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Cuijpers MD, Meij-de Vries A, van Zuijlen PPM, Baartmans MGA, Nieuwenhuis M, van Baar ME, Pijpe A. The prevalence and predictors of reconstructive surgery in pediatric burn care. Burns 2024:S0305-4179(24)00217-1. [PMID: 39317543 DOI: 10.1016/j.burns.2024.07.017] [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: 01/25/2024] [Revised: 05/23/2024] [Accepted: 07/13/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE This study aimed to examine the prevalence and predictors of reconstructive surgery among pediatric burn patients in the Netherlands. METHODS Pediatric burn patients were identified through the Dutch Burn Repository R3. Eligibility criteria included a burn requiring hospital admission or surgical treatment at one of the Dutch burn centers in 2009-2019. First, patient, burn, and treatment characteristics were summarized using descriptive statistics. Second, time to the first reconstructive surgery was modelled using Kaplan Meier curves. Third, a prediction model was developed using univariate and multivariate logistic regression. The model's performance was assessed using calibration, discrimination, and explained variance. Fourth, internal validation was performed using bootstrapping. RESULTS Approximately three percent (n = 84) of pediatric patients (n = 3072) required reconstructive surgery between the initial burn-related hospital admission and September 2021. Median time to the first reconstructive surgery was 1.2 (0.7-1.6) years. Most surgeries were performed on the face, arm, neck, hand, or anterior trunk, owing to contractures or hypertrophic scarring. Predictors of reconstruction included the etiology, anatomical site, extent of full-thickness burn, surgical treatment in the acute phase, and length of hospital stay. CONCLUSION Our study provided an overview of the prevalence and independent predictors of reconstructive surgery in the pediatric burn population.
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Affiliation(s)
- M D Cuijpers
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VU University Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands.
| | - A Meij-de Vries
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Pediatric Surgical Center, Emma Children's Hospital, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P P M van Zuijlen
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VU University Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands; Pediatric Surgical Center, Emma Children's Hospital, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - M G A Baartmans
- Department of Pediatrics, Maasstad Hospital, Rotterdam, the Netherlands; Association of Dutch Burn Centers, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands
| | - M Nieuwenhuis
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Association of Dutch Burn Centers, Burn Center, Martini Hospital, Groningen, the Netherlands; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - M E van Baar
- Association of Dutch Burn Centers, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A Pijpe
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VU University Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
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Parry I, Bell J. Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry. Burns 2024; 50:813-822. [PMID: 38503574 DOI: 10.1016/j.burns.2024.03.002] [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] [Received: 07/25/2023] [Revised: 02/15/2024] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Throughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen's model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level. METHODS This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income. RESULTS The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect. DISCUSSION Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.
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Affiliation(s)
- Ingrid Parry
- University of California, Davis, School of Nursing and Health Care Leadership, California, USA.
| | - Janice Bell
- University of California, Davis, School of Nursing and Health Care Leadership, California, USA
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Alvedro-Ruiz P, Díaz-Ros N, García-García M, Merino-Romero M, Heredia-Alcalde I, Andresen-Lorca B, Pérez-Plaza A, Pérez-Del-Caz MD. Occipito-Cervico-Dorsal Flap for Neck Reconstruction After Postburn Contractures: A Case Report and Literature Review. PLASTIC AND AESTHETIC NURSING 2024; 44:124-127. [PMID: 38639969 DOI: 10.1097/psn.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Because the head and neck are one of the most frequent locations of burns, it is of paramount importance that plastic surgeons and plastic surgical nurses understand the most effective surgical methods for treating neck contractures and the reconstructive technique required for each case. We introduce the case of a 42-year-old woman who presented with a severe postburn neck contracture that was reconstructed with a pedicled occipito-cervico-dorsal flap. We closed the donor-site wound primarily and completely covered the defect with good results. In addition to conventional skin grafts, dermal matrices, and microsurgical techniques, using an occipito-cervico-dorsal flap should be considered for reconstructing postburn neck contractures as it offers good aesthetic and functional outcomes, provides enough tissue and pliable skin, and results in minimal donor-site morbidity.
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Affiliation(s)
- Pedro Alvedro-Ruiz
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Nerea Díaz-Ros
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - María García-García
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Mar Merino-Romero
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Iván Heredia-Alcalde
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Belén Andresen-Lorca
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Aranzazu Pérez-Plaza
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - María Dolores Pérez-Del-Caz
- Pedro Alvedro-Ruiz, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Nerea Díaz-Ros, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María García-García, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Mar Merino-Romero, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Iván Heredia-Alcalde, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Belén Andresen-Lorca, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Aranzazu Pérez-Plaza, MD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- María Dolores Pérez-Del-Caz, MD, PhD, is at Plastic and Reconstructive Surgery and Burns Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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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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van de Warenburg MS, Munk EFL, Davies A, McBride CA, Edgar DW, Vehmeijer-Heeman MLAW, Young AE. Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care. J Burn Care Res 2024; 45:112-119. [PMID: 37310702 PMCID: PMC10768758 DOI: 10.1093/jbcr/irad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.
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Affiliation(s)
- Milly S van de Warenburg
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Elleke F L Munk
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anna Davies
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Craig A McBride
- Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Node, The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Mariëlle L A W Vehmeijer-Heeman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Amber E Young
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
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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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9
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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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10
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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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11
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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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12
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Plaza A, Paratz J, Cottrell M. A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial. Burns 2023; 49:55-67. [PMID: 36115795 DOI: 10.1016/j.burns.2022.08.014] [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: 02/06/2022] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exercise programmes are essential for burn rehabilitation, however patients often have barriers accessing these services. Home-based telerehabilitation (HBT) may be an alternative. This study aimed to determine if exercise programs delivered via HBT were as effective as in-person (IP) programs with respect to clinical outcomes and participant and therapist satisfaction. METHODS A single center, randomized, controlled, non-inferiority pilot trial with blinded assessment was undertaken. Forty-five adults with ≤ 25% total body surface area (TBSA) burns were randomized to receive a 6-week exercise program delivered either by HBT or IP. The primary outcome was burn-specific quality of life (Burn Specific Health Scale - Brief). Secondary outcomes included health-related quality of life, burn scar-specific outcomes, exercise self-efficacy, pain severity, muscle strength and range of motion (ROM). Participant and therapist satisfaction, technical disruptions and adverse events were also recorded. RESULTS We found no significant within- or between-group differences for any outcome measures except ROM. Achievement of full ROM was significantly different between groups at Week 12 (IP=100% vs HBT=70%, p = 0.005). Non-inferiority was inconclusive. Participant satisfaction was high (median ≥ 9.8/10), with no significant between-group differences. Therapist satisfaction was high (median ≥ 8.9/10), major technical disruptions low (8%) and no adverse events reported. CONCLUSION HBT is a safe, effective option to deliver exercise programs for patients with burn injuries ≤ 25% TBSA with comparable clinical outcomes to in-person programmes. Ongoing research is required to further analyze ROM and investigate the effectiveness of HBT for patients with larger burns.
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Affiliation(s)
- Anita Plaza
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia; Professor Stuart Pegg Adult Burn Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Jennifer Paratz
- Physiotherapy Department, Griffith University, Brisbane, QLD 4222, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
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13
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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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14
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desJardins-Park HE, Gurtner GC, Wan DC, Longaker MT. From Chronic Wounds to Scarring: The Growing Health Care Burden of Under- and Over-Healing Wounds. Adv Wound Care (New Rochelle) 2022; 11:496-510. [PMID: 34521257 PMCID: PMC9634983 DOI: 10.1089/wound.2021.0039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Significance: Wound healing is the largest medical market without an existing small molecule/drug treatment. Both "under-healing" (chronic wounds) and "over-healing" (scarring) cause a substantial biomedical burden and lifelong consequences for patients. These problems cost tens of billions of dollars per year in the United States alone, a number expected to grow as the population ages and the prevalence of common comorbidities (e.g., diabetes) rises. However, no therapies currently exist to produce the "ideal" healing outcome: efficient wound repair through regeneration of normal tissue. Recent Advances: Ongoing research continues to illuminate possible therapeutic avenues for wound healing. By identifying underlying mechanisms of wound repair-for instance, tissue mechanics' role in fibrosis or cell populations that modulate wound healing and scarring-novel molecular targets may be defined. This Advances in Wound Care Forum issue includes reviews of scientific literature and original research from the Hagey Laboratory for Pediatric Regenerative Medicine at Stanford and its alumni, including developing approaches for encouraging wound healing, minimizing fibrosis, and coaxing regeneration. Critical Issues: Wound healing problems reflect an enormous and rapidly expanding clinical burden. The issues of both under- and over-healing wound outcomes will continue to expand as their underlying causes (e.g., diabetes) grow. Targeted treatments are needed to enable wound repair with functional tissue restoration and decreased scarring. Future Directions: Basic scientists will continue to refine understanding of factors driving undesirable wound outcomes. These discoveries are beginning to be translated and, in the coming years, will hopefully form the foundation for antiscarring drugs and other wound therapeutics.
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Affiliation(s)
- Heather E. desJardins-Park
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey C. Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery; Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine; Stanford University School of Medicine, Stanford, California, USA
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15
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Teelucksingh S, Chang C, Henton J, Lewis CJ. Immediate Application of Biodegradable Temporizing Matrix To a Muscle Free Flap for Complex Soft Tissue Reconstruction. EPLASTY 2022; 22:e29. [PMID: 36000007 PMCID: PMC9361344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background. Extensive degloving skin injuries in children are particularly challenging for the possible complications of restricting growth and function. Biodegradable temporizing matrix (BTM, PolyNovo) is traditionally used for acute burn care reconstruction and in this case was successfully used to manage a child with lower limb open fractures associated with severe degloving injuries. This novel use offers excellent short and intermediate outcomes.
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Affiliation(s)
- Sachin Teelucksingh
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, England
| | - Chad Chang
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, England
| | - John Henton
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, England
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16
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Özkal Ö. Letter to the editor concerning the article: "Efficacy of whole-body vibration on balance control, postural stability, and mobility after thermal burn injuries: A prospective randomized controlled trial". Clin Rehabil 2022; 36:995-996. [PMID: 35469468 DOI: 10.1177/02692155221088768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Özden Özkal
- 37523Bursa Uludağ University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bursa, Turkey
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17
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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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18
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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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19
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Acute burn care in resource-limited settings: a cohort study on treatment and outcomes in a rural hospital referral center in Tanzania. Burns 2022; 48:1966-1979. [DOI: 10.1016/j.burns.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022]
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20
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Perera C, Hajith Z. Closed dressing orthosis for axillary burns. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.08.036] [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] Open
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21
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Chen Y, Niu Z, Yin X, Li Y, Han Y, Chai M, Li D, Tao R, Guo L, Lei Y, Han Y. Treatment of Severe Postburn Contracture of the Elbow via Distraction With External Circular Frame in Pediatric Patient. Ann Plast Surg 2021; 87:253-259. [PMID: 34397514 DOI: 10.1097/sap.0000000000002960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although external circular frame (ECF) has been widely used for the correction of knee and ankle deformities, few studies reported the use of ECF for the treatment of severe postburn elbow contracture and stiffness (SPECS). The purpose of this retrospective study was to investigate the effectiveness and safety of the distraction using ECF in treating SPECS. METHODS After institutional review board approval, we implemented a retrospective single-center case series study composed of consecutive patients treated for SPECS at Chinese PLA General Hospital between January 2010 and January 2018. After scar release and skin grafting, distraction with ECF was performed for 4 to 6 weeks, and the frame was retained for 2 more weeks before removal. Four weeks of splinting and at least 1 year of rehabilitation were recommended. Patient demographics, active and passive range of motion (ROM) of the elbow at different time points (preoperative, postdistraction, and final follow-up), and complications were collected from the electronic medical record. The primary outcome was the long-term improvement of the ROM. Other outcomes included complications and recurrence. RESULTS The ECF was used to treat SPECS in 6 patients (3 males and 3 females, average age of 11.7 ± 2.6 years). Scar release and distraction with ECF significantly increased both active (from 3° preoperative to 38.7° postdistraction) and passive (from 3.5° preoperative to 48.3° postdistraction) ROM over an average distraction duration of 5.2 weeks. The long-term improvement of active and passive ROM was 38° ± 13.4° and 46° ± 14.7°, respectively, over a median follow-up of 4.1 years. Pin-tract infection occurred in 2 patients and were treated with local wound care and oral antibiotics. A tendon readhesion developed in 1 of the 6 patients because of noncompliance with splinting and physiotherapy, and was treated with revision surgery. CONCLUSIONS The 3C strategy (i.e., contracture release, coverage of the defect with skin grafting, and correction of articular angle with gradual distraction using the ECF) is able to increase the ROM with minor complications. We recommend distraction with ECF as part of the treatment arsenal, particularly for severe contractures in which 1-stage correction is unfeasible because of considerable soft tissue shortening.
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Affiliation(s)
- Youbai Chen
- From the Department of Plastic and Reconstructive Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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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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23
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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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24
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Ma Z, Mo R, Chen C, Meng X, Tan Q. Surgical treatment of joint burn scar contracture: a 10-year single-center experience with long-term outcome evaluation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:303. [PMID: 33708930 PMCID: PMC7944269 DOI: 10.21037/atm-20-4947] [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] [Indexed: 11/23/2022]
Abstract
Background Burn patients often have functional problems due to joint scar contracture. Patients suffering from such contracture often experience considerable limitations in daily life. Therefore, surgical treatment is often necessary. Skin grafts, especially full-thickness skin grafts and flaps remain the most commonly used surgical methods in clinical practice. However, there are no clear guidelines stating which technique is the most effective treatment. Herein, we conducted a retrospective cohort study over 10 years of experience at a single center to investigate whether flaps or FTSGs exhibit a better long-term effect. Methods We performed a retrospective chart review of patients with joint burn scar contracture and collected data related to patient demographic profiles, and detailed descriptions of the scars, surgical procedures, and follow-up were collected. We performed follow-up evaluation of three aspects: adverse events (recontracture, ache, and pruritus), satisfaction scores for function and aesthetics, and scar quality (Vancouver Scar Scale score). Results Follow-up results 1 year after surgery from 88 patients were analyzed. In total, 4 (10%) patients in the flap group and 13 (27.1%) patients in the FTSG group had recontracture; the incidence of recontracture was lower in the flap group than in the FTSG group (P=0.043). The functional satisfaction score of the flap group was higher than that of the FTSG group (P=0.027). Moreover, follow-up results 5 year after surgery for 47 patients were analyzed. In total, 1 (4.8%) patient in the flap group and 7 (26.9%) patients in the FTSG group had recontracture; the incidence of recontracture was significantly lower in the flap group than in the FTSG group (P=0.044). The functional satisfaction score in the flap group was higher than that of the FTSG group (P=0.041). In this study, no significant differences in scar quality were observed between the two groups. Conclusions If conditions permit, the application of different types of flaps may represent a better choice than FTSGs in terms of reducing the recontracture rate and improving joint function.
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Affiliation(s)
- Zhouji Ma
- Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Ran Mo
- Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing, China
| | - Chen Chen
- Department of Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing, China
| | - Xueyong Meng
- Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing, China
| | - Qian Tan
- Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing, China
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25
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Hendriks TCC, Botman M, de Haas LEM, Mtui GS, Nuwass EQ, Jaspers MEH, Niemeijer AS, Nieuwenhuis MK, Winters HAH, van Zuijlen PPM. Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country. Burns 2021; 47:1285-1294. [PMID: 33485727 DOI: 10.1016/j.burns.2020.12.024] [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: 09/04/2020] [Revised: 12/10/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Burn scar contractures limit range of motion (ROM) of joints and have substantial impact on disability and the quality of life (QoL) of patients, particularly in a Low- and Middle-Income Country (LMIC) setting. Studies on the long-term outcome are lacking globally; this study describes the long-term impact of contracture release surgery performed in an LMIC. METHODS This is a pre-post cohort study, conducted in a referral hospital in Tanzania. Patients who underwent burn scar contracture release surgery in 2017-2018 were eligible. ROM (goniometry), disability (WHODAS 2.0) and QoL (EQ-5D) were assessed. The ROM data were compared to the ROM that is required to perform activities of daily living without compensation, i.e. functional ROM. Assessments were performed preoperatively and at 1, 3, 6 and 12 months postoperatively. RESULTS In total, 44 patients underwent surgery on 115 affected joints. At 12 months, the follow-up rate was 86%. The mean preoperative ROM was 37.3% of functional ROM (SD 31.2). This improved up to 108.7% at 12 months postoperatively (SD 42.0, p < 0.001). Disability-free survival improved from 55% preoperatively to 97% at 12 months (p < 0.001) postoperatively. QoL improved from 0.69 preoperatively, to 0.93 (max 1.0) at 12 months postoperatively (p < 0.001). Patients who regained functional ROM in all affected joints reported significantly less disability (p < 0.001) and higher QoL (p < 0.001) compared to patients without functional ROM. CONCLUSIONS Contracture release surgery performed in an LMIC significantly improved functional ROM, disability and QoL. Results showed that regaining a functional joint is associated with less disability and higher QoL.
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Affiliation(s)
- T C C Hendriks
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Haydom Lutheran Hospital, Haydom, Tanzania; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands.
| | - M Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands
| | - L E M de Haas
- 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
| | - M E H Jaspers
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - A S Niemeijer
- Burn Center, Martini Hospital, Groningen, The Netherlands; Association of Dutch Burn Centers, The Netherlands
| | - M K Nieuwenhuis
- Burn Center, Martini Hospital, Groningen, The Netherlands; Association of Dutch Burn Centers, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - P P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Amsterdam Movement Sciences, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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26
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Gravelier C, Kanny G, Adetu S, Goffinet L. Spa therapy and burn scar treatment: a systematic review of the literature. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:2195-2203. [PMID: 32875343 DOI: 10.1007/s00484-020-01988-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Spa therapy is an integral part of the treatment of burn scars. The objective of this systematic review is to provide an overview of the spa therapy used in the treatment of burn scars and analyze its effects reported in clinical studies. We used the PRISMA checklist and queried 8 scientific databases from August 2019 to July 2020 for articles referenced with the specific key words: (burn) AND ((spa) OR (crenotherap*) OR (sulfur bath) OR (balneo*) OR (hydrotherap*) OR (mineral water) OR (thermal water) OR (spring water) OR (health resort medicine)). We used the EPHPP-QAT to assess the quality of the studies. Out of 10,050 publications identified in our database searches, 3 studies were selected: 2 clinical trials and 1 descriptive multicenter study that polled surgeons for their opinion on spa therapy for burn patients. All of the articles concluded that spa therapy is positive in burn scar recovery. No strong study on the effectiveness of spa therapy for burn scars care according to the EPHPP-QAT was identified. Spa therapy in the Saint Gervais spa center appears to be the only spa technique to have been evaluated for burn scar care. This review underscores the need to perform clinical studies to evaluate the effects and benefits of spa therapy for burn scars on patient's quality of life, and improve our understanding of the mechanisms of action of physiotherapy. Care programs should be harmonized in order to conduct multicenter studies.
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Affiliation(s)
- Camille Gravelier
- Research team INTERPSY EA 4432, axe PRISME, Medical School of Nancy, University of Lorraine, Interregional Burn Treatment Center for Adults, Mercy Regional Hospital (Metz-Thionville), 1 allée du château, 57530, Ars-Laquenexy, France.
| | - Gisèle Kanny
- Internal Medicine, Clinical Immunology and Allergology, Laboratory of Medical Hydrology and Climatology, Faculté de Médecine, University Hospital of Nancy - Research Team INTERPSY, axe PRISME, University of Lorraine, 9 rue de la Forêt de Haye, 54505, Vandœuvre-lès-Nancy, France
| | - Sorin Adetu
- Interregional Burn Treatment Center for Children, Nancy University Hospital (CHU), rue du Morvan, 54511, Vandœuvre-lès-Nancy, France
| | - Laetitia Goffinet
- Interregional Burn Treatment Center for Children, Nancy University Hospital (CHU), rue du Morvan, 54511, Vandœuvre-lès-Nancy, France
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27
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Özkal Ö, Seyyah M, Topuz S, Konan A. Lower limb functional status and its determinants in moderate/major burns 3-6 months following injury: A two-center observational study. Burns 2020; 47:676-683. [PMID: 32859438 DOI: 10.1016/j.burns.2020.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Severe complications which may cause impaired physical functionoften develops over time following severe burn to the lower extremities. The purpose of this study was to clarify the clinical determinants of lower limb functional status, functional mobility and exercise capacity in moderate/major burns 3-6 months following the injury. METHODS The study included 42 patients, 12 with moderate injury and 30 with major injury, aged 19-59 years old. Lower Limb Functional Index was used to determine the lower limb functional status. Functional mobility and exercise capacity were evaluated with the Timed Up and Go test and the 6-min walk test, respectively. Scar quality and kinesiophobia were assessed with the Patient and Observer Scar Assessment Scale (POSAS) and the Tampa Scale for Kinesiophobia, respectively. Active range of motion (ROM) was measured with a universal goniometer. RESULTS Significant and independent predictors of lower limb functional status, functional mobility and exercise capacity related to POSAS score, kinesiophobia level, gender, burn severity, the number of operations, the presence of burnsinvolving any of the lower limb joints, knee ROM limitations, limitation in any of the lower limb joint ROMs, comorbidities, and truncal burns (p < 0.05). CONCLUSIONS Burn characteristics and clinical evaluations of patients are important determinants of the lower limb functional status, mobility and exercise capacity in burn patients. These predictors should be considered to improve physical functions related to the lower limb when creating a personalized rehabilitation program.
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Affiliation(s)
- Özden Özkal
- Bursa Uludağ University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bursa, Turkey.
| | - Mine Seyyah
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Education and Research Hospital, Burn and Wound Treatment Department, İstanbul, Turkey
| | - Semra Topuz
- Hacettepe University, Faculty of Physcial Therapy and Rehabilitation, Ankara, Turkey
| | - Ali Konan
- Hacettepe University, School of Medicine, Department of General Surgery, Ankara, Turkey
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28
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The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2907. [PMID: 32802643 PMCID: PMC7413812 DOI: 10.1097/gox.0000000000002907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Worldwide, many scar contracture release surgeries are performed to improve range of motion (ROM) after a burn injury. There is a particular need in low- and middle-income countries (LMICs) for such procedures. However, well-designed longitudinal studies on this topic are lacking globally. The present study therefore aimed to evaluate the long-term effectiveness of contracture release surgery performed in an LMIC.
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29
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DeJong H, Abbott S, Zelesco M, Spilsbury K, Martin L, Sanderson R, Ziman M, Kennedy BF, Wood FM. A Novel, Reliable Protocol to Objectively Assess Scar Stiffness Using Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1614-1629. [PMID: 32386847 DOI: 10.1016/j.ultrasmedbio.2020.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
The aim of this research was to investigate the use of shear wave elastography as a novel tool to quantify and visualize scar stiffness after a burn. Increased scar stiffness is indicative of pathologic scarring which is associated with persistent pain, chronic itch and restricted range of movement. Fifty-five participants with a total of 96 scars and 69 contralateral normal skin sites were evaluated. A unique protocol was developed to enable imaging of the raised and uneven burn scars. Intra-rater and inter-rater reliability was excellent (intra-class correlation coefficient >0.97), and test-retest reliability was good (intra-class correlation coefficient >0.85). Shear wave elastography was able to differentiate between normal skin, pathologic scars and non-pathologic scars, with preliminary cutoff values identified. Significant correlations were found between shear wave velocity and subjective clinical scar assessment (r = 0.66). Shear wave elastography was able to provide unique information associated with pathologic scarring and shows promise as a clinical assessment and research tool.
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Affiliation(s)
- Helen DeJong
- Perth Scar and Pain Clinic, Fremantle, Western Australia 6160, Australia; School of Medical and Health Science, Edith Cowan University, Joondalup, Western Australia 6027, Australia; BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre Nedlands and Centre for Medical Research, University of Western Australia, Crawley, Western Australia 6009, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia.
| | - Steven Abbott
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia
| | - Marilyn Zelesco
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia 6959, Australia
| | - Lisa Martin
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Rowan Sanderson
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre Nedlands and Centre for Medical Research, University of Western Australia, Crawley, Western Australia 6009, Australia; Department of Electrical, Electronic and Computer Engineering, School of Engineering, University of Western Australia, Crawley 6009, Western Australia
| | - Melanie Ziman
- School of Medical and Health Science, Edith Cowan University, Joondalup, Western Australia 6027, Australia; School of Biomedical Science, University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre Nedlands and Centre for Medical Research, University of Western Australia, Crawley, Western Australia 6009, Australia; Department of Electrical, Electronic and Computer Engineering, School of Engineering, University of Western Australia, Crawley 6009, Western Australia
| | - Fiona M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia 6009, Australia; Burn Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia
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