1
|
Murtaugh B, Warthman R, Boulter T. Rehabilitation Management of the Burned Hand. Phys Med Rehabil Clin N Am 2023; 34:767-782. [PMID: 37806696 DOI: 10.1016/j.pmr.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Burns to the hands constitute a small total surface area burn, but can result in significant functional challenges and disability. The complexity of multiple anatomical structures and intricate interplay of bones, muscles, and connective tissues requires specialized knowledge of how burns of the hand can affect function and independence. This article will provide an evidence-based overview of rehabilitation of the burned hand across the burn care continuum including a focus on evaluation, pain management, treatment interventions, and outcome assessment. Additionally, various deficits that can put the hand at significant risk for loss of function will be discussed. Finally, the authors will address the special considerations and treatment caveats of addressing the pediatric hand burn.
Collapse
Affiliation(s)
- Brooke Murtaugh
- Department of Rehabilitation Programs, Madonna Rehabilitation Hospitals, 5401 South Street, Lincoln, NE 68506, USA.
| | - Renee Warthman
- Arizona Burn Center, Valleywise Health Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Trudy Boulter
- Children's Hospital Colorado Burn Center, 13123 East 16th Avenue, Aurora, CO 80045, USA
| |
Collapse
|
2
|
O'Neil A, Hines D, Wirdzek E, Thornburg C, Murray D, Porter J. Early Mobilization, Early Ambulation, and Burn Therapy in the Acute Hospital Setting. Phys Med Rehabil Clin N Am 2023; 34:733-754. [PMID: 37806694 DOI: 10.1016/j.pmr.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Rehabilitation therapies in the burn acute care environment continue to evolve. Immediate access to therapy is considered standard, and therapy is a key component of the transprofessional care team. Early positioning, edema management, and therapy care in the intensive care unit (ICU) environment can limit later complications; mobility in the ICU can be engaged safely using a systems-based approach in the absence of nondirectable agitation. Later in the course of acute care, early ambulation is an appropriate intervention that can improve outcomes.
Collapse
Affiliation(s)
- Audrey O'Neil
- Burn Rehabilitation Services; Eskenazi Health, Richard M Fairbanks Burn Center, 720 Eskenazi Avenue, 4th Floor, Indianapolis, IN 46202, USA
| | - Danika Hines
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Emily Wirdzek
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Cody Thornburg
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Derek Murray
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA.
| | - John Porter
- Physiatry, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA; Trauma and Burn Services, Department of Surgery, University of Arizona, Creighton University, Phoenix, AZ, USA
| |
Collapse
|
3
|
Thomas R, Wicks S, Toose C, Dale M, Pacey V. Reliability, Validity, and Predictive Validity of Cutaneous Functional Units Predicted to Scar Following Palmar Burn Injury in Young Children. J Burn Care Res 2023; 44:918-924. [PMID: 36478206 DOI: 10.1093/jbcr/irac179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Identification of children at risk of palmar burn scar is important for early initiation of scar management. This study determined the interrater reliability of face-to-face and photographic assessments of 29 palmar cutaneous functional units (CFUs) predicted to scar following palmar burn. The validity of photographic compared to face-to-face assessment, and the predictive validity of both assessment types to identify scarring at 3 to 6 months following burn, was also established. Thirty-nine children (40 hands) post burn injury were assessed face-to-face in the clinical setting, following healing of their palmar burn, by three burn therapists. Photographs of the children's hands at initial assessment were assessed by the same therapists a minimum of 6 months later. To determine which CFUs scarred, children were reassessed face-to-face in the clinical setting 3 to 6 months following their burn. For analysis, 29 CFUs were merged into eight separate groups to determine the number of CFUs predicted to scar per CFU group for face-to-face and photographic assessments. The range of agreement for individual CFUs within CFU groups was also calculated for both assessment types. Excellent interrater reliability was established for face-to-face assessment in all eight CFU groups (ICC2,1 0.83-0.96). Photographic assessment demonstrated good to excellent interrater reliability in six CFU groups (ICC2,1 0.69-0.90) and validity in seven CFU groups (ICC2,1 0.66-0.87). Good to excellent predictive validity was established for both assessment types in seven CFU groups (face-to-face ICC2,1 0.60-0.95, photographic ICC2,1 0.69-0.89). Experienced therapists can reliably assess CFUs face-to-face or via photographs and predict future scar development.
Collapse
Affiliation(s)
- Rhianydd Thomas
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Claire Toose
- Burns Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Marita Dale
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Hege AR, Choubisa CA, Kasatwar P. Physiotherapeutic Rehabilitation of a Patient Following an Electrical Burn: A Case Report. Cureus 2022; 14:e29702. [PMID: 36320961 PMCID: PMC9616556 DOI: 10.7759/cureus.29702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022] Open
Abstract
Electrical burn is one of the common burn injuries occurring nowadays due to the increase in the use of technology; among others, electricians are more prone to electrical burn injury as they work all day to make and repair electrical equipment and systems. In this case report, we are presenting such a scenario. The patient, a 36-year-old male, was brought to casualty with an injury by a flash of electricity while working. The patient sustained a burn on the right hand and presented with burn injury over the right hand and forearm with bleb over the anterior aspect of the wrist joint, skin discolouration, local rise in temperature, line of demarcation seen over the palmar aspect of the forearm at middle 2/3rd, clear serous discharge present from bleb, discolouration of tips of all fingers of the right hand and nail beds, and tenderness. The patient was diagnosed with an electrical burn injury after the evaluation and investigations. The investigations were done on complete blood count (CBC), coagulation profile, peripheral smear, liver function test (LFT), and random blood glucose (RBS). The injury site was cleaned and the dressing was done with one percent silver sulfadiazine, some medications were prescribed by the physician, and plaster was applied to prevent contractures. The physiotherapeutic intervention for the prevention of burn contracture includes positioning, splinting, massage, stretching, scar management, pressure therapy, and strengthening. This case report concludes that early physiotherapeutic interventions helped in the prevention of electrical burn contractures and the patient’s functional mobility.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Ankle contracture serial casting technique and maintenance orthosis. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
7
|
Two-piece facial orthosis. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
8
|
Khor D, Liao J, Fleishhacker Z, Schneider JC, Parry I, Kowalske K, Richard R, Wibbenmeyer L. Update on the practice of splinting during acute burn admission from the ACT study. J Burn Care Res 2021; 43:640-645. [PMID: 34490885 DOI: 10.1093/jbcr/irab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Burn scar contracture (BSC) is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in function. Despite a paucity of research addressing its efficacy, static splinting of affected joints is a common preventative practice. A survey of therapists performed 25 years ago showed a widely divergent practice of splinting during the acute burn injury. We undertook this study to determine the current practice of splinting during the index admission for burn injuries. METHODS This is a review of a subset of patients enrolled in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database. ACT was an observational multicenter study conducted from 2010-2013. The most commonly splinted joints (elbow, wrist, knee and ankle) and their 7 motions were included. Variables included patients' demographics, burn variables, rehabilitation treatment and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P< 0.05 was significant. RESULTS Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. Splinting was associated with larger burns and increased injury severity on the patient level and increased involvement with burns requiring grafting in the associated cutaneous functional unit (CFU) on the joint level. The requirement for skin grafting in both analyses remained independently related to splinting, with requirement for grafting in the associated CFU increasing the odds of splinting 6 times (OR =6.0, 95% CI=3.8-9.3, p<0.001). On average splinting was initiated about a third into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50 ± 26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. The wrist was most frequently splinted joint being splinted with one third of wrists splinted ( 30.7%) while the knee was the least frequently splinted joint with 8.2% splinted. However, when splinted, the knee was splinted the most hours per day (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). Almost one third had splinting continued to discharge (20, 27%). CONCLUSIONS The current practice of splinting, especially the initiation, hours of wear and duration of splinting following acute burn injury remains variable. Splinting is independently related to grafting, grafting in the joint CFU, larger CFU involvement and is more likely to occur around the time of surgery. A future study looking at splinting application and its outcomes is warranted.
Collapse
Affiliation(s)
- Desmond Khor
- Department of Surgery, University of Iowa Hospitals and Clinics
| | - Junlin Liao
- Department of Surgery, University of Iowa Hospitals and Clinics
| | | | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Department of Physical Medicine and Rehabilitation, Harvard Medical School
| | - Ingrid Parry
- Department of Occupational and Physical Therapy, Shriners Hospital for Children, Northern California, University of California, Davis
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern
| | | | | |
Collapse
|
9
|
Parry IS, Schneider JC, Yelvington M, Sharp P, Serghiou M, Ryan CM, Richardson E, Pontius K, Niszczak J, McMahon M, MacDonald LE, Lorello D, Kehrer CK, Godleski M, Forbes L, Duch S, Crump D, Chouinard A, Calva V, Bills S, Benavides L, Acharya HJ, De Oliveira A, Boruff J, Nedelec B. Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines. J Burn Care Res 2021; 41:503-534. [PMID: 31504622 DOI: 10.1093/jbcr/irz150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.
Collapse
Affiliation(s)
- Ingrid S Parry
- From the Shriners Hospital for Children, Northern California, University of California-Davis, Sacramento
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Patricia Sharp
- Cincinnati Children's Hospital, University of Cincinnati College of Allied Health Sciences Program in Occupational Therapy, Ohio
| | - Michael Serghiou
- Bio Med Sciences Inc., Allentown, Pennsylvania Shriners Hospitals for Children Boston, Massachusetts
| | - Colleen M Ryan
- Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | - Jonathan Niszczak
- Bio Med Sciences Inc., Allentown, Pennsylvania Shriners Hospitals for Children Boston, Massachusetts.,Thomas Jefferson University Burn Center, Philadelphia, Pennsylvania.,Bio Med Sciences, Inc. Allentown, Pennsylvania
| | - Margaret McMahon
- Our Lady's Hopsice and Care Services, Harold's Cross, Dublin, Ireland
| | | | - David Lorello
- The Arizona Burn Center at Maricopa Medical Center, Phoenix
| | | | - Matthew Godleski
- Department of Physical Medicine and Rehabilitation, Ross Tilley Burn Centre, St. John's Rehab, University of Toronto, Ontario, Canada
| | - Lisa Forbes
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Sarah Duch
- Westchester Medical Center, Valhalla, New York
| | - Donna Crump
- Parkland Health and Hospital System, PMR Department, Dallas, Texas
| | - Annick Chouinard
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada.,CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Valerie Calva
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada
| | - Sara Bills
- Madonna Rehabilitation Hospitals, Lincoln, Nebraska University of Nebraska Medical Center, Omaha
| | | | - Hernish J Acharya
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ana De Oliveira
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - Jill Boruff
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Bernadette Nedelec
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
10
|
Mc Kittrick A, Gustafsson L. A Cross-sectional Survey of Health Professionals Across Australia and New Zealand to Determine What Outcome Measures Are Important From a Clinical Perspective Post Hand Burn Injury. J Burn Care Res 2021; 43:77-84. [PMID: 34226927 DOI: 10.1093/jbcr/irab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Outcome measures are used in healthcare to evaluate clinical practice, measure efficiencies and to determine the quality of health care provided. The Burns Trauma Rehabilitation: Allied Health Practice Guidelines advocates for the collection of outcome measures post burn injuries across different time points. These guidelines recommend multiple tools which can be utilized when measuring outcomes post burn injuries. The aim of this study was to gather information from specialist clinicians regarding their clinical practice and the outcome measurement tools used post hand burn injuries. This cross-sectional study used a survey design to collect data at one given point in time across a sample population. A total of 43 clinical specialists allied health professionals responded to the survey. Respondents indicated that their patients considered hand dexterity was the most important outcome. Three months post burn injury was the most common timepoint for measurement (n = 31, 72.1%) followed by six months (n = 27, 62.8%). Patient report of hand function (n = 42, 97.7%) and observation (n = 41, 95.3%) were the most frequently reported assessment methods. The Jamar Dynamometer (n = 40, 93%), goniometer (n = 39, 90.7%) and pinch gauge (n = 36, 83.7) were the most frequency cited assessment tools. The findings of this study suggest that clinical specialist allied health collect some outcome measures in their routine practice. Based on the respondent's perceptions of barriers when using outcome measures and lack of reliable/validated tools to measure hand burn outcomes, there is a need for further studies in this area.
Collapse
Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.,Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Nathan, QLD, Australia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Kaplan A, Ergani H, Yasar B, Duru Ç. Dynamic external fixators for the proximal interphalangeal joint injuries: detailed biomechanical analysis of effectiveness. TURKISH JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.4103/tjps.tjps_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Randomized Controlled Trial of Compression Interventions for Managing Hand Burn Edema, as Measured by Bioimpedance Spectroscopy. J Burn Care Res 2020; 41:992-999. [DOI: 10.1093/jbcr/iraa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Compression, a common treatment of choice for the management of edema, is one intervention that is applied with little objective understanding of the optimal parameters of application or efficacy in acute burn wounds. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The primary hypothesis tested was that in acute hand burn injury, the application of cohesive bandage will reduce edema faster than a generic compression glove. It is a randomized controlled study of 100 patients presenting with hand burn injury. Compression was randomized to one of the three methods of application: 1) spiral application of Coban to fingers, figure of eight to hand and wrist; 2) pinch application of Coban to fingers, spiral application to hand and wrist; or 3) a generic compression glove (control condition). Bioimpedance spectroscopy was used to measure hand volumes. Hand and wrist range of movement, pain scores, and QuickDASH were recorded. One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods. Both methods of applying Coban resulted in significantly greater reductions in edema compared to the generic compression glove. Notwithstanding compression method, all range of movement measures improved, with significant improvement in thumb opposition (P = .046), hand span (P = .020), and wrist flexion (P = .020). QuickDASH decreased between sessions (P < .001). Different methods of applying Coban are superior to generic compression gloves for managing acute hand burn edema.
Collapse
Affiliation(s)
- Dale O Edwick
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia
| | - Dana A Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia
| | - Jeremy M Rawlins
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Department of Plastic and Maxillofacial Surgery, Royal Perth Hospital, Western Australia
| | - Fiona M Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Unit, University of Western Australia, Perth
| | - Dale W Edgar
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Western Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia
- Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia
- Burn Injury Research Unit, University of Western Australia, Perth
| |
Collapse
|
14
|
Chow L, Yick KL, Kwan MY, Yuen CF, Ng SP, Yu A, Yip J. Customized Fabrication Approach for Hypertrophic Scar Treatment: 3D Printed Fabric Silicone Composite. Int J Bioprint 2020; 6:262. [PMID: 32782991 PMCID: PMC7415855 DOI: 10.18063/ijb.v6i2.262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic scars (HS) are considered to be the greatest unmet challenge in wound and burn rehabilitation. The most common treatment for HS is pressure therapy, but pressure garments may not be able to exert adequate pressure onto HS due to the complexity of the human body. However, the development of three-dimensional (3D) scanning and direct digital manufacturing technologies has facilitated the customized placement of additively manufactured silicone gel onto fabric as a component of the pressure therapy garment. This study provides an introduction on a novel and customized fabrication approach to treat HS and discusses the mechanical properties of 3D printed fabric reinforced with a silicone composite. For further demonstration of the suggested HS therapy with customized silicone insert, silicone inserts for the finger webs and HS were additively manufactured onto the fabric. Through the pressure evaluation by Pliance X system, it proved that silicone insert increases the pressure exerted to the HS. Moreover, the mechanical properties of the additively manufactured fabric silicone composites were characterized. The findings suggest that as compared with single viscosity print materials, the adhesive force of the additively manufactured silicone and fabric showed a remarkable improvement of 600% when print materials with different viscosities were applied onto elevated fabric.
Collapse
Affiliation(s)
- Lung Chow
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Kit-Lun Yick
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Mei-Ying Kwan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Chun-Fai Yuen
- University Research Facility in 3D Printing, The Hong Kong Polytechnic University, Hong Kong
| | - Sun-Pui Ng
- Division of Science, Engineering and Health Studies, College of Professional and Continuing Education, The Hong Kong Polytechnic University, Hong Kong
| | - Annie Yu
- Department of Advanced Fibro Science, Kyoto Institute of Technology, Japan
| | - Joanne Yip
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
15
|
Chow L, Yick KL, Kwan MY, Yuen CF, Ng SP, Yu A, Yip J. Customized Fabrication Approach for Hypertrophic Scar Treatment: 3D Printed Fabric Silicone Composite. Int J Bioprint 2020. [PMID: 32782991 DOI: 10.18063/ijb.v6i2.262.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic scars (HS) are considered to be the greatest unmet challenge in wound and burn rehabilitation. The most common treatment for HS is pressure therapy, but pressure garments may not be able to exert adequate pressure onto HS due to the complexity of the human body. However, the development of three-dimensional (3D) scanning and direct digital manufacturing technologies has facilitated the customized placement of additively manufactured silicone gel onto fabric as a component of the pressure therapy garment. This study provides an introduction on a novel and customized fabrication approach to treat HS and discusses the mechanical properties of 3D printed fabric reinforced with a silicone composite. For further demonstration of the suggested HS therapy with customized silicone insert, silicone inserts for the finger webs and HS were additively manufactured onto the fabric. Through the pressure evaluation by Pliance X system, it proved that silicone insert increases the pressure exerted to the HS. Moreover, the mechanical properties of the additively manufactured fabric silicone composites were characterized. The findings suggest that as compared with single viscosity print materials, the adhesive force of the additively manufactured silicone and fabric showed a remarkable improvement of 600% when print materials with different viscosities were applied onto elevated fabric.
Collapse
Affiliation(s)
- Lung Chow
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Kit-Lun Yick
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Mei-Ying Kwan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Chun-Fai Yuen
- University Research Facility in 3D Printing, The Hong Kong Polytechnic University, Hong Kong
| | - Sun-Pui Ng
- Division of Science, Engineering and Health Studies, College of Professional and Continuing Education, The Hong Kong Polytechnic University, Hong Kong
| | - Annie Yu
- Department of Advanced Fibro Science, Kyoto Institute of Technology, Japan
| | - Joanne Yip
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
16
|
Pham TN, Goldstein R, Carrougher GJ, Gibran NS, Goverman J, Esselman PC, Kazis LE, Ryan CM, Schneider JC. The impact of discharge contracture on return to work after burn injury: A Burn Model System investigation. Burns 2020; 46:539-545. [PMID: 32088093 DOI: 10.1016/j.burns.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine the association of extremity contractures with employment after burn injury. METHODS We obtained data from the Burn Model System database from 1994 to 2003. We included in the study cohort all adult patients who were working prior to injury and identified those discharged with and without a contracture in one of the major extremity joints (shoulder, elbow, wrist, hip, knee and ankle). We classified contracture severity according to mild, moderate and severe categories. We performed descriptive analyses and predictive modeling to identify injury and patient factors associated with return to work (RTW) at 6, 12, and 24 months. RESULTS A total of 1,203 participant records met criteria for study inclusion. Of these, 415 (35%) had developed a contracture at discharge; 9% mild, 12% moderate, and 14% severe. Among 801 (67%) participants who had complete data at 6 months after discharge, 70% of patients without contracture had returned to work compared to 45% of patients with contractures (p < 0.001). RTW increased at each subsequent follow-up time point for the contracture group, however, it remained significantly lower than in no-contracture group (both p < 0.01). In multivariable analyses, female sex, non-Caucasian ethnicity, larger burn size, alcohol abuse, number of in-hospital operations, amputation, and in-hospital complications were associated with a lower likelihood of employment. In adjusted analyses, discharge contracture was associated with a lower probability of RTW at all 3 time points, although its impact significantly diminished at 24 months. CONCLUSIONS This study indicates an association between discharge contracture and reduced employment 6, 12 and 24 months after burn injury. Among many other identified patient, injury, and hospitalization related factors that are barriers to RTW, the presence of a contracture at discharge adds a significant reintegration burden for working-age burn patients.
Collapse
Affiliation(s)
- Tam N Pham
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States.
| | - Richard Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Nicole S Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Jeremy Goverman
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, United States
| | - Lewis E Kazis
- Department of Health Law and Policy and Management, Boston University School of Public Health, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
| |
Collapse
|
17
|
Elnaggar RK, Samhan AF, Elshafey MA. Differential Effects of Extracorporeal Shockwave Therapy and Botulinum Toxin-A Injection on Postburn Contractures and Gait Kinematics in Burn Children. J Burn Care Res 2019; 41:612-618. [DOI: 10.1093/jbcr/irz212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Postburn contracture is a complex and multifactorial problem that requires intensive inputs from the burn care staff. This study endeavored to evaluate the effectiveness of extracorporeal shockwave therapy and botulinum toxin-A for treating the postburn plantar flexion contracture and optimizing ankle kinematics in burn children. Thirty-eight children with burns and plantar flexion contracture were randomized to receive the standard physical rehabilitation program (control group; n = 13), unfocused extracorporeal shockwave therapy (0.2 mJ/mm2) once a week over four consecutive weeks in addition to the standard physical rehabilitation (n = 12), or botulinum toxin-A injection (0.5–2 U/kg/muscle group with maximum dose of 12 U/kg/body weight) once at entry besides the standard physical rehabilitation (n = 13). Dorsiflexion active range of motion and ankle kinematics were measured before and immediately after treatment. The posttreatment dorsiflexion active range of motion increased significantly in the extracorporeal shockwave therapy group (P = .025) and botulinum toxin-A group (P = .04) when compared to the control group. Likewise, the initial stance–dorsiflexion, stance-maximum dorsiflexion, and swing-peak dorsiflexion angle improved significantly in the extracorporeal shockwave therapy group (P ˂ .001, P = .005, and P = .002, respectively) and botulinum toxin-A group (P = .004, P = .012, and P ˂ .001, respectively) compared to the control group. No significant differences were observed between the extracorporeal shockwave therapy and botulinum toxin-A groups with respect to any of the measured variables. To conclude, extracorporeal shockwave therapy and botulinum toxin-A injection could be effectively used to treat postburn plantar flexion contracture and to optimize the ankle kinematics during walking in children, without preference for either of them.
Collapse
Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed F Samhan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Egypt
| | - Mohammed A Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| |
Collapse
|
18
|
Majeed YR, Baker BG, Stanyer L, Sheikh Z. Thermoplastic splints: Minimising morbidity in paediatric foot and ankle burns. Burns 2019; 46:255-256. [PMID: 31796228 DOI: 10.1016/j.burns.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Yousef R Majeed
- Department of Burns & Plastic Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom.
| | - Benjamin G Baker
- Department of Burns & Plastic Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Lorna Stanyer
- Department of Burns & Plastic Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Zeeshan Sheikh
- Department of Burns & Plastic Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| |
Collapse
|
19
|
Thomas R, Wicks S, Toose C, Pacey V. Outcomes of Early Use of an End of Range Axilla Orthotic in Children Following Burn Injury. J Burn Care Res 2019; 40:678-688. [PMID: 30950500 DOI: 10.1093/jbcr/irz058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Scar contracture is a significant complication of burn injury. This study aimed to describe outcomes of early axilla orthotic use at end of range abduction in children, following a burn to the axilla region. A retrospective review of 76 children (mean age 3.9 years [SD 3.6]) treated at a tertiary children's hospital from 2006 to 2016 was conducted. No child developed axilla contracture for the duration of the 2-year study follow-up with no adverse events recorded. If orthotic use was ceased <60 days post-burn, it was considered not an essential intervention to maintain range of movement, leaving 49 children using the orthotic ≥60 days. Compared with the children who ceased orthotic use in <60 days, children who required the orthotic ≥60 days had a significantly higher frequency of deep-dermal burn (59 vs 25%, p = .01), flame mechanism (25 vs 5%, p = .03), and burn injury distribution involving the anterior trunk, flank, and arm (18 vs 3%, p = .03). Early signs of contracture, considered loss of full axilla range or significant banding, developed in nine children within 3 months post-burn. With intensive therapy, all returned to full axilla range by 9 months post-burn. Children with skin tension at end of range shoulder movement at the 1-month clinical assessment were 11 times more likely to develop early signs of contracture (95% confidence interval [CI]: 1.9-62.1, p = .007). Intensive orthotic use at end of range shoulder abduction in children with axilla burns is well tolerated. When undertaken with ongoing therapist review, full axilla range can be maintained.
Collapse
Affiliation(s)
- Rhianydd Thomas
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Stephanie Wicks
- Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Claire Toose
- Physiotherapy Department, The Children's Hospital at Westmead, New South Wales, Australia
| | - Verity Pacey
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| |
Collapse
|
20
|
Lewinson RT, Capozzi LC, Johnson K, Harrop AR, Fraulin FOG, Nickerson D. A Review of Perforator Flaps for Burn Scar Contractures of Joints. Plast Surg (Oakv) 2018; 27:66-77. [PMID: 30854364 DOI: 10.1177/2292550318767433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Perforator flaps are one possible surgical treatment for burn scar contractures; however, a review of evidence on this topic is lacking. Methods MEDLINE was searched for articles related to perforator flaps for burn contractures. Following title and abstract screen, full texts were searched to identify articles describing perforator flaps for burn scar joint contractures. Data were extracted and summarized descriptively. Only articles that contained ≥10 patients with burn scar contracture were considered. Results Two hundred forty-eight articles were identified, of which 17 met criteria for review. Of these, 16 were low-quality case series, while 1 was an open randomized controlled trial. In total, perforator flaps were performed on 339 patients (age range: 3-75 years), with the most common contracture locations being cervical (n = 218) and knee (n = 41). Nine of the 17 articles described a rehabilitation strategy. In general, functional outcomes were excellent, with the majority of patients experiencing return of normal joint range of motion and no recontracture. Compared to full-thickness skin grafts, perforator flaps showed greater improvements in joint range of motion. Cosmetically, perforator flaps were shown to have good color match with surrounding tissue, good contour around anatomical landmarks, and improved overall patient appearance. The most common complications were marginal flap necrosis (n = 26 patients) and venous congestion (n = 17 patients). Conclusions Preliminary evidence from low-quality case series and 1 high-quality trial suggests perforator flaps may be successful for resurfacing released burn scar contractures; however, there is a need for additional trials comparing perforator flaps to other approaches.
Collapse
Affiliation(s)
- Ryan T Lewinson
- Leaders in Medicine Program, University of Calgary, Calgary, Alberta, Canada
| | - Lauren C Capozzi
- Leaders in Medicine Program, University of Calgary, Calgary, Alberta, Canada
| | - Kody Johnson
- Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alan Robertson Harrop
- Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada.,Section of Pediatric Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Frankie O G Fraulin
- Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada.,Section of Pediatric Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Duncan Nickerson
- Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
21
|
Jacobson K, Fletchall S, Dodd H, Starnes C. Current Concepts Burn Rehabilitation, Part I: Care During Hospitalization. Clin Plast Surg 2017; 44:703-712. [PMID: 28888296 DOI: 10.1016/j.cps.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article summarizes current interventions for several of the most common challenges faced by patients during their rehabilitation from burn injury. These include preservation of range of motion through scar contracture management, and achieving maximal independence through exercise, and training in activities of daily living.
Collapse
Affiliation(s)
- Keith Jacobson
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA.
| | - Sandra Fletchall
- Burn Rehabilitation, Firefighters Burn Center, 890 Madison Avenue, TG 043, Memphis, TN 380103, USA
| | - Heather Dodd
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
| | - Carrie Starnes
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
| |
Collapse
|
22
|
Dodd H, Fletchall S, Starnes C, Jacobson K. Current Concepts Burn Rehabilitation, Part II: Long-Term Recovery. Clin Plast Surg 2017; 44:713-728. [PMID: 28888297 DOI: 10.1016/j.cps.2017.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article summarizes current interventions for several of the most common challenges faced by patients during their rehabilitation from burn injury. These challenges include range of motion preservation through scar contracture management, achieving maximal independence through exercise and activities of daily living training, and psychological recovery through nonpharmacologic approaches pain and anxiety.
Collapse
Affiliation(s)
- Heather Dodd
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
| | - Sandra Fletchall
- Burn Rehabilitation, Firefighters Burn Center, 890 Madison Avenue, TG 043, Memphis, TN 380103, USA
| | - Carrie Starnes
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
| | - Keith Jacobson
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA.
| |
Collapse
|
23
|
Abstract
Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Although nonoperative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation. These treatment tools provide an effective resource for the reconstructive surgeon to treat hypertrophic hand scars.
Collapse
Affiliation(s)
- Michael Sorkin
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109, USA
| | - David Cholok
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109, USA
| | - Benjamin Levi
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109, USA; Burn/Wound and Regenerative Medicine Laboratory, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109, USA.
| |
Collapse
|
24
|
Successful treatment of postburn flexion contracture in fingers of early childhood with dynamic splint therapy after operation: long-term follow-up. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1288-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
25
|
Zhang YT, Li-Tsang CW, Au RK. A Systematic Review on the Effect of Mechanical Stretch on Hypertrophic Scars after Burn Injuries. Hong Kong J Occup Ther 2017; 29:1-9. [PMID: 30186067 PMCID: PMC6092002 DOI: 10.1016/j.hkjot.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 02/05/2023] Open
Abstract
Objective/Background To review the effect of mechanical stretch on hypertrophic scars after burn
injuries. Methods A systematic review of all controlled trials related to the effect of
mechanical stretch on post burn hypertrophic scars was conducted. Studies of
conservative scar managements that applied mechanical forces parallel to the
scar surface, including stretching exercise, massage, and splinting, were
appraised. Eligible studies published in English between 1995 and 2016 were
extracted from The Cochrane Library, MEDLINE, CINAHL, Science direct,
SPORTDiscus, and Physiotherapy Evidence Database Scale (PEDro). The journals
were further screened with inclusion and exclusion criteria. PEDro was
selected for further analysis and appraisal. Results There were 853 articles identified. After a standardized screening mechanism
stipulated, only nine full-text articles were selected for critical
appraisal using PEDro. There were five articles of high quality, two of fair
quality, and two of poor quality. Detailed training regime and outcomes of
nine studies were summarised, including two studies with stretching
exercise, six studies with massage, and one study with splinting. The
physical parameters of scar assessments and the range of motion on affected
areas were compared. Conclusion From extensive literature search, there was no strong evidence indicating the
positive effect of mechanical stretch using stretching exercise, massage, or
splinting on hypertrophic scars. A firm conclusion cannot be drawn for the
discrepancy of outcome measures and varied effectiveness. Most of the
included studies lacked objective evaluation or control group for
comparison. Further high quality studies with larger sample size and using
standardized measurements are needed.
Collapse
Affiliation(s)
- Yu-ting Zhang
- Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Rehabilitation
Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Cecilia W.P. Li-Tsang
- Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of
Rehabilitation Sciences, The Hong Kong Polytechnic University, Room QT509, 5/F,
Block QT, Hung Horn, Kowloon, Hong Kong, China. E-mail address:
| | - Ricky K.C. Au
- Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
26
|
|
27
|
Prevalence of scar contractures after burn: A systematic review. Burns 2016; 43:41-49. [PMID: 27639820 DOI: 10.1016/j.burns.2016.08.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/07/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the prevalence, course, and determinants is essential. METHODS A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar contracture assessment, point prevalence, and possible determinants. RESULTS Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38-54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity. CONCLUSIONS The prevalence of burn scar contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar contractures, their evolvement over time, and risk factors.
Collapse
|
28
|
Serghiou M, Niszczak J, Parry I, Richard R. Clinical practice recommendations for positioning of the burn patient. Burns 2016; 42:267-75. [DOI: 10.1016/j.burns.2015.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
|
29
|
Development of a Best Evidence Statement for the Use of Pressure Therapy for Management of Hypertrophic Scarring. J Burn Care Res 2016; 37:255-64. [DOI: 10.1097/bcr.0000000000000253] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
30
|
Cen Y, Chai J, Chen H, Chen J, Guo G, Han C, Hu D, Huan J, Huang X, Jia C, Li-Tsang CW, Li J, Li Z, Liu Q, Liu Y, Luo G, Lv G, Niu X, Peng D, Peng Y, Qi H, Qi S, Sheng Z, Tang D, Wang Y, Wu J, Xia Z, Xie W, Yang H, Yi X, Yu L, Zhang G. Guidelines for burn rehabilitation in China. BURNS & TRAUMA 2015; 3:20. [PMID: 27574666 PMCID: PMC4964028 DOI: 10.1186/s41038-015-0019-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 02/05/2023]
Abstract
Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.
Collapse
Affiliation(s)
| | | | - Ying Cen
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Jiake Chai
- Department of Burn & Plastic Surgery, the First Hospital Affiliated to General Hospital of PLA, Beijing, China
| | - Huade Chen
- Department of Burns, General Hospital of Guangdong Province, Guangzhou, Guangdong China
| | - Jian Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Guanghua Guo
- Department of Burns, the First Affiliated Hospital of Nanchang Univerisity, Research Center of Technology of Wound Repair Engineering in Jiangxi Province, Nanchang, Jiangxi China
| | - Chunmao Han
- Department of Burns and Wound Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi China
| | - Jingning Huan
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyuan Huang
- Department of Burns and Plastic Surgery, Central South University, Changsha, Hunan China
| | - Chiyu Jia
- Plastic Beauty and Burn Repair Center, the 309th Hospital of the Chinese PLA, Beijing, China
| | - Cecilia Wp Li-Tsang
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Jianan Li
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu China
| | - Zongyu Li
- Department of Burns and Plastic Surgery, the Fifth Hospital of Harbin, Harbin, Heilongjiang Province China
| | - Qun Liu
- Department of Burn and Plastic Surgery, the Fourth Hospital of Tianjin, Burn Institution of Tianjin, Tianjin, China
| | - Yi Liu
- Burns and Plastic Surgery Center, PLA Lanzhou General Hospital of Lanzhou Command, Lanzhou, Gansu China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Guozhong Lv
- Department of Burn Surgery, the Third People's Hospital of Wuxi, Jiangsu, China
| | - Xihua Niu
- Department of Burn Surgery, the First People's Hospital of ZhengZhou, Zhengzhou, Henan China
| | - Daizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Hongyan Qi
- Department of Burn Surgery, Beijing Children's Hospital, Beijing, China
| | - Shunzhen Qi
- The Center of Burn and Plastic of Hebei Province, Bethune International Peace Hospital, Shijiazhuang, Hebei China
| | - Zhiyong Sheng
- Department of Burn & Plastic Surgery, the First Hospital Affiliated to General Hospital of PLA, Beijing, China
| | - Dan Tang
- Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, Guangdong China
| | - Yibing Wang
- Department of Burns and Plastic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong China
| | - Jun Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Zhaofan Xia
- Department of Burn Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weiguo Xie
- Institute of Burns, Wuhan City Hospital No. 3 & Tongren Hospital of Wuhan University, Wuhan, Hubei China
| | - Hongming Yang
- Department of Burn & Plastic Surgery, the First Hospital Affiliated to General Hospital of PLA, Beijing, China
| | - Xianfeng Yi
- Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, Guangdong China
| | - Lehua Yu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoan Zhang
- Department of Burns, Beijing Jishuitan Hospital, Forth Medical College of Peking University, Beijing, China
| | | |
Collapse
|
31
|
Gabriel V, Kowalske K. Measurement of change in the mechanical properties of burned skin to therapist intervention with a vacuum device. Burns 2015; 41:796-802. [PMID: 25767063 DOI: 10.1016/j.burns.2014.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/12/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The currently available clinical scales used to describe healed burn wounds have limitations. Quantitative measurement of the outcomes from burn therapy treatment would be useful in planning clinical care, resource allocation and research. The purpose of this study was to observe the measurements of a portable materials testing device before and after burn therapist intervention for closed burns. METHODS A recording was taken using a hand-held vacuum device to measure deformation of the skin in the same location prior to and following a treatment session with a burn therapist in an outpatient clinic at a tertiary burn center. RESULTS Twenty-eight subjects were recruited to the study. Statistically significant differences were noted in modulus and elasticity change between sheet and meshed split thickness autografts (p=0.0233). Positive change in modulus was correlated with increasing therapy time (R=0.46), specifically for meshed grafts (R=0.70). Positive change in modulus was noted in therapy time greater than 48 min. CONCLUSIONS Quantitative measurement of the outcomes of burn therapies on the mechanical properties of healed burns is possible in an outpatient clinic setting. Improvement in the stiffness of burn scars was observed in treatment sessions that last at least 48 min.
Collapse
Affiliation(s)
- Vincent Gabriel
- Division of Physical Medicine and Rehabilitation, Departments of Clinical Neurosciences, Surgery and Pediatrics, Alberta Children's Hospital Research Institute, Firefighters' Burn Treatment Centre, University of Calgary, Canada.
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, United States
| |
Collapse
|
32
|
Remy C, Jacquemin D, Massage P, Damas P, Rousseau AF. La prise en charge précoce du patient brûlé en kinésithérapie. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-013-0709-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Schouten H, Nieuwenhuis M, van Zuijlen P. Response to Letter to the Editor: “Support for burn splint research”. Burns 2013; 39:541. [DOI: 10.1016/j.burns.2012.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 09/27/2012] [Indexed: 11/28/2022]
|
34
|
Richard R, Dewey S, Parry I, Jones J. Letter to the Editor. Burns 2013; 39:539-41. [DOI: 10.1016/j.burns.2012.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
|
35
|
The effects of splinting on shoulder function in adult burns. Burns 2012; 38:638-44. [DOI: 10.1016/j.burns.2012.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/10/2012] [Accepted: 01/13/2012] [Indexed: 11/17/2022]
|