OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS' EXPERIENCE

OBJECTIVE

Burn injuries in hands are much more complex and the appearance of contractures is a common complication. Hand burn injuries often result in limited functionality, flexion and extension of fingers and present a major hindrance in rehabilitation. The aim of physical therapy and splinting after hand burn injury is to maintain mobility, prevent the development of the contracture and to promote the functionality of hand and good cosmetic results. The purpose of this study is to presents our experience of 38 children with hand burn injuries, admitted and treated at the Department of Plastic Surgery, UCCK-Pristina, Kosovo, during the years 2012-2015.

METHODS

Physical therapy is focused on active/passive range of motion in affected joints, management of cicatrix, strengthening exercise, coordination and use of splints for correction contractures. Patients were evaluated in three, six months and the definitive evaluation is done after 9 months of physical therapy and splinting.

RESULTS

We have improvement in range of motion (ROM), functionality, coordination, muscle force, decrease of keloids scars.

CONCLUSION

This study shows the importance of physical therapy and splinting, achieving good results in preventing contracture, improving range of motion, muscle force and good cosmetic results.

Surgical treatment of burns sequelae. our experience in the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo

Burn injuries are very frequent in Kosovo, leading to long-lasting physical, functional, aesthetic, psychological and social consequences directly proportional to the time of healing; the longer it takes for the burn wound to heal, the more serious are the sequelae. The objectives of the present study are to review the epidemiological, clinical and therapeutic aspects of burn patients presenting with post-burn sequelae and treated at the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo, from January 2005 until December 2011. This study included 188 patients with burns sequelae. The following variables were considered: age, sex, anatomical location, pathological types, and surgical procedure. There were 82 men (43.6%) and 106 women (56.4%), ranging in age from 0 to 67 years (mean age 33.5 years), most of the patients were children (139 = 73.9%). Burn contractures were observed in 135 (71.8%) patients, hypertrophic scars in 32 (17%), keloids in 10 (5.3%), alopecia in 6 (3.2%), syndactyly in 12 (6.4%), ectropion in 4 (2.1%) and ear deformity in 1 (0.53%) cases. To correct the deformities the most common choice was the Z-plasty technique, used in 31.4% of cases, followed by Z-plasty+full thickness skin grafts in 21.8%, full thickness skin grafts in 18.1%, tissue expansion in 8%, Z-plasty+local flaps in 4.8%, flaps (local, fascio-cutaneous, radial forearm) in 6.9% and direct closure in 6.4%. Timely wound closure and the development of an individual programme for surgical treatment of burns sequelae are crucial for optimal outcomes in patients with burns.

Electrical Burn Injuries. An Eight-year Review

Electrical injuries are very aggressive pathological lesions with heavy functional and aesthetic consequences. The primary cause of their gravity is the progressive tissue necrosis that occurs with the continuous extension of wound necrosis, even leading to loss of the entire injured extremity. The goal of this study is to analyse the role of the inefficiency of the electric energy system in the incidence of electrical injuries in Kosovo during the period December 2000 to 2007 suffered by a total number of 182 patients treated in the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo. Electrical injuries accounted overall for 17.25% of all patients admitted with burns; 35.72% of the burns were due to high voltage and 64.28% to low voltage; among the patients with contact burns the amputation rate was 28.58%, and four patients (7.14%) died. These results suggest that the aggravation of the electric energy system led to an increase in the number of patients with electrical injuries.

Surgical Treatment of a Burns Case of 40% TBSA

We describe the case of a two-year-old boy with massive burns. After the period of shock and sepsis, very successful four-phase operative treatment was performed, with combined skin grafting homograft plus autograft. With regard to the four surgical interventions, in the first two we used the above combined method, while in the other two we used grafting only with skin autograft. We also used the donor region of the epicranial scalp.