Novel Use of Orthosis in a Case of Burn Contracture Microstomia

Clinical trials of 3D printing splints to avoid contracture development in burned children

Background/aim

We evaluated the feasibility of producing splints with 3D printer technology to prevent contractures in burned children in our clinical prospective study.

Materials and methods

After approvals, children with burns greater than 2nd degree were included in the study. Age, sex, burn percentages, printing time, filament types, number of filament trials, splint suitability, patient and doctor comments, preclinical trials’ significances and financial impact were evaluated statistically.

Results

Seventy-six trials were conducted on 18 patients. Fourteen of the patients were male and 4 are female. Average ages of boys and girls were 5 and 3, respectively. Burn percentage was 36.9 ± 13. Polylactic acid (PLAFlex), polyurethane (PolyFlex), semiflexible copolyester (nGenFlex), and thermoplastic polyurethane (TPU) were the main filaments that were used in the study. Printing time differed from 4 to 29 h according to body regions. Splints were suitable for 81.25% in upper extremity, for 66.7% in lower extremity, and for 100% in mouth. Burn percentage was significantly correlated with total number of filament (p = 0.049). Other statistical evaluations were insignificant.

Conclusion

The 3D printer seems to be useful in children with burns. However, difficulties caused by some reasons like production must be overcome. By increasing clinical experience, this emerging custom-made technology may become standard, and documented problems can be solved.

Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines

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.

The Importance of Dental Appliances for Oral Commissure Reconstruction in Trauma-Induced Microstomia: A Clinical Report

Reconstruction of the oral commissure is necessary after trauma, pathological resection, or electrical, chemical, or thermal burns. Using dental appliances is strongly recommended to prevent microstomia in victims with oral commissure injury caused by burns. These appliances can be modified from dynamic to static for more patient comfort during the healing period and used in trauma patients to prevent rounding of the labial commissure. Preventing relapse of microstomia and forming acute angles at the corner of the mouth are 2 optimal goals when performing this surgery.