644 Use of Plantar Foot Plate Splints and High-Profile Leg Net Devices for Prevention of Plantarflexion Contracture following Placement of Cultured Epidermal Autograft to Lower Extremities

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S178-S179
Author(s):  
Brooke Dean ◽  
Gregory Andre ◽  
Scott F Vocke
Keyword(s):  
Lower Extremity ◽  
Burn Injury ◽  
Lower Extremities ◽  
Ankle Dorsiflexion ◽  
Burn Scar ◽  
Thermoplastic Material ◽  
Scar Contracture ◽  
High Profile ◽  
Left Ankle

Abstract Introduction Burn Therapists strive to prevent burn scar contracture through positioning strategies beginning in the acute phase of burn injury. This task is even more challenging when paired with posterior offloading and joint immobilization required for the viability of cultured epidermal autograft (CEA). High profile leg net devices are the standard for posterior offloading after application of CEA circumferentially to lower extremities but can result in poor positioning of the ankle. Custom foot plate splints were designed and fabricated to preserve ankle dorsiflexion during the initial stages of CEA healing. Methods The high-profile leg net devices were assembled using 3/4 inch PVC piping and PVC fittings (45 degrees, 90 degrees, and tees) with double layered elastic tubular netting to allow proper wound ventilation while supporting the lower extremity with the patient in supine. The plantar foot plates were custom molded to the patient’s foot using thermoplastic material and lined with medium density temper foam for pressure relief. The foot plate was attached to the frame using Velcro and straps. Instructions with photographs were posted in the patient’s room for nursing staff to reference. Netting was exchanged daily and frames were disinfected using standard techniques. Results Goniometric measures were taken for ankle dorsiflexion were taken on day of CEA application with lower extremities positioned on high profile nets (in alignment with cutaneous functional unit modified position): -6 degrees right ankle, -2 degrees left ankle. Repeat measures were taken after one week period of bilateral lower extremity immobilization per CEA protocol: -1 degree right ankle, 2 degrees left ankle. One month follow-up at the discontinuance of leg net devices showed bilateral ankle dorsiflexion preserved with 3-degree right ankle dorsiflexion and 5 degrees on the left. Conclusions The use of custom foot plates on high profile leg net devices appears to improve ankle dorsiflexion range of motion while maintaining adequate posterior offloading required for CEA precautions for a burn survivor with extensive lower extremity burn wounds.

Effect of Frequency on Human Unipedal Hopping

2002 ◽  
Vol 95 (3) ◽  
pp. 733-740 ◽  
Author(s):  
Gary P. Austin ◽  
David Tiberio ◽  
Gladys E. Garrett
Keyword(s):  
Lower Extremity ◽  
Knee Flexion ◽  
Lower Extremities ◽  
Ankle Dorsiflexion ◽  
Vertical Force ◽  
Two Dimensional ◽  
Vertical Stiffness ◽  
Hip Flexion ◽  
Force Displacement ◽  
Healthy Males

All mature forms of locomotion involve periods of unilateral stance. Unipedal hopping may provide useful information about the neuromuscular and biomechanical capabilities of a single lower extremity in adults. This study investigated whether hopping influenced vertical stiffness and lower extremity angular kinematics during human unipedal hopping. Vertical force and two-dimensional kinematics were measured in 10 healthy males hopping at three frequencies: preferred, +20%, and −20%. At +20%, compared to preferred, vertical stiffness increased 55% as hip flexion, knee flexion, and ankle dorsiflexion decreased, while at −20% vertical stiffness decreased 39.4% as hip flexion, knee flexion, and ankle dorsiflexion increased. As in bipedal hopping, the force-displacement relationship was more springlike at the preferred rate and +20% than at −20%. Given the prevalence of unilateral stance during walking, running, and skipping, findings related to unipedal hopping may be useful in the rehabilitation or conditioning of lower extremities.

scholarly journals Influence of prophylactic ankle tapes on lower-extremity kinematics during a stop-jump task in chronic ankle instability

2021 ◽  
Keyword(s):  
Lower Extremity ◽  
Knee Flexion ◽  
Ankle Instability ◽  
Three Dimensional ◽  
Lower Extremities ◽  
Chronic Ankle Instability ◽  
Ankle Dorsiflexion ◽  
Ankle Inversion ◽  
Motion System ◽  
Hip Flexion

Background and objective: Numerous tape applications have been used in patients with chronic ankle instability (CAI). However, the effect of prophylactic ankle taping on lower-extremity kinematics is still not well understood. This study aimed to investigate the effects of traditional taping, fibular repositioning taping, and kinesiology taping on the peak angles of the lower extremities in patients with CAI. Materials and Methods: A total of 14 men (age, 24.07 ± 4.46 years; height, 175.06 ± 5.10 cm; weight, 82.24 ± 10.38 kg (mean ± standard deviation)) with CAI identified using screening questionnaires (Cumberland Ankle Instability Tool, 17.64 ± 4.14; Foot and Ankle Ability Measure (FAAM) Activity of Daily Living, 86.69 ± 6.71; and FAAM Sports Subscale, 75.45 ± 6.70) participated. The peak angles of the hip, knee, and ankle joints during a stop-jump task, with and without tape application, were collected using a three-dimensional motion system. Results: The following peak angles were measured: hip flexion, hip adduction (ADD), hip internal rotation (IR), knee flexion, knee abduction (ABD), knee IR, ankle dorsiflexion, ankle inversion, and ankle ADD. No significant differences were observed in the peak angle of each joint across conditions (hip flexion, F(3,39) = 0.85, p = 0.47; hip ADD, F(1.729,22.478) = 1.90, p = 0.18; hip IR, F(1.632,21.220) = 0.67, p = 0.49; knee flexion, F(3,39) = 1.24, p = 0.15; knee ABD, F(1.691,21.982) = 1.24, p = 0.30; knee IR, F(1.830,23.794) = 0.44, p = 0.63; ankle dorsiflexion, F(3,39) = 0.66, p = 0.58; ankle inversion, F(1.385,18.007) = 0.85, p = 0.40; ankle ADD, F(1.865,24.249) = 2.23, p = 0.13). Conclusion: The application of different taping techniques did not significantly change the peak joint angles of the lower extremities during a stop-jump task. These results contradict those of previous studies, suggesting that ankle taping restricts joint range of motion.

scholarly journals A decade of Australian reconstructive burn surgery in Nepal 2004-2014

2018 ◽  
Vol 1 (1) ◽  
pp. 46-53
Author(s):  
David George Pennington
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Burn Injury ◽  
International Health ◽  
Primary Treatment ◽  
High Rate ◽  
Burn Scar ◽  
Scar Contracture ◽  
Significant Burden ◽  
Burn Surgery

Nepal is a nation with an emerging economy that traditionally has faced challenges related to terrain, weather, political instability, natural disasters and poverty. It has a high rate of burn injury. Due to the above factors, adequate primary treatment of burns is frequently rudimentary, resulting in a significant burden of human suffering in the form of chronic debilitating burn-scar contractures. For several decades, international health teams have played a significant role in relieving the burden of disease and deformity, such as cleft lip and palate and burn-scar reconstruction. The current article summarises the experience of an Australian surgical team assembled to manage problems of burn-scar contracture in Nepal over the ten year period 2004-2014. The article discusses patient assessment protocola, patient statistics, conditions treated, procedures and results, complications.

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.

scholarly journals A decade of Australian reconstructive burn surgery in Nepal 2004-2014

2018 ◽  
Vol 1 (1) ◽  
pp. 124-131
Author(s):  
David George Pennington
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Burn Injury ◽  
International Health ◽  
Primary Treatment ◽  
High Rate ◽  
Burn Scar ◽  
Scar Contracture ◽  
Significant Burden ◽  
Burn Surgery

Nepal is a nation with an emerging economy that traditionally has faced challenges related to terrain, weather, political instability, natural disasters and poverty. It has a high rate of burn injury. Due to the above factors, adequate primary treatment of burns is frequently rudimentary, resulting in a significant burden of human suffering in the form of chronic debilitating burn-scar contractures. For several decades, international health teams have played a significant role in relieving the burden of disease and deformity, such as cleft lip and palate and burn-scar reconstruction. The current article summarises the experience of an Australian surgical team assembled to manage problems of burn-scar contracture in Nepal over the ten year period 2004-2014. The article discusses patient assessment protocola, patient statistics, conditions treated, procedures and results, complications.

Outcomes of Early Use of an End of Range Axilla Orthotic in Children Following Burn Injury

2019 ◽  
Vol 40 (5) ◽  
pp. 678-688 ◽  
Author(s):  
Rhianydd Thomas ◽  
Stephanie Wicks ◽  
Claire Toose ◽  
Verity Pacey
Keyword(s):  
Burn Injury ◽  
Intensive Therapy ◽  
Shoulder Abduction ◽  
Range Of Movement ◽  
Scar Contracture ◽  
Shoulder Movement ◽  
Early Signs ◽  
Early Use ◽  
Anterior Trunk

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.

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.

Delayed Neural Reconstruction in the Lower Extremity: Results of Interfascicular Nerve Grafting

Foot & Ankle ◽  
1986 ◽  
Vol 7 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Steven J. Hattrup ◽  
Michael B. Wood
Keyword(s):  
Lower Extremity ◽  
Lower Extremities ◽  
Nerve Grafting ◽  
Nerve Transection ◽  
Lost To Follow Up

During a 4-year period, one of the authors (M.B.W.) performed 16 nerve reconstructions by interfascicular grafting in the lower extremities of 13 patients. Three patients were excluded from the study: one was lost to follow-up and two had less than 1-year follow-up. At an average follow-up of 30 months, the results of 13 procedures in 10 patients were evaluated. Results were good after five procedures, fair after five, and poor after three. Superior results were evident with shorter graft lengths and after nerve transection injuries.

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