Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome

Double Stiletto Flap for Soft Tissue Cover as a Firebreak Following Contracture Release of Digits and Full-Thickness Grafting: A Surgical Technique

Contracture release followed by full-thickness skin grafting is often performed while releasing severe contracture of the digits. We report a technique for flexion contracture of the finger, by using two triangular flaps from either side of the digit as a firebreak over the proximal interphalangeal (PIP) joint while using a skin graft following contracture release. We reviewed the medical records of patients who underwent contracture release at our institution from January 2018 to July 2021, and this technique was used for the release of flexion contracture of the five digits belonging to four patients. Our technique used triangular flaps from either side of the digit, which were rotated and brought over the PIP region, and hence, a single sheet of graft spanning the PIP joint is avoided. We believe that this acts as a firebreak and thus reduces the recurrence of contracture at the PIP joint.

Effect of augmented reality-based rehabilitation of hand burns on hand function in children: A randomized controlled trial

BACKGROUND

Despite the use of traditional rehabilitation methods, hand function may still remain impaired in children suffering from burn injuries.

PURPOSE

This study aimed to assess the impact of implementing an augmented reality (AR) rehabilitation booklet designed for pediatric hand burn on their hand functionality.

STUDY DESIGN

This was a randomized controlled trial.

METHODS

Seventy-two children, aged 8-14 years with a hand burn, were randomly allocated into intervention (n = 36) and control (n = 36) groups. Children in the control group received routine rehabilitation program, while in the intervention group, children performed exercises using a printed booklet with related AR application. The Jebsen-Taylor Hand Function Test was completed before the intervention at the time of the patients' discharge and 1 month later.

RESULTS

The results of analysis of covariance based on baseline- and fully-adjusted models showed significant intervention effect after discharge as well as after intervention for hand function (mean difference [95% confidence interval] for discharge: -8.2 [-15.0 to -1.4] and for after intervention: -74.0 [-88.8 to -59.1]) and the items (all p < 0.05), except for writing and lifting large light objects for both after discharge and after intervention measures (all p-value > 0.05).

CONCLUSIONS

A significant decrease in the total time taking to complete the Jebsen-Taylor hand function test was observed in the intervention group compared to the control group 1 month after discharge. Rehabilitation of children with hand burns, using printed educational booklet with related AR application, improves their hand function.

Dermal substrate application in the treatment of pediatric hand burns: clinical and functional outcomes

BACKGROUND

Hand burn injuries are common among pediatric patients. Management of deep partial thickness and full thickness hand burns varies by center, with some favoring upfront autografting and others using dermal substrates (DS) as biologic dressings to accelerate burn wound healing. Achieving best outcomes is critical in children given the propensity of burn wound scars to affect hand function as a child grows and develops. Given potential complications associated with autografting in children, our center often prefers to treat pediatric hand burns initially with DS, with subsequent autografting if there is failure to heal. In this case series, we examined the outcomes of this practice.

METHODS

We conducted a retrospective review of pediatric burn patients with <10% total body surface area (TBSA) burns who underwent application of DS to hand burn injuries between 2013 and 2021. Burn mechanism, patient demographics, wound treatment details, healing and functional outcomes, and complications were collected. Descriptive statistics were computed.

RESULTS

Fifty patients with hand burns and overall <10% TBSA burns underwent application of DS to hands. Median age at the time of injury was 4.1 years (IQR: 1.8, 10.7) and 29 patients (58%) were male. Eighteen (36%) patients had bilateral hand burns, 10 (20%) had burns to their dominant hand, 6 (12%) their non-dominant hand, and 16 (32%) had unestablished or unknown hand dominance. Subsequent autografting was required in 5 (10%) patients treated initially with DS; four of these patients had full thickness injuries. Five (10%) patients developed contracture at the site of DS application for which two underwent scar release with tissue rearrangement, one underwent laser treatment, and two were managed conservatively. Most patients had splints (94%), or compression garments (54%) prescribed to aid in functional recovery.

CONCLUSION

Children with hand burns who underwent DS application healed well with few requiring autografting or developing contractures. Most patients who needed autografting had deeper injuries. Most patients who developed a contracture required additional procedural intervention. Recognizing factors that contribute to the need for autografting after initial treatment with DS can help direct intervention decisions in pediatric patients with hand burn injuries.

Concepts in soft-tissue reconstruction of the contracted hand and upper extremity after burn injury

Burns and their subsequent contracture result in devastating functional and aesthetic consequences which disproportionally affect the upper extremity. By focusing on reconstruction with analogous tissue and utilizing the reconstructive elevator, function can be restored concomitantly with form and aesthetic appearance. General concepts for soft-tissue reconstruction after burn contracture are presented for different sub-units and joints.

Effects of Virtual Reality and Task-Oriented Training on Hand Function and Activity Performance in Pediatric Hand Burns: A Randomized Controlled Trial

OBJECTIVE

To assess the efficacy of a motion-sensing, hands-free gaming device and task-oriented training (TOT) programs on improving hand function, activity performance, and satisfaction in pediatric hand burns.

DESIGN

A randomized controlled trial.

SETTING

Outpatient rehabilitation center.

PARTICIPANTS

Fifty children with deep partial-thickness or full-thickness hand burns. (N=50; mean age, 10.70±1.64y; range, 7-14y) INTERVENTIONS: Children were randomized into 1 of the following 3 groups: the motion-sensing, hands-free gaming device group that used interactive video games plus traditional rehabilitation (TR); the TOT group that used real materials plus TR; and the control group that only received TR, all groups received the interventions 3 days per week for 8 weeks.

MAIN OUTCOME MEASURES

We assessed the children at the baseline and after 8 weeks of intervention. The primary outcome measures were the Jebsen-Taylor Hand Function Test, Duruoz Hand Index (DHI), and Canadian Occupational Performance Measure (COPM). The secondary outcome measures were range of motion (ROM) of the digits, grip strength, and pinch strengths (tip, palmer, and lateral pinch).

RESULTS

There was a significant increase in all measurements of the motion-sensing, hands-free gaming device and TOT groups compared with that of the control group postintervention (P<.05). There was no significant change in Jebsen-Taylor Hand Function Test, COPM performance, ROM, grip strength, and tip and lateral pinch strengths between the motion-sensing, hands-free gaming device group and TOT group (P>.05), whereas there was a significant increase in DHI, COPM satisfaction, and palmer pinch strength (P<.05) in the motion-sensing, hands-free gaming device group compared with the TOT group postintervention.

CONCLUSIONS

The motion-sensing, hands-free gaming device and TOT programs resulted in significant improvement in hand function, activity performance and satisfaction, ROM of the digits, grip strength, and pinch strengths in pediatric hand burns compared with the traditional hand rehabilitation.

[How to treat palmar burn sequelae in children, about 49 cases]

INTRODUCTION

Even if they represent only 2.5 % of the total body surface area, the hands are burnt in 50 % of hospitalized patients. The risk of sequelae is significant, especially in children, human being in full growth, and a source of aesthetic and functional handicap. The aim of this study is to research the predictive factors of sequelae, to study their treatment of and their evolution.

MATERIAL AND METHODS

We included children under six years of age with deep palmar burns of the hand between 1998 and 2008. Demographics, characteristics of the initial burn and its treatment were noted. Then, we studied the types of hand burn sequelae and their treatment. Finally, we observed their evolution over time with an aesthetic and functional evaluation and their impact on quality of life.

RESULTS

Forty-nine children, representing 70 hands, were included in the study. The mean age at the time of the initial burn was 16.2 months (6; 60). The initial treatment was directed healing in 39 % of cases and thin skin excision-grafting in 61 % of cases. The type of sequelae most represented was bridle in 73 % of cases. Treatment consisted of rehabilitation measures (13 %) or surgery (69 %). The mean age at the time of surgery was 10.1 years (4; 19). These were plasties (62 %), total skin grafts (15 %) or a combination of both (23 %). The current follow-up is 16.2 years. The aesthetic result is considered good in 52 % of cases, the functional result is good in 78 % of cases. The impact on the quality of life is low and the parents are satisfied with the initial care.

CONCLUSION

The treatment of the sequelae of burnt hands gives good results but involves well-conducted rehabilitation and regular monitoring. The treatment period must be adapted and the surgery simple, effective and specific to the type of sequelae.

Pediatric burn contractures in low- and lower middle-income countries: A systematic review of causes and factors affecting outcome

In low- and lower middle-income countries (LMICs), timely access to primary care following thermal injury is challenging. Children with deep burns often fail to receive specialized burn care until months or years post-injury, thus suffering impairments from hypertrophic scarring or joint and soft tissue contractures. We aimed to examine the correlation between limited access to care following burn injury and long-term disability in children in LMICs and to identify specific factors affecting the occurrence of late burn complications. A systematic literature search was conducted to retrieve articles on pediatric burns in LMICs using Medline, Embase, the Cochrane Library, LILACS, Global Health, African Index Medicus, and others. Articles were assessed by two reviewers and reported in accordance with PRISMA guidelines. Of 2896 articles initially identified, 103 underwent full-text review and 14 met inclusion criteria. A total of 991 children who developed long-term burn sequelae were included. Time from injury to consultation ranged from a few months to 17 years. Factors associated with late complications included total body surface area burned, burn depth, low socio-economic status, limited infrastructure, perceived inability to pay, lack of awareness of surgical treatment, low level of maternal education, and time elapsed between burn injury and reconstructive surgery.

Upper Extremity Burns in the Developing World: A Neglected Epidemic

Burns are devastating injuries that cause significant morbidity, emotional distress, and decreased quality of life. Advances in care have improved survival and functional outcomes; however, burns remain a major public health problem in developing countries. More than 95% of burns occur in low- and middle-income countries, where access to basic health care is limited. The upper extremity is involved in the majority of severe burn injuries. The purpose of this article is to review upper extremity burn epidemiology, risk factors, prevention strategies, and treatment options in resource-limited settings.

Treating Pediatric Hand Problems in a Low-resource Environment

Although individual pediatric hand problems are rare, the combined burden of congenital anomalies, neuromuscular disease, and trauma is considerable in low-resource environments where treatment is unavailable. Surgeons from high-income countries respond to the need for care with short-term trips to low-resource environments to operate and teach local surgeons. Hand problems are amenable to this model, because they may be disabling and treatable with low-risk, low-resource surgery. Pediatric hand problems are especially compelling, because growth may adversely affect outcomes, and resulting disability is lifelong. This article addresses considerations for treating children's hands in low-resource environments, and approaches to specific conditions.

Postburn Contractures of the Hand

Postburn contractures are a common occurrence after severe burn injuries. It is important to understand the pathologic condition and anatomy of specific postburn deformities in order to provide comprehensive surgical care. Postburn contractures can result in a flexion contracture, boutonniere deformity, burn syndactyly, metacarpophalangeal extension contracture, wrist contracture, or claw hand. A patient evaluation is performed before proceeding to the operating room. Surgery sequences require proper incision design, release of the skin, and deeper contracted structures and coverage with an appropriate flap or graft. Postoperative splinting, scar care, and therapy are equally important for a successful outcome.