibroblast heterogeneity, including their defined cell markers and dermal niches, dynamic changes, and contributions to skin wound healing, with the emphasis on scarless healing, healing with excessive scars (HTS and keloids), chronic wounds, and the potential application of this heterogeneity for developing cell-based therapies that allow wounds to heal faster with less scarring. Future Directions: Heterogeneous dermal fibroblast populations and their functions are poorly characterized. Refining and advancing our understanding of dermal fibroblast heterogeneity and their participation in skin homeostasis and wound healing may create potential therapeutic applications for nonhealing chronic wounds or wounds that heal with excessive scarring.
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Affiliation(s)
- Meilang Xue
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ruilong Zhao
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Lyn March
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Christopher Jackson
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Wang BB, Patel KF, Wolfe AE, Wiechman S, McMullen K, Gibran NS, Kowalske K, Meyer WJ, Kazis LE, Ryan CM, Schneider JC. Adolescents with and without head and neck burns: comparison of long-term outcomes in the burn model system national database. Burns 2022; 48:40-50. [PMID: 33975762 PMCID: PMC8526620 DOI: 10.1016/j.burns.2021.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Facial burns account for persistent differences in psychosocial functioning in adult burn survivors. Although adolescent burn survivors experience myriad chronic sequelae, little is known about the effect of facial injuries. This study examines differences in long-term outcomes with and without head and neck involvement. METHODS Data collected for 392 burn survivors between 14-17.9 years of age from the Burn Model System National Database (2006-2015) were analyzed. Comparisons were made between two groups based on presence of a head and neck burn (H&N) using the following patient reported outcome measures: Satisfaction with Appearance Scale, Satisfaction with Life Scale, Community Integration Questionnaire, and Short Form-12 Health Survey at 6, 12, and 24 months after injury. Regression analyses were used to assess association between outcome measures and H&N group at 12-months. RESULTS The H&N group had more extensive burns, had longer hospital stays, were more likely to be burned by fire/flame and were more likely to be Hispanic compared to the non-H&N group. Regression analysis found that H&N burn status was associated with worse SWAP scores. No significant associations were found between H&N burn status and other outcome measures. CONCLUSIONS Adolescents with H&N burn status showed significantly worse satisfaction with appearance at 12-months after injury. Future research should examine interventions to help improve body image and coping for adolescent burn survivors with head and neck burns.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Audrey E. Wolfe
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Nicole S. Gibran
- Department of Surgery, University of Washington Harborview, Seattle, WA, United States
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Walter J. Meyer
- Department of Psychiatry, University of Texas Medical Branch, Galveston, TX, United States
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States,Corresponding author. (J.C. Schneider)
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The contracture-in-a-well. An in vitro model distinguishes bulk and interfacial processes of irreversible (fibrotic) cell-mediated contraction. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2022; 133:112661. [DOI: 10.1016/j.msec.2022.112661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/21/2022]
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Harada T, Yamanishi T, Kurimoto T, Uematsu S, Yamamoto Y, Inoue N, Nishio J. Long-term Morphological Changes of the Velum and the Nasopharynx in Patients With Cleft Palate. Cleft Palate Craniofac J 2021; 59:1264-1270. [PMID: 34662220 DOI: 10.1177/10556656211045287] [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: 11/16/2022] Open
Abstract
OBJECTIVE To investigate long-term morphological changes in the soft palate length and nasopharynx in patients with cleft palate. We hypothesized that there would be differences in the morphological development of the soft palate and nasopharynx between patients with and without cleft palate and that these developmental changes would negatively affect the soft palate length to pharyngeal depth ratio involved in velopharyngeal closure for patients with cleft palate. DESIGN Retrospective, case-control study. SETTING Institutional practice. PATIENTS Ninety-two patients (Group F) with unilateral cleft lip, alveolus, and palate and 67 patients (Group CLA) with unilateral cleft lip and alveolus not requiring palatoplasty were included. MAIN OUTCOME MEASURES The soft palate length, nasopharyngeal size, and soft palate length to pharyngeal depth ratio were measured via lateral cephalograms obtained at three different periods. RESULTS Group F showed a shorter soft palate length and smaller nasopharyngeal size than Group CLA at all periods. Both these parameters increased with age, but the increase in amount was significantly less in Group F compared with that in Group CLA. The soft palate length to pharyngeal depth ratio in Group F decreased with age. CONCLUSIONS In patients with cleft palate, the soft palate length to pharyngeal depth ratio, which is involved in velopharyngeal closure, can change with age. Less soft palate length growth and unfavorable relationship between the soft palate and nasopharynx may be masked in early childhood but can manifest later on with age.
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Affiliation(s)
- Takeshi Harada
- 13608Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.,38654Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | | | | | - Setsuko Uematsu
- 13608Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yuri Yamamoto
- 13608Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Naoko Inoue
- 13608Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Juntaro Nishio
- 13608Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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Demir Yiğit Y, Yiğit E. Flame burns. Dermatol Ther 2021; 34:e15133. [PMID: 34532951 DOI: 10.1111/dth.15133] [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: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/27/2022]
Abstract
Flame burns lead to significant long-term morbidity and functional consequences. This study analyzed the mortality-related factors in patients with flame burns to compare with the existing literature. This retrospective descriptive study was carried out at the General Surgery Clinic, Gazi Yaşargil Training and Research Hospital, Turkey, to include 131 patients admitted and treated with emergency surgery for flame burns between January 2016 and December 2019. Of the patients hospitalized for flame burn, 103 (78.6%) were male and 28 (21.4%) were female (M:F = 3.6) with a mean age of 25.3 ± 20.78 years. The 15-34 years age group was the most affected by flame burns. The most frequently affected body areas were the upper extremities and face (n = 68, 51.9%); conjunctivitis developed in 49 (37.4%) patients. The wound infection rate was 34.3%, and Staphylococcus epidermidis had the highest growth rate in wound culture results (24.4%). Flame burns were most common in winter and autumn. The majority of patients (n = 95, 72.5%) were treated with escharectomy and dressing, while grafting was performed in 36 (27.5%) patients. A total of 3 (2.2%) patients died-one died in a suicide attempt, one due to inhalation burn after flame burn, and another died due to sepsis. The average length of hospital stay was 8.0 ± 3.9 days. Flame burns are much more common in young men, causing deeper and wider burns and requiring greater surgical intervention. This leads to frequent wound infections and longer hospital stays.
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Affiliation(s)
- Yasemin Demir Yiğit
- Department of Pediatrics, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ebral Yiğit
- Department of General Surgery, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
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Khor D, Liao J, Fleishhacker Z, Schneider JC, Parry I, Kowalske K, Richard R, Wibbenmeyer L. Update on the practice of splinting during acute burn admission from the ACT study. J Burn Care Res 2021; 43:640-645. [PMID: 34490885 DOI: 10.1093/jbcr/irab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Burn scar contracture (BSC) is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in function. Despite a paucity of research addressing its efficacy, static splinting of affected joints is a common preventative practice. A survey of therapists performed 25 years ago showed a widely divergent practice of splinting during the acute burn injury. We undertook this study to determine the current practice of splinting during the index admission for burn injuries. METHODS This is a review of a subset of patients enrolled in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database. ACT was an observational multicenter study conducted from 2010-2013. The most commonly splinted joints (elbow, wrist, knee and ankle) and their 7 motions were included. Variables included patients' demographics, burn variables, rehabilitation treatment and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P< 0.05 was significant. RESULTS Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. Splinting was associated with larger burns and increased injury severity on the patient level and increased involvement with burns requiring grafting in the associated cutaneous functional unit (CFU) on the joint level. The requirement for skin grafting in both analyses remained independently related to splinting, with requirement for grafting in the associated CFU increasing the odds of splinting 6 times (OR =6.0, 95% CI=3.8-9.3, p<0.001). On average splinting was initiated about a third into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50 ± 26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. The wrist was most frequently splinted joint being splinted with one third of wrists splinted ( 30.7%) while the knee was the least frequently splinted joint with 8.2% splinted. However, when splinted, the knee was splinted the most hours per day (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). Almost one third had splinting continued to discharge (20, 27%). CONCLUSIONS The current practice of splinting, especially the initiation, hours of wear and duration of splinting following acute burn injury remains variable. Splinting is independently related to grafting, grafting in the joint CFU, larger CFU involvement and is more likely to occur around the time of surgery. A future study looking at splinting application and its outcomes is warranted.
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Affiliation(s)
- Desmond Khor
- Department of Surgery, University of Iowa Hospitals and Clinics
| | - Junlin Liao
- Department of Surgery, University of Iowa Hospitals and Clinics
| | | | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Department of Physical Medicine and Rehabilitation, Harvard Medical School
| | - Ingrid Parry
- Department of Occupational and Physical Therapy, Shriners Hospital for Children, Northern California, University of California, Davis
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern
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Parry IS, Schneider JC, Yelvington M, Sharp P, Serghiou M, Ryan CM, Richardson E, Pontius K, Niszczak J, McMahon M, MacDonald LE, Lorello D, Kehrer CK, Godleski M, Forbes L, Duch S, Crump D, Chouinard A, Calva V, Bills S, Benavides L, Acharya HJ, De Oliveira A, Boruff J, Nedelec B. Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines. J Burn Care Res 2021; 41:503-534. [PMID: 31504622 DOI: 10.1093/jbcr/irz150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.
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Affiliation(s)
- Ingrid S Parry
- From the Shriners Hospital for Children, Northern California, University of California-Davis, Sacramento
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Patricia Sharp
- Cincinnati Children's Hospital, University of Cincinnati College of Allied Health Sciences Program in Occupational Therapy, Ohio
| | - Michael Serghiou
- Bio Med Sciences Inc., Allentown, Pennsylvania Shriners Hospitals for Children Boston, Massachusetts
| | - Colleen M Ryan
- Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | - Jonathan Niszczak
- Bio Med Sciences Inc., Allentown, Pennsylvania Shriners Hospitals for Children Boston, Massachusetts.,Thomas Jefferson University Burn Center, Philadelphia, Pennsylvania.,Bio Med Sciences, Inc. Allentown, Pennsylvania
| | - Margaret McMahon
- Our Lady's Hopsice and Care Services, Harold's Cross, Dublin, Ireland
| | | | - David Lorello
- The Arizona Burn Center at Maricopa Medical Center, Phoenix
| | | | - Matthew Godleski
- Department of Physical Medicine and Rehabilitation, Ross Tilley Burn Centre, St. John's Rehab, University of Toronto, Ontario, Canada
| | - Lisa Forbes
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Sarah Duch
- Westchester Medical Center, Valhalla, New York
| | - Donna Crump
- Parkland Health and Hospital System, PMR Department, Dallas, Texas
| | - Annick Chouinard
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada.,CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Valerie Calva
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada
| | - Sara Bills
- Madonna Rehabilitation Hospitals, Lincoln, Nebraska University of Nebraska Medical Center, Omaha
| | | | - Hernish J Acharya
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ana De Oliveira
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - Jill Boruff
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Bernadette Nedelec
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Davenport LM, Cuttle L, McBride CA, Kimble R. The morbidity associated with paediatric burn wound escharotomies. ANZ J Surg 2021; 91:2139-2144. [PMID: 34427042 DOI: 10.1111/ans.17153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/22/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An escharotomy is an effective surgical procedure for the rapid decompression of a constricting and unyielding eschar, to permit restoration of blood flow. However, an escharotomy is also a full-thickness incision, which adds additional scarring to the burn injury area. The cosmetic and functional morbidity of escharotomy scarring in children is poorly characterised. METHODS Children who required a burn wound escharotomy at the Queensland Children's Hospital (QCH) between May 2011 and May 2020 were included. Demographics of these children were described. In addition, the number of operations for revision of escharotomy scars was recorded as an indicator of functional or cosmetic concern. RESULTS A total of 19 patients required an escharotomy after a burn injury. Children with 1% to 96% TBSA burns required an escharotomy, with a median of 28% (IQR 10-39%) TBSA. Two patients (81% and 96% TBSA) died. Seventy-one percent (12/17) of survivors had operative revisions of their escharotomy scars. The median time from burn to first scar intervention was 35 weeks (IQR 19-70 weeks). CONCLUSION There is substantial morbidity associated with escharotomies in children. Further investigation of the current methods of decompression after burn injury, and the long-term morbidity of escharotomy, is required.
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Affiliation(s)
- Lisa M Davenport
- Surgical Services Group, Townsville University Hospital, Townsville, Queensland, Australia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Craig A McBride
- Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Roy Kimble
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
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43
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Zhu Z, Kong W, Wang H, Xiao Y, Shi Y, Gan L, Sun Y, Tang H, Xia Z. Prevalence and predictors of scar contracture-associated re-hospitalisation among burn inpatients in China. Sci Rep 2021; 11:14973. [PMID: 34294790 PMCID: PMC8298512 DOI: 10.1038/s41598-021-94432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Scar contracture, a common destructive complication causing increased re-hospitalisation rate of burn survivors and aggravated burden on the medical system, may be more seriously in Chinese population because of their higher susceptibility to scar formation. This study aims to evaluate the prevalence and predictors of scar contracture-associated re-hospitalisation among Chinese burn inpatients. This cross-sectional study screened burn inpatients hospitalised during 2013 to 2018 through the Hospital Quality Monitoring System database, among whom re-hospitalised for scar contracture were identified. Variables including sex, age, occupations, burn area, burn site and surgical treatment were analysed. Potential predictors of scar contracture-associated re-hospitalisation among burn inpatients were determined by univariate regression analyses. Of the 220,642 burn inpatients, 2146 (0.97%) were re-hospitalised for scar contracture. The re-hospitalised inpatients were predominantly men and blue-collar workers, showing younger median age at the time of burns, larger burn sizes, and higher percentage of surgical treatment compared other burn inpatients. Significant univariate predictors of scar contracture-associated re-hospitalisation included male sex, age < 50 years, blue-collar work, ≥ 40% total body superficial area burned, inhalation injured, and surgical treatment. Scar contracture is an intractable complication and a significant factor to increase re-hospitalisation rate among Chinese burn inpatients.
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Affiliation(s)
- Zhe Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China
| | - Weishi Kong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China
| | - Haibo Wang
- Clinical Trial Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.,Centre for Data Science in Health and Medicine, Peking University, Beijing, 100191, China
| | - Yongqiang Xiao
- Department of Burn and Plastic Surgery, The 970Th Hospital of People's Liberation Army, Yantai, 264000, Shandong, China
| | - Ying Shi
- China Standard Medical Information Research Center, 288 Haide 2nd road, Shenzhen, 518000, China
| | - Lanxia Gan
- China Standard Medical Information Research Center, 288 Haide 2nd road, Shenzhen, 518000, China
| | - Yu Sun
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China.
| | - Hongtai Tang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China.
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China.
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Nabai L, Pourghadiri A, Ghahary A. Hypertrophic Scarring: Current Knowledge of Predisposing Factors, Cellular and Molecular Mechanisms. J Burn Care Res 2021; 41:48-56. [PMID: 31999336 DOI: 10.1093/jbcr/irz158] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypertrophic scarring (HSc) is an age-old problem that still affects millions of people physically, psychologically, and economically. Despite advances in surgical techniques and wound care, prevention and treatment of HSc remains a challenge. Elucidation of factors involved in the development of this common fibroproliferative disorder is crucial for further progress in preventive and/or therapeutic measures. Our knowledge about pathophysiology of HSc at the cellular and molecular level has grown considerably in recent decades. In this article, current knowledge of predisposing factors and the cellular and molecular mechanisms of HSc has been reviewed.
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Affiliation(s)
- Layla Nabai
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir Pourghadiri
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aziz Ghahary
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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45
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Correa-Gallegos D, Rinkevich Y. Cutting into wound repair. FEBS J 2021; 289:5034-5048. [PMID: 34137168 DOI: 10.1111/febs.16078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
The skin is home to an assortment of fibroblastic lineages that shape the wound repair response toward scars or regeneration. In this review, we discuss the distinct embryonic origins, anatomic locations, and functions of fibroblastic lineages, and how these distinct lineages of fibroblasts dictate the skin's wound response across injury depths, anatomic locations, and embryonic development to promote either scarring or regeneration. We highlight the supportive role of the fascia in dictating scarring outcomes; we then discuss recent findings that indicate fascia mobilization by its resident fibroblasts supersede the classical de novo deposition program of wound matrix formation. These recent findings reconfigure our traditional view of wound repair and present exciting new therapeutic avenues to treat scarring and fibrosis across a range of medical settings.
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Affiliation(s)
- Donovan Correa-Gallegos
- Institute of Lung Biology and Disease, Comprehensive Pneumology Center, Helmholtz Zentrum München, Munich, Germany
| | - Yuval Rinkevich
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum München, Munich, Germany
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Kong W, Xiao Y, Wang B, Zhu Z, Hu L, Tang H, Wang K, Fang H, Shi Y, Long J, Gan L, Wang H, Sun Y, Xia Z. Comorbidities of scars in China: a national study based on hospitalized cases. BURNS & TRAUMA 2021; 9:tkab012. [PMID: 34212062 PMCID: PMC8240520 DOI: 10.1093/burnst/tkab012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Background Scar comorbidities seriously affect the physical and mental health of patients, but few studies have reported the exact epidemiological characteristics of scar comorbidities in China. This study aimed to investigate the prevalence of scar comorbidities in China. Methods The data of 177,586 scar cases between 2013 and 2018 were obtained from the Hospital Quality Monitoring System based on the 10th edition of the International Classification of Diseases coding system. The total distribution of scar comorbidities and their relationship with age, aetiology and body regions were analysed. Results Six comorbidities (contracture, malformation, ocular complications, adhesion, infection and others) were the main focus. In general, male patients outnumbered females and urban areas outnumbered rural areas. The proportion of contractures was the highest at 59,028 (33.24%). Students, workers and farmers made up the majority of the occupation. Han Chinese accounted for the majority of the ethnic. The highest proportion of scar contracture occurred at 1-1.9 years of age (58.97%), after which a significant downward trend was observed. However, starting from 50 years of age, ocular complications increased gradually and significantly, eventually reaching a peak of 34.49% in those aged >80 years. Scar contracture was the most common comorbidity according to aetiology, and the highest proportion was observed in patients who were scalded (29.33%). Contractures were also the most frequent comorbidity in hands (10.30%), lower limbs (6.97%), feet (6.80%) and upper limbs (6.02%). The mean and median hospitalization durations were 12.85 and 8 days, respectively. Conclusions Contractures were the most common comorbidities, and different comorbidities tended to occur at different ages and with different causative factors.
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Affiliation(s)
- Weishi Kong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China.,Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai 200433, P.R.China
| | - Yongqiang Xiao
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China.,Department of Burn and Plastic Surgery, The 970th Hospital of People's Liberation Army, Yantai, Shandong, 264000, China
| | - Baoli Wang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China
| | - Zhe Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China
| | - Lunyang Hu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China
| | - Hongtai Tang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China
| | - Kangan Wang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China
| | - He Fang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China
| | - Ying Shi
- China Standard Medical Information Research Centre, Shenzhen 518000, P.R.China
| | - Jianyan Long
- China Standard Medical Information Research Centre, Shenzhen 518000, P.R.China
| | - Lanxia Gan
- China Standard Medical Information Research Centre, Shenzhen 518000, P.R.China
| | - Haibo Wang
- China Standard Medical Information Research Centre, Shenzhen 518000, P.R.China
| | - Yu Sun
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China.,Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai 200433, P.R.China
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, P.R.China.,Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai 200433, P.R.China
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Price K, Moiemen N, Nice L, Mathers J. Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation: a qualitative study. BURNS & TRAUMA 2021; 9:tkab005. [PMID: 34212058 PMCID: PMC8240530 DOI: 10.1093/burnst/tkab005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Indexed: 02/03/2023]
Abstract
Background Scar assessment plays a key role during burns aftercare, to monitor scar remodelling and patients’ psychosocial well-being. To aid assessment, subjective scar assessment scales are available that use health-care professionals’ and patients’ opinions to score scar characteristics. The subjective scales are more widely used in clinical practice over objective scar measures. To date, there is no research that considers patients’ views on scar assessment and the role of subjective and objective assessment tools. Therefore, the aim of this qualitative study was to explore patients’ perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation. Methods Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring. Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital, Birmingham, UK. Topics covered during interview included patient experience of scar assessment, the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars. A thematic analysis using the Framework Method was conducted. Results Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment. These are: patient-led care; continuity in care; learning how to self-manage scarring; and psychological assessment. Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies, indicating their potential patient-centred contributions. The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools. Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial functioning. However, minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose. Patients perceived objective tools to be of primary use for health-care professionals, though the measures may aid patients’ understanding of scar properties. Conclusions Scar assessment tools should be used to support, rather than replace, health-care professionals’ subjective judgements of scarring. Adapting the way in which clinicians introduce and use scar assessment tools, according to patient needs, can support a patient-centred approach to scar assessment.
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Affiliation(s)
- Kate Price
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Nice
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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48
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Hendriks TCC, Botman M, Binnerts JJ, Mtui GS, Nuwass EQ, Niemeijer AS, Mullender MG, Winters HAH, Nieuwenhuis MK, van Zuijlen PPM. The development of burn scar contractures and impact on joint function, disability and quality of life in low- and middle-income countries: A prospective cohort study with one-year follow-up. Burns 2021; 48:215-227. [PMID: 34716045 DOI: 10.1016/j.burns.2021.04.024] [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: 12/16/2020] [Revised: 04/04/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country. METHODS Patients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury. RESULTS Thirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns. CONCLUSION The prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.
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Affiliation(s)
- T C C Hendriks
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands.
| | - M Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands
| | | | - G S Mtui
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - E Q Nuwass
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - A S Niemeijer
- Association of Dutch Burn Centers, Burn Center, The Netherlands; Burn Center, Martini Hospital, Groningen, The Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - M K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center, The Netherlands; Burn Center, Martini Hospital, Groningen, The Netherlands
| | - P P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, Location AMC and VUmc, Amsterdam, The Netherlands
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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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Williams KL, Garza LA. Diverse cellular players orchestrate regeneration after wounding. Exp Dermatol 2021; 30:605-612. [PMID: 33251597 PMCID: PMC8059097 DOI: 10.1111/exd.14248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/30/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Abstract
Fibrosis is one of the largest sources of human morbidity. The skin is a complex organ where interplay between diverse cell types and signalling pathways is essential both in homeostasis and wound repair, which can result in fibrosis or regeneration. This makes skin a useful model to study fibrosis and regeneration. While fibrosis often occurs postinjury, both clinical and laboratory observations suggest skin regeneration, complete with reconstituted cell diversity and de novo hair follicles, is possible. Extensive research performed in pursuit of skin regeneration has elucidated the key players, both cellular and molecular. Interestingly, some cells known for their homeostatic function are not implicated in regeneration or wound-induced hair neogenesis (WIHN), suggesting regeneration harnesses separate functional pathways from embryogenesis or other non-homeostatic mechanisms. For example, classic bulge cells, noted for their role in normally cycling hair follicles, do not finally contribute to long-lived cells in the regenerated tissue. During healing, multiple populations of cells, among them specific epithelial lineages, mesenchymal cells, and immune cells promote regenerative outcomes in the wounded skin. Ultimately, targeting specific populations of cells will be essential in manipulating a postwound environment to favour regeneration in lieu of fibrosis.
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Affiliation(s)
- Kaitlin L Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luis A Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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