76 The Effect of Splinting of Metacarpophalangeal Joints After Skin Grafting: A Review of the ACT Database

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S49-S50
Author(s):  
Ashley M Welsh ◽  
William S Dewey ◽  
James C Casey ◽  
Kyle B Cunningham
Keyword(s):  
Burn Injury ◽  
Treatment Time ◽  
Healing Process ◽  
Skin Grafting ◽  
The Body ◽  
Patient Acuity ◽  
Burn Scar ◽  
Dorsal Aspect ◽  
Dorsal Hand ◽  
Significant Difference

Abstract Introduction Hands are the most common area of the body to sustain a burn injury. Maintaining motion and function throughout the healing process of a burn injury is one of the most important goals of the rehabilitation process. After a deep burn to the dorsal aspect of the hand requiring skin grafting, the adjacent metacarpophalangeal (MCP) joints are at risk for developing a burn scar contracture (BSC), limiting the joints’ ability to fully flex towards a fist position. Post-operative positioning protocols state that patient’s hand should be temporarily immobilized for graft protection. A resting hand splint is used to maintain the wrist in approximately 20–30 degrees of extension, MCP joints at approximately 50–70 degrees of flexion and the interphalangeal joints in full extension. The purpose of this study was to assess the benefit of splinting as a treatment intervention to prevent MCP joint extension contractures following dorsal hand skin grafting. Methods This was a retrospective review of prospectively collected observational data from the “Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes” (ACT) study. Patients were included with grafted dorsal hand burns occurring within 1 of the 4 established cutaneous functional units (CFU) along the dorsal aspect of the second through fifth metacarpals. Since most subjects had more than one dorsal hand CFU involved, the number of CFUs were analyzed as opposed to the number of subjects. Isolated MCP joint flexion measurements were utilized to determine incidence of contracture. Included causes of contracture were scar tissue or other soft tissue limitations. Data were then analyzed by two groups: contracted and non-contracted. Results A total of 221 dorsal hand CFUs were included in this study; 119 contracted and 102 non-contracted. There was no statistical significant difference between the average splint wear time between the 2 groups. The average percent of affected CFUs grafted within the contracted group was 92.4% compared to 76.8% in the non-contracted group. In burns to the dorsal hand with less than 99% of the CFU grafted, splinting was effective in preventing 60% of MCP joint extension contractures. When greater than 99% of affected CFU was grafted, splinting was effective in prevention only 36% of contractures. Conclusions Splinting can be an effective intervention option in preventing MCP extension contractures when less than 75% of the affected CFU has been grafted; however, its effectiveness decreases as the percentage of CFU involvement increases to greater than or equal to 99%. Applicability of Research to Practice Determine most effective post-operative rehabilitations plan following dorsal hand skin grafts.

Update on the practice of splinting during acute burn admission from the ACT study

2021 ◽  
Author(s):  
Desmond Khor ◽  
Junlin Liao ◽  
Zachary Fleishhacker ◽  
Jeffrey C Schneider ◽  
Ingrid Parry ◽  
...  
Keyword(s):  
Current Practice ◽  
Injury Severity ◽  
Burn Injury ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Hospital Length Of Stay ◽  
Patient Acuity ◽  
Burn Scar ◽  
Rehabilitation Treatment ◽  
Scar Contracture

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.

Burns

2018 ◽  
Author(s):  
Sanjay Bhananker ◽  
Paul Bhalla
Keyword(s):  
Burn Injury ◽  
Carbon Monoxide Poisoning ◽  
Fluid Management ◽  
Skin Grafting ◽  
The Body ◽  
Smoke Inhalation ◽  
Accurate Estimation ◽  
Burn Victims ◽  
Anesthesia Providers ◽  
Catabolic State

Burns injuries are a leading cause of morbidity and mortality in children. A significant burn injury affects every major organ system of the body. Initial management focuses on resuscitation along the ABCDE approach, with particular vigilance for the possibility of airway burn causing progressive edema and narrowing. Smoke inhalation is associated with carbon monoxide poisoning and possible cyanide toxicity. Fluid management depends on accurate estimation on the extent of the burn and use of a formula to calculate infusion rate, with careful monitoring of end-organ perfusion. Significant burn injuries are associated with hypermetabolic changes and a catabolic state, and burn victims are at high risk of developing sepsis. Treatment of a burn injury with debridement and skin grafting can involve multiple visits to the operating room with frequent need for sedation and anesthesia. Providers need a thorough understanding of potential anesthetic issues in burn-injured pediatric patients.

scholarly journals The Effects of Wireless Micro Current Stimulation for Partial Thickness Burn Injury Treatment

1970 ◽  
Vol 1 (3) ◽  
Author(s):  
Defry Utama ◽  
Aditya Wardhana
Keyword(s):  
Wound Healing ◽  
Electrical Stimulation ◽  
Burn Injury ◽  
Healing Process ◽  
Case Series ◽  
Electrical Current ◽  
The Body ◽  
Transfer Energy ◽  
Partial Thickness ◽  
Partial Thickness Burn

Backgrounds: The body has its own bioelectric system that influences wound healing. Wireless Micro Current Stimulation (WMCS) or Electrical Stimulation (ES) is defined as the use of an electrical current to transfer energy to a wound. The type of electricity transferred is controlled by the electrical source. Although scarce, there have been studies proposing that this type of electricity increased healing rate of various wounds. However the effect of this electrical stimulation on burn wounds has not yet been studied.Patient and Methods: We present case series of superficial and deep partial thickness burns treated with ES and examine its effect on healing process. Six cases of second degree burn admitted to Cipto Mangunkusumo General Hospital (RSCM) from March–May 2011. They were chosen randomly to be treated with WMCS/ES. We applied the stimulation on the wound one hour daily. The wound was cleansed conventionally with moist gauze before and after the stimulation.Results: All the patients reported that they feel comfort during and after the application. We found epithelialization within 6 to 9 days. However we cannot determined if the WCMS/ES induce faster wound healing, because we do not compare it with other treatment. Summary: From six cases that we studied, we concluded that, the use of this WCMS/ES could have an effect of the epithelialization within 6-9 days. All the patients reported that they feel comfort during and after the application of WMCS/ES.

scholarly journals 27. The Effectiveness Of High Protein Nutrient To The Post Sectio Caesarea Healing Process

2019 ◽  
Vol 13 (2) ◽  
Author(s):  
Darmawati Darmawati ◽  
Cut Husna ◽  
Aida Fitri ◽  
Dahrul Munira
Keyword(s):  
Wound Healing ◽  
Cesarean Section ◽  
Treatment Time ◽  
Healing Process ◽  
Intervention Group ◽  
High Protein ◽  
Sectio Caesarea ◽  
Control Group ◽  
Wound Healing Process ◽  
Significant Difference

The prevalence of cesarean section (SC) continues to increase along with the quality of technical facilities improvement. Failure to recover the surgical wounds after cesarean section is one of the possible SC complications that should be taken seriously. Proper nutrition greatly affect to wound healing. This study aims to found the effectiveness of high protein nutrients intake for post SC wound healing process at dr. Zainoel Abidin Hospital Banda Aceh. Design: This study is an experimental research with post test for intervention and control group design and using purposive sampling with the observation format as the measuring instrument. A total of 30 mother with post sectio caesarea participated in this study. There was a significant difference between post-SC wound healing in the intervention group (46.7%) compare to the control group (6.7%) (0.000). The mean of wound healing in the proliferation phase in the intervention group was faster than the control group respectively (10.47; 7.93). The hospital should provide information and evaluate high protein intake especially in post-SC patients during the treatment time, so that the patient is able to apply the information until they are going back home.

scholarly journals THE EFFECTIVENESS OF THE ELECTROMAGNETIC FIELD MATRIX TO THE WOUND HEALING PROCESS IN PARTIAL – THICKNESS BURNS

2020 ◽  
Vol 30 (6) ◽  
pp. 95-98
Author(s):  
Raminta Česnaitienė ◽  
Rytis Rimdeika
Keyword(s):  
Wound Healing ◽  
Treatment Period ◽  
Body Surface ◽  
Research Group ◽  
Standard Treatment ◽  
Healing Process ◽  
The Body ◽  
Control Group ◽  
Treatment Methods ◽  
Significant Difference

Burns are one of the most serious injuries, affecting around 11 million people a year worldwide. About 200/100000 inhabitants in Lithuania. Treatment is com­plex: the priorities of specialized facilities focus on sta­bilizing the patient, preventing infection, and optimizing functional recovery; and requires a lot of resources, both human and financial. Therefore, more and more effective treatments for burns are constantly being sought in order to accelerate the healing itself and thus reduce the du­ration of hospitalization. Number of recent reports sug­gests that EMF has a positive impact at different stages of healing. Processes impacted by EMF include, but are not limited to, cell migration and proliferation, expres­sion of growth factors, nitric oxide signaling, cytokine modulation, and more. Objectives and methods. The objective of this work was to study the effect of electromagnetic matrix on wound healing in burns. We evaluated medical records of 18 patients who underwent treatment in the department of plastic and reconstructive surgery from 2018.01.01 to 2019.12.30. All patients had IIA-IIB degree burns affec­ting less than 10% of the body surface and underwent the standard general treatment. They were divided into two groups: control group 55,6% (n=10) – treated only with the standard treatment and research group 44,4% (n=8) – to whom the EMF matrix were applied. Statistical data analysis was carried out using the SPSS 23.0 software. Results. Pain assessment, wound granulation area, and epithelialization were chosen to evaluate the burn healing process. These indicators were assessed on day 0-1; 3(±1) days and 7(±1) days after hospitalization. There was a statistically significant increase in wound granulation 5 days after the start of treatment in patients treated with the applicator (p = 0.019). Pain and epithelialization ra­tes between standard and applicator treatment methods did not differ statistically significantly over the treatment period. The partial nonparametric Spearman correlation coefficient, eliminating potentially influencing factors such as time after injury, the area of burn showed that the treatment method had a direct effect on the area of wound granulation (r = 0.625; p = 0.04). Conclusion. During the period from 2018.01.01 to 2019.12.31 patients had IIA-IIB degree burns affecting less than 10% of the body surface. 55,6 % of patients were treated only with the standard treatment and 44,4% with EMF matrix. The analysis showed that the average hospitalization time of the control group was 8.5 (0.898) days, while in the research group it was 7.88 (1.493) days, no statistically significant difference (p>0.05). There was a statistically significant increase in wound granulation 5 days after the start of treatment in patients treated with the applicator (p = 0.019). Pain and epitheli­alization rates between standard and applicator treatment methods did not differ statistically significantly over the treatment period.

532 Early Debridement and Cultured Allogenic Keratinocyte Dressing Prevent Hypertrophic Scarring in Infants with Deep Dermal Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S103-S104
Author(s):  
SeungJe Lee
Keyword(s):  
Functional Disability ◽  
Skin Grafting ◽  
Healing Time ◽  
The Body ◽  
Hypertrophic Scarring ◽  
Burn Scar ◽  
The Mean ◽  
Patients Experience ◽  
Early Debridement

Abstract Introduction Deep dermal burns are frequently treated with excision and skin grafting. Otherwise, wound healing may take up to 4 to 6 weeks, with serious scarring. Especially in pediatric patients, post-burn scarring could result in psychologic trauma and functional disability. We aimed to investigate the efficacy of early debridement and dressing using cultured allogenic keratinocytes in infants with deep dermal burns to prevent hypertrophic scarring. Methods From April 2016 to April 2018, 18 infants were treated for deep dermal burns. Except for 5 infants who underwent skin grafting or excision, 13 infants were included in this study. We performed early debridement in these patients using Hydrosurgery device and serial dressings using cultured allogenic keratinocytes. Results The average operative date was 8.3 days after the accident. The mean healing time was 18.3 days after the accident. The patients did not experience any contraction, but 3 patients had hyperpigmentation, 2 patients had mild hypertrophic scarring, and 1 patient had mixed pigmentation (hyperpigmentation and hypopigmentation). Conclusions Our prophylactic scar therapy, using early debridement with VersajetTM and dressings with Kaloderm®, may be beneficial for infants with dermal burns. This method was able to shorten the healing time, resulting in better scar outcomes. Our follow-up findings revealed that the scars had an aesthetically pleasing appearance and patients were able to perform normal activities without restrictions. Applicability of Research to Practice Burn scars are painful regardless of their seriousness. They restrict the function of the body, are aesthetically unappealing, and may feel unpleasant. Patients with a post-burn scar may have aesthetic, functional, and psychological problems. In particular, infant patients experience difficulties due to scarring as they grow up.

Effectiveness and Safety of Compound Polymyxin B Ointment in Treatment of Burn Wounds: A Meta-analysis

2021 ◽  
Author(s):  
Li-Chin Lu ◽  
Fei-Yu Chang ◽  
Shao-Huan Lan ◽  
Guo-Zhong Lv
Keyword(s):  
Wound Healing ◽  
Treatment Group ◽  
Burn Injury ◽  
Polymyxin B ◽  
The Body ◽  
Health Concern ◽  
Burn Wounds ◽  
Burn Care ◽  
First Choice ◽  
Significant Difference

Abstract Burn injuries represent a global public health concern. The guidelines for burn care mention that the treatment depends on burn injury depth of tissue, area of wounds, and site on the body. At present, several topical antimicrobial agents are used in treatment of burns wounds as a first choice. This study aims to investigate the effectiveness of the compound polymyxin B topical agents for treatment of burn wounds. PubMed, the Web of Science, ProQuest and China National Knowledge Infrastructure databases were searched for articles published until January 2021. The studies that conducted clinical trials comparing compound polymyxin B ointment with other treatment reagent for burn wound treatment were included. A total of 3 outcomes were investigator-assessed clinical response, including mortality, bacterial counts, efficacy and safety.In total, 12 randomized controlled trials, 1 clinical trial, 2 prospective studies, and 1 retrospective study were extracted. The result of mortality showed no significant difference (risk ratio [RR]: 0.70, 95% CI: 0.21-2.31, P = .56); wound healing revealed [RR]:1.59 (95% CI: 1.40-1.81, P < .001); time to heal revealed a mean difference of −5.09 (95% CI: −6.31 to −3.86) days (P < .001); scar incidence was no significantly lower in the treatment group (RR: 0.70, 95% CI: 0.38-1.30, P = .26); and adverse event incidence was significantly lower in the treatment group (RR: 0.26, 95% CI: 0.09-0.72, P < .01. The compound polymyxin B ointment show the effectiveness of increase the wound healing and accelerate the time of healing with fewer adverse effects.

122 In Patients with Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Kathleen A Iles ◽  
Lori Chrisco ◽  
Stephen Heisler ◽  
Booker King ◽  
Felicia N Williams ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Lower Extremity ◽  
Burn Injury ◽  
Healing Process ◽  
Common Mechanism ◽  
P Value ◽  
Diabetic Patients ◽  
Significant Difference ◽  
History Of ◽  
The Impact

Abstract Introduction Diabetes mellitus (DM) is a critical comorbidity with burn injury due to the disrupted healing process. Previous reports have confirmed the increased rate of osteomyelitis (OM) and subsequent amputation in this cohort, however this has yet to be studied in comparison to non-diabetic patients. In this retrospective analysis, we investigate OM and amputation in both the diabetic and non-diabetic lower extremity burn populations to determine the impact of DM on these outcomes. Methods The burn registry was used to identify all patients admitted to our tertiary burn center from January 1, 2014 to December 31, 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Patients with burns to additional body areas were excluded. Amputations were categorized by time from injury. Statistical analysis was performed using Student’s t test, chi-squared test, and Fischer’s exact test. Results Of the 315 patients identified, 103 had a known diagnosis of DM and 212 did not. Scald injury was the most common mechanism and average TBSA was similar. Differences were observed in average length of stay (LOS) and admission cost, with diabetics demonstrating both a higher LOS (13.7 days vs 9.2 days, p-value= 0.0016) and cost ($72,883 vs $50,500, p-value= 0.0058) (Table 1). In total, 17 patients were found to have radiologically confirmed OM within three months of the burn injury. Fifteen of these patients had a history of DM and two had no history of DM (p-value= < 0.001) (Table 2). The DM OM patients were found to have a higher blood glucose level on admission (219 mg/dL vs 110 mg/dL, p-value= 0.0452). No significant difference was seen in Hgb A1c in diabetics with or without OM (9.26% vs 8.81%, p= 0.2743). Notably, when non-diabetics were diagnosed with OM, significant differences were observed in both LOS and cost in comparison to their counterparts without OM (36 days vs 9 days; p= 0.0003; $226,289 vs $48,818, p=0.0001). Of the 11 patients who required an amputation, 10 (90.9%) of these patients had comorbid DM. Conclusions DM patients with lower extremity burns are more likely to develop OM than their non-diabetic counterparts. When radiologically confirmed OM is present, DM patients have an increased rate of amputation. OM incurs significant healthcare utilization and cost in both the diabetic and non-diabetic populations.

Demographic and Burn Injury-Specific Variables Associated with Limited Joint Mobility at Discharge in a Multicenter Study

2020 ◽  
Vol 41 (2) ◽  
pp. 363-370 ◽  
Author(s):  
Jonathan Lensing ◽  
Lucy Wibbenmeyer ◽  
Junlin Liao ◽  
Ingrid Parry ◽  
Karen Kowalske ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Burn Injury ◽  
Limited Range ◽  
Joint Motion ◽  
Patient Acuity ◽  
Related Factors ◽  
Limited Joint Mobility ◽  
Burn Scar ◽  
Rehabilitation Treatment ◽  
Limited Range Of Motion

Abstract Burn scar contractures. Existing research on contractures is limited by incomplete analysis of potential contributing variables and differing protocols. This study expands the exploration of contributing variables to include surgery and rehabilitation treatment-related factors. Additionally, this study quantifies direct patient therapy time and patient exposure to rehabilitation prevention therapies. Data from subjects enrolled in the prospective Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) were analyzed to determine variables related to a limited range of motion (limROM) in seven joints and 18 motions (forearm supination) at discharge. Chi-squared and Student’s t-test were used accordingly. Multivariate analysis was performed at the patient and joint motion level to control for confounders. Of the 300-member study group, 259 (86.3%) patients had limROM at discharge. Variables independently related to the development of moderate-to-severe limROM on the patient level were larger TBSA, having skin grafted and prolonged bed rest. Variables independently related to moderate–severe limROM on the joint motion level were the percentage of cutaneous functional unit (CFU) burned (P = .044), increase in the length of stay, weight gain, poor compliance with rehabilitation therapy and lower extremity joint burns. Rates of limROM are increased in patients who had larger burns, required surgery, had a greater percentage of the associated CFU burned, and had lower extremity burns. Attention to adequate pain control to ensure rehabilitation tolerance and early ambulation may also decrease limROM at discharge and quicker return to pre-burn activities and employment.

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