831 Optimal Timing for Range of Motion to Upper Extremities Following Split Thickness Skin Autographing: A Five Year Retrospective Review

Abstract Introduction The hand and upper extremity is one of the most common sites for burn injury. The total body surface area (TBSA) of the hand is small but the resultant impairment can limit a patient’s ability to return to functional independence. Split thickness skin grafting (STSG) has long been supported in the literature as the main means of treatment following full thickness burn injury. Surgical placement of STSG is often followed by a period of immobilization to the grafted area for graft adherence. The length of time which the grafted area is immobilized has evolved over time as surgical methods have improved. There is no set standard to balance the length of time necessary to prevent complications while maintaining functional mobility. A literature review revealed several studies and a meta-analysis examining the optimal timing for immobilization and bedrest following STSG to the lower extremities. Additional studies have examined guidelines for range of motion protocols and splinting as well as reconstructive procedures for improved function following burn injury. There are currently no studies examining the optimal timing for immobility following the placement of STSG and the implications this can have on functional independence. The proposed study details the results of one burn center’s standard of treatment following STSG to the upper extremity. Methods Following obtaining approval from the IRB, deidentified data was retrospectively collected from the electronic medical record from January 1, 2014-January 1, 2019 for all inpatients ages 18 and up who underwent split thickness skin grafting to the upper extremity. Results Data collected from 2014–2018 revealed a decreasing trend in the days of immobilization following STSG from an average of 4 days to 2 days to the resumption of range of motion (ROM). Additional trends include a decrease in the utilization of splinting as a prophylactic treatment for contractures with a shift towards interventional splinting. Access to home health care services upon hospital discharge also showed a decline from 2014–2018. Conclusions The decrease in days of immobilization following STSG combined with the shift from prophylactic to interventional splinting put more emphasis on increasing patient autonomy for functional independence. This trend coincides with a significant decrease in the utilization of home health services upon hospital discharge in the same time period. Applicability of Research to Practice The findings of this retrospective study provide evidence supporting that decreasing the length of immobilization following STSG to 2 days did not result in an increase in post-operative complications. There was also not a significant decrease in functional independence found with a change in splinting practices from prophylactic to interventional.

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Minimally Invasive Technologies for Treatment of HTS and Keloids: Fractional Laser

Textbook on Scar Management ◽

10.1007/978-3-030-44766-3_33 ◽

2020 ◽

pp. 279-285

Author(s):

M. Tretti Clementoni ◽

E. Azzopardi

Keyword(s):

Minimally Invasive ◽

Burn Injury ◽

State Of The Art ◽

Skin Grafting ◽

Complex Problem ◽

Fractional Laser ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Insight Into

AbstractThis chapter presents a state-of-the-art insight into the use of fractional laser for the management of this complex problem. In particular, we focus on the management of complex scars such as those occurring post-burn injury and split-thickness skin grafting.

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Safety of Early Postoperative Range of Motion in Burn Patients With Newly Placed Hand Autografts: A Pilot Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa072 ◽

2020 ◽

Vol 41 (4) ◽

pp. 809-813

Author(s):

William Scott Dewey ◽

Kyle B Cunningham ◽

Sarah K Shingleton ◽

Kaitlin A Pruskowski ◽

Ashley Welsh ◽

...

Keyword(s):

Range Of Motion ◽

Graft Loss ◽

Skin Grafting ◽

Thickness Skin ◽

Additional Surgery ◽

Split Thickness Skin Grafting ◽

Risk Areas ◽

Matched Case ◽

Hand Burns

Abstract Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection. Recent practice at our burn center includes an early range of motion (EROM) following hand grafting to limit unnecessary immobilization. The purpose of this study was to determine whether EROM is safe to perform after hand grafting and if there is any clinical benefit. This retrospective, matched case–control study of adults compared patients who received EROM to subjects who received the standard 3 to 5 days of postoperative immobilization. Patients were evaluated for graft loss and range of motion. Seventy-one patients were included in this study: 37 EROM patients and 34 matched controls. Six patients experienced minor graft loss, three of these were not attributable to EROM. All graft loss was less than 1 cm and none required additional surgery. Significantly more patients who received EROM achieved full-digital flexion by the first outpatient visit (25/27 = 92.6% vs 15/22 = 68.2%; P = .028). Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow-up. Additional prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas.

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Split-thickness skin graft of a pedal oil burn in an adolescent female

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-81-8-435 ◽

1991 ◽

Vol 81 (8) ◽

pp. 435-439 ◽

Cited By ~ 1

Author(s):

ME Leen ◽

M Feldman ◽

S Schoenberger ◽

KC Chae

Keyword(s):

Burn Injury ◽

Skin Grafting ◽

Split Thickness Skin Graft ◽

Age Group ◽

Case Presentation ◽

Granulation Process ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Active Patient ◽

Excellent Coverage

Split-thickness skin grafting of the foot following a burn injury provides excellent coverage to promote early rehabilitation and to facilitate healing. When compared to a more slowly healing, cosmetically unacceptable secondary granulation process, grafting is especially important for the young, active patient for whom hospitalization and immobilization are difficult to maintain. Cosmetic results are also a great concern, especially in the female sector of this age group. The case presentation shows grafting as a successful means of treatment in consideration of these primary goals.

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T2 Safety of Early Post-operative Range of Motion in Burn Patients with Newly Placed Hand Autografts

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.001 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S1-S2 ◽

Cited By ~ 1

Author(s):

William S Dewey ◽

Kyle B Cunningham ◽

Sarah K Shingleton ◽

Kaitlin A Pruskowski ◽

Ashley M Welsh ◽

...

Keyword(s):

Range Of Motion ◽

Graft Loss ◽

Skin Grafting ◽

Operative Management ◽

Adult Patients ◽

Thickness Skin ◽

Additional Surgery ◽

Split Thickness Skin Grafting ◽

Hand Burns

Abstract Introduction Patients who suffer hand burns are at a high risk for developing contractures, partly due to the presence of numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting (STSG) are often immobilized post-operatively for graft protection. Restricting mobility following a STSG is thought to protect against subdermal edema and shear forces, despite limited evidence. Early range of motion (EROM) has been described previously. Recent practice at our burn center includes EROM following hand STSG to limit unnecessary immobilization. The purpose of this retrospective study was to determine if EROM is safe to perform after hand STSG and if there is any clinical benefit. Methods In an approved, retrospective, matched case-control study of adult patients who sustained hand burns, patients who received EROM were defined as cases; patients who did not receive EROM were considered controls and received the standard 3–5 days of post-operative immobilization in a resting hand splint. Adult patients admitted over a 3-year period were eligible for inclusion. Patients were evaluated for graft loss and range of motion. Results Seventy-two patients were included in this study; 37 EROM patients and 35 matched controls. EROM patients tended to have a larger area excised (170.4 ± 69.8cm2 vs. 132.9 ± 76.2cm2; p=0.034) and grafted (171 ± 70.8 cm2 vs. 132.9 ± 76.2 cm2; p=0.033). Most patients were male, with an average age of 39 years. Patients had an average of approximately 5% TBSA burns with 1.5% to the hands. On post-op day (POD) 1 and 2, patients received EROM for an average of 30 minutes (29.25 ± 14.9 vs. 31 ± 16.4 minutes). Six patients experienced minor graft loss. Three patients (8%) experienced graft loss not attributable to EROM. One patient (2.7%) experienced graft loss pre-EROM on POD2 and 3 patients (8%) experienced graft loss post-EROM on either POD1 or POD2. All graft loss was less than 1 cm in greatest dimension and no patient who experienced graft loss required additional surgery as they all closed by their first outpatient follow-up. Significantly more patients who received EROM achieved full digital flexion by the first outpatient visit (25/27=92.6% vs. 15/22=68.2%; p=0.028). Conclusions Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow up. Further prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas. Applicability of Research to Practice Clinical change in post-operative management after hand grafting.

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Plaštakų nudegimų gydymo metodų lyginamoji studija

Lietuvos chirurgija ◽

10.15388/lietchirur.2004.3.2357 ◽

2004 ◽

Vol 2 (3) ◽

pp. 0-0

Author(s):

Kęstutis Maslauskas ◽

Rytis Rimdeika ◽

Jolita Rapolienė ◽

Tarvilas Norkus ◽

Žilvinas Saladžinskas ◽

...

Keyword(s):

Burn Injury ◽

Skin Grafting ◽

University Hospital ◽

Wrist Flexion ◽

Burn Treatment ◽

Control Measurement ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Flexion Extension ◽

Group A

Kęstutis Maslauskas1, Rytis Rimdeika1, Jolita Rapolienė3, Tarvilas Norkus1, Žilvinas Saladžinskas2, Paulius Karčauskas31 Kauno medicinos universiteto klinikųChirurgijos klinikosPlastinės ir rekonstrukcinės chirurgijos skyrius2 Kauno medicinos universiteto klinikųChirurgijos klinika3 Kauno medicinos universitetas,Eivenių g. 2, LT-50009, KaunasEl paštas: [email protected] Įvadas KMUK Chirurgijos klinikos Plastinės chirurgijos ir nudegimų skyriuje (2001 01–2004 06) atliktas randomizuotas atsitiktinių imčių tyrimas, kuriuo lyginti du gydymo metodai. Ligoniai ir metodai Traukiant vokus pacientai suskirstyti į grupes. Patekusiems į A grupę pacientams per 7 paras nuo nudegimo atliekama nekrektomija ir dalies storio autodermoplastika. Pacientams, patekusiems į B grupę, atliekami perrišimai vartojant sidabro sulfadiaziną, o atsidalijus negyvybingiems audiniams, – autodermoplastika. Iš stacionaro pacientai išrašomi sugijus >95% žaizdų. Kontrolės metu tiriami pirštų ir riešo aktyvūs ir pasyvūs judesiai, matuojama pirštų ir plaštakos jėga. Tirta 71 nudegusios plaštakos funkcija (44 pacientai). Rezultatai Lygindami minėtų grupių pacientų riešo judesius nustatėme, kad riešo judesių amplitudė atliekant fleksinius, ekstenzinius judesius, radialinis ir ulnarinis nuokrypis buvo didesni A grupės. Palyginus nykščio metakarpofalanginių ir interfalanginių sąnarių fleksinių judesių amplitudę bei ekstenziją per interfalanginius sąnarius, taip pat nykščio atitraukimą ir opoziciją išsiaiškinome, kad statistiškai reikšmingai geresnė funkcija buvo A (ankstyvos plastikos) grupės. Nustatėme statistiškai reikšmingą skirtumą lygindami visų pirštų fleksinius judesius per metakarpofalanginius, proksimalinius interfalanginius ir distalinius interfalanginius sąnarius. Lygindami ekstenzinius judesius per sąnarius, statistiškai reikšmingo skirtumo negavome. Pirštų ir plaštakų jėga buvo didesnė ankstyvos nekrektomijos ir plastikos, t. y. A, grupėje. Išvados Plaštakų nudegimą gydant ankstyva nekrektomija ir plastika, žaizdos sugyja greičiau, atkuriama didesnė riešo ir pirštų judesių amplitudė, plaštakos jėga, sutrumpėja paciento gydymo ligoninėje trukmė ir sumažėja gydymo išlaidos. Reikšminiai žodžiai: plaštakų sužalojimas, nudegimas, nekrektomija, plastika Comparative study of hand burn treatment Kęstutis Maslauskas1, Rytis Rimdeika1, Jolita Rapolienė3, Tarvilas Norkus1, Žilvinas Saladžinskas2, Paulius Karčauskas3 Objective During the period 01.2001–06.2004 in the Unit of Plastic Surgery and Burns of Kaunas Medical University Hospital a prospective randomised clinical trial was performed to compare two methods of treatment. Patient and methods Patients were selected into two groups by the envelope method. For patients in group A, necrectomy and immediate split thickness skin grafting were performed during the first 7 days after burn injury. In group B, daily local applications of silversulfadiazine and escharectomy with delayed split thickness skin grafting were performed. Patients were discharged from hospital when wound healing more than 95% was achieved. During the control, measurement of movements of all wrist and finger joints was performed. Also, the power of fingers and of all hand was measured. We examined 71 burned hands (44 patients). Results Comparing wrist flexion, extension, ulnar and radial deviation we found that the amplitude of movements was statistically significantly better in group A. Thumb flexion, extension, abduction and opposition were also better in the early necrectomy group. Conclusions The amplitude of movements of metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints as well as the strength of fingers and hands were statistically better in group of early necrectomy with immediate split thickness skin grafting. Keywords: hand burns, hand injuries, grafting, early grafting

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Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series

Military Medicine ◽

10.1093/milmed/usy280 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 16-20 ◽

Cited By ~ 4

Author(s):

Khurshid Alam ◽

Steven L A Jeffery

Keyword(s):

Burn Injury ◽

Donor Site ◽

Case Series ◽

Skin Grafting ◽

Viral Disease ◽

Skin Substitute ◽

Skin Grafts ◽

Fish Skin ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract When treating large burns, autologous skin availability becomes a problem and burn surgeons rely heavily on allogenic and xenogeneic skin for temporary coverage after excision. Application of cadaveric and pig skin grafts carries a risk of auto-immune response and risk of viral and bacterial diseases transmission, and there are many cultural and religious rejections for use of porcine grafts. There has recently become available an alternative resource of xenograft using acellular fish skin (KerecisTM Omega3 Burn). This has been described as providing an effective, safe, efficient skin substitute, free of the risk of transmission of viral disease, and auto-immune reaction risk. Methods Ten patients having split-thickness skin grafting for burn injury were treated with the fish skin xenografts. Results There were no adverse reactions noted on the use of the fish skin grafts. No patient had any reaction to the fish skin and there was a zero incidence of infection. The handling of the fish skin was excellent, a robust and pliable xenograft that was easy to apply. The quality of donor site healing was judged to be good in all cases. Both the analgesic effect noted and the relatively short average times until 100% re-epithelialization are promising. We also illustrate two cases where the dressing was used to treat superficial burns.

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