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Sabapathy SR, Shanmugakrishnan RR, Hultman CS. Acute and Reconstructive Burn Care of the Hand. Clin Plast Surg 2024; 51:365-377. [PMID: 38789146 DOI: 10.1016/j.cps.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The hand is commonly affected in thermal injuries. Hand burns account for 39% of all burns and they are involved in 34% of instances when the total body surface area of a burn exceeds 15%. Inadequate or inappropriate treatment could result in significant morbidity. The ultimate integration of a burn patient into the society largely depends on the functionality of the hands. Hence, it is important to reduce complications by providing good care during the acute stage.
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Affiliation(s)
- Shanmuganathan Raja Sabapathy
- Department of Plastic Surgery, Hand & Reconstructive Microsurgery & Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India.
| | - R Raja Shanmugakrishnan
- Department of Plastic Surgery, Hand & Reconstructive Microsurgery & Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India; Department of Hand, Reconstructive Microsurgery, Faciomaxillary and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Charles Scott Hultman
- WPP Plastic and Reconstructive Surgery, WakeMed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610, USA
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Rajasekar S, Gomathinayagam K, Madan Mohan SN. Evaluation of Functional Outcomes After Reconstruction of Post-burn Contracture of the Hand in the Pediatric Age Group: A Prospective Study. Cureus 2024; 16:e57102. [PMID: 38681339 PMCID: PMC11054307 DOI: 10.7759/cureus.57102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background Injuries on the hand due to burns affect the quality and functions of activities of daily living (ADL). Severe burns cause lasting complications and deformities, such as contracture of the hand, which require multiple staged surgeries and rehabilitation for extended periods to regain function. This is of major significance to children, as they are in the growing and developmental age group, which should be considered while planning a reconstructive procedure. Psychological counselling is equally important for these patients to accept the residual deformity and cosmesis of the hand following surgery. Methods A prospective interventional study was conducted on 40 patients to assess the functional outcomes of various reconstructive procedures for post-burn contracture of the hand and to find out which is the better surgical intervention for restoring the hand functions needed for ADL. Functional outcomes were analyzed using the Modified Jebson Hand Function Test (JHFT) after a minimum of four months. Results In the group of children operated on with flap procedures, the maximum number of patients had average functional outcomes. Functional outcomes were assessed using the Modified JHFT, in which fine motor, weighted, and non-weighted hand function activities were assessed and analyzed. However, in the group of children operated on by the Z-plasty procedure and skin graft procedure, the maximum number of patients had poor functional outcomes. Conclusion The management of burn injuries on the hand and subsequent contractures is often challenging, especially in pediatric patients. Timely intervention, patient education, and surgical skills with an appropriate choice of reconstructive procedures play a vital role in achieving good postoperative results. This study showed that hands reconstructed using flap procedures had good functional outcomes compared to graft and Z-plasty procedures.
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Affiliation(s)
- Shobhana Rajasekar
- Department of Hand Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Karthikeyan Gomathinayagam
- Department of Plastic and Reconstructive Surgery, Tamil Nadu Government Multi Super Speciality Hospital, Chennai, IND
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McNamara CT, Iorio ML, Greyson M. Concepts in soft-tissue reconstruction of the contracted hand and upper extremity after burn injury. Front Surg 2023; 10:1118810. [PMID: 37206342 PMCID: PMC10188946 DOI: 10.3389/fsurg.2023.1118810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Burns and their subsequent contracture result in devastating functional and aesthetic consequences which disproportionally affect the upper extremity. By focusing on reconstruction with analogous tissue and utilizing the reconstructive elevator, function can be restored concomitantly with form and aesthetic appearance. General concepts for soft-tissue reconstruction after burn contracture are presented for different sub-units and joints.
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Putri AC, Runisa PA, Hasibuan L, Faried A, Mose JC. The use of modified glove-like abdominal flap for reconstruction of contracture following burns of dorsal hand and fingers: A case report. Int J Surg Case Rep 2022; 94:106962. [PMID: 35398780 PMCID: PMC9006244 DOI: 10.1016/j.ijscr.2022.106962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Burn contracture has been a challenge for its acquired functional disabilities and deformities. Surgical reconstruction poses a significant challenge for optimal aesthetic and functional improvement. Super thin abdominal skin pedicle flap can be used, but it has only one pedicle from one site of abdomen and needs tissue expander for a larger defect. The use of modified glove-like abdominal flap has been stated to be an option mainly for the use on acute hand burn. In this study, application of the modified glove-like abdominal flap was applied to contracture of dorsal hand and fingers. Case presentation A 39-year-old male patient with severe contracted hand, eight-month post-burn injury presented at outpatient clinic Santosa Central Hospital in 2017. Multiple series of surgeries were performed on this patient, consisting of released contracture, defect closure using a modified “glove-like” thin abdominal flap, and flap separation. Clinical discussion Abdominal flap has been the commonly used technique but has the disadvantage of being bulky. Glove-like abdominal flap, a subcutaneous layer plane flap, can be performed simply, safely, and briefly. It has been published mainly for reconstruction for acute burn hand injuries, not for burn hand contracture. Conclusion The use of modified glove abdominal flap technique for reconstruction in hand burn contracture gives a satisfactory result in terms of functional and aesthetic outcome and can be an option in reconstruction in contracted dorsal hand and fingers. Abdominal flap has been used to be an option for hand burn reconstruction but has the disadvantage of being bulky. Glove-like abdominal flap has been published mainly for reconstruction for acute burn hand injuries, not burn hand contracture. Glove-like abdominal flap is an easy technique, safely, briefly, not bulky, and give better functional aesthetic results. Modified glove abdominal flap technique can be an option in reconstruction in contracted dorsal hand and fingers.
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Affiliation(s)
- Almahitta Cintami Putri
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjajaran (FK UNPAD)-Dr. Hasan Sadikin Hospital, Bandung, Indonesia; Graduate School of Biomedical Sciences, Doctoral Program, FK UNPAD, Bandung, Indonesia.
| | - Puti Adla Runisa
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjajaran (FK UNPAD)-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Lisa Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjajaran (FK UNPAD)-Dr. Hasan Sadikin Hospital, Bandung, Indonesia; Graduate School of Biomedical Sciences, Doctoral Program, FK UNPAD, Bandung, Indonesia
| | - Ahmad Faried
- Graduate School of Biomedical Sciences, Doctoral Program, FK UNPAD, Bandung, Indonesia
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Singh V, Haq A, Sharma S, Jain R, Gupta SK, Srivastava R. Pre-operative scrutiny of late burned hand presentations: Crucial step for the improvement of results. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhou R, Qiu L, Xiao J, Mao X, Yuan X. Early wound repair versus later scar repair in children with treadmill hand friction burns. J Burn Care Res 2021; 43:269-276. [PMID: 34015124 DOI: 10.1093/jbcr/irab083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of pediatric treadmill hand friction burns has been increasing every year. The injuries are deeper than thermal hand burns, the optimal treatment remains unclear. This was a retrospective study of children who received surgery for treadmill hand friction burns from January 1, 2015, to December 31, 2019, in a single burn center. A total of 22 children were surveyed. The patients were naturally divided into two groups: the wound repair group (13 patients), which was admitted early to the hospital after injury and received debridement and vacuum sealing drainage initially, and a full-thickness skin graft later; and the scar repair group (9 patients), in which a scar contracture developed as a result of wound healing and received scar release and skin grafting later. The Modified Michigan Hand Questionnaire score in the wound repair group was 116.31 ± 10.55, and the corresponding score in the scar repair group was 117.56 ± 8.85 (P>0.05), no statistically significant difference. The Vancouver Scar Scale score in the wound repair group was 4.15 ± 1.21, and the corresponding score in the scar repair group was 7.22 ± 1.09 (P<0.05). Parents were satisfied with the postoperative appearance and function of the hand. None in the two groups required secondary surgery. If the burns are deep second degree, third degree, or infected, early debridement, vacuum sealing drainage initially, and a full-thickness skin graft can obviously relieve pediatric pain, shorten the course of the disease, and restore the function of the hand as soon as possible.
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Affiliation(s)
- Rong Zhou
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Lin Qiu
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Jun Xiao
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Xiaobo Mao
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - Xingang Yuan
- Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
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Abstract
Objective To evaluate the efficacy of different surgical procedures on post burn contracture of hand. Methods A quasi-experimental study design was conducted at the Department of Plastics and Reconstructive Surgery, Dow University of Health Science, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan from 1st June 2019 to 30th November 2019. Ninety-three participants of burned hand contracture of either gender, aged between 6- 60 years were included in the study. Resurfacing surgery with skin graft and loco-regional flaps were done according to type of contracture with individualization for each patient. All patients were kept under follow up for ninety days to assess efficacy of contracture release for each surgical procedure was noted. SPSS version 23 was used to analyse data. Results Full thickness skin graft (FTSG) was performed in 60.2% cases, 17.2% with split thickness skin graft (STSG) and 12.9% with cross finger flaps. About 25% of recurrence was observed in cross finger flaps, whereas no recurrence was seen in Z-plasties and posterior interosseous flap. The significant association was between recurrence and surgical procedures (p<0.05). Conclusion Z-plasty followed by FTSG was effective in the management of post burn contractures of hand.
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Affiliation(s)
- Suneel Kumar
- Suneel Kumar, FCPS-2, Post Graduate Trainee of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
| | - Faisal Akhlaq Ali Khan
- Faisal Akhlaq Ali Khan, Chairperson and Assistant Professor, Head of Department of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
| | - Hyder Ali
- Hyder Ali, Assistant Professor of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
| | - Saba Kiran
- Saba Kiran, FCPS-2, Post Graduate Trainee of Plastic Surgery. Department of Plastics and Reconstructive Surgery, Dow University of Health Sciences, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan
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8
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Chim H, Buchanan PJ, Chopan M. Dynamic Hand Pain from Generalized Skin Tightness Treated with First Webspace Release and Resurfacing. J Hand Microsurg 2019; 12:201-203. [PMID: 33408447 DOI: 10.1055/s-0039-1680279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Contractures from burns or other trauma generally manifest as discrete areas of skin deficiency or localized scar bands in the hand, and are treated successfully with release and resurfacing of the affected area. We report a case of generalized bilateral skin tightness in the hand from severe childhood burns, with no obvious localized area of contracture, manifesting with pain and numbness when making a fist and with certain activities. This was treated with release and resurfacing of the first webspace with bilateral free lateral arm flaps as well as endoscopic carpal tunnel release, resulting in increased laxity of skin throughout both hands, and resolution of dynamic symptoms with activity.
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Affiliation(s)
- Harvey Chim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida Health, Gainesville, Florida, United States
| | - Patrick J Buchanan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida Health, Gainesville, Florida, United States
| | - Mustafa Chopan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida Health, Gainesville, Florida, United States
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Abstract
The upper limb is involved in burns in a high percentage of cases and its reconstruction is extremely important, given the functional impact of this anatomical region. Among the reconstruction choices for severe and large structural defects, the pedicled anterolateral thigh flap is an available option. This case study discusses the utilization of the pedicled anterolateral thigh flap for reconstruction of a complex full-thickness hand burn, when adequate arterial perforators were not available. Complex hand burns can often present challenges for reconstructive coverage, because of the complex anatomy of the upper extremity and the need to preserve as much function as possible. The use the anterolateral thigh free flap is one option that can be utilized for coverage of these large hand defects, in the face of poor local tissue advancement options. The finding of inadequate or lack of perforator vessels necessitates intraoperative changes in the surgical approach. In these cases, different alternatives exist depending on the dimensions and characteristics of the required coverage, the dissection of a pedicled flap being one of them. The pedicled anterolateral thigh flap represents an alternative for the coverage of large hand defects in the absence of valid perforators during free-flap dissection.
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10
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Prasetyono T, Andrian CR. Dorsal pentagonal island flap to reconstruct post-burn interdigital web. Ann R Coll Surg Engl 2019; 101:290-296. [PMID: 30698454 DOI: 10.1308/rcsann.2019.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study reports the use of a dorsal pentagonal island flap for post-burn webbing contracture, in which the islanded flap is harvested from the burn scar tissue. METHODS Fourteen dorsal pentagonal island flaps were harvested in seven patients with post-burn webbing. Each flap was selected by examining the scar tissue donor using a modified Vancouver scar scale. Modification from the basic design was made according to the density of the donor scar tissue and the metacarpophalangeal joint movement. RESULTS All the flaps survived with normal abduction of the affected fingers. Modification of the flap design needed adjustment by assessing it through flexion and extension of the metacarpophalangeal joints. There was no incidence of web creep after two months to one year of follow-up. CONCLUSION Dorsal pentagonal island flap shows promising results as an alternative for reconstructing post-burn webbing.
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Affiliation(s)
- Toh Prasetyono
- Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia.,Indonesian Clinical Training and Education Centre, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia
| | - C R Andrian
- Indonesian Clinical Training and Education Centre, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia
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Mohammadi AA, Foroutan A, Mohammadi S, Zardosht M. Evaluation of Patients' Satisfaction and Functional Outcome of Dorsal Hand Unit Reconstruction in Burn Patients in Shiraz, Southern Iran. J Burn Care Res 2018; 39:572-579. [PMID: 29901797 DOI: 10.1093/jbcr/irx019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of this study was to assess patients' satisfaction and functional outcome of dorsal hand unit reconstruction in burn patients in Shiraz, southern Iran.From September 2013 to February 2017, 11 patients (15 hands) with hand aesthetic complaint who were unhappy with their hand appearance were included for dorsal hand unit reconstruction. Under general anesthesia and tourniquet control, the burned tissue on dorsal surface of the hands was excised and a thick partial thickness skin graft was used for coverage, whereas the fingers were fixed by sutures to the palm. After 1 year, the five-points scale was used for evaluation of patients' satisfaction regarding the five major activities considered for hand function before and after operation. The mean age of the patients was 25.8 ± 5.17 years. The skin grafts were well taken. Six (40%) and eight patients (53%) reported the result of operation as completely satisfied and satisfied, respectively. Dorsal hand unit reconstruction in patients with dorsal hand contracture and significant dorsal scar was shown to simultaneously improve the function and aesthetic outcome of the surgery.
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Affiliation(s)
- Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Foroutan
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheil Mohammadi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Zardosht
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
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Elsherbiny OE, El Fahar MH, Weheida SM, Shebl AM, Shrief WI. Effect of burn rehabilitation program on improving quality of life (QoL) for hand burns patients: a randomized controlled study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1379-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Thermal injuries of the hand can have a great impact on function. Initial treatment should focus on the prevention of contracture through the use of tissue-sparing techniques and optimized occupational therapy. Surgical intervention should follow the standard reconstructive ladder and can involve several techniques from simple to complex including minimally invasive techniques, such as laser and steroid injection, contracture release and skin grafting, and local tissue rearrangement and regional flaps as well as distant pedicled and free flaps. Reconstructive surgery of the hand, when performed well, can lead to meaningful functional improvement in severe burns.
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Affiliation(s)
- Ryan P Cauley
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Lydia A Helliwell
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Matthias B Donelan
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Plastic and Reconstructive Surgery, Shriner's Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
| | - Kyle R Eberlin
- Plastic and Reconstructive Surgery, Shriner's Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA; MGH Hand Surgery Fellowship, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Centre for Burn Treatment between 2009 and 2015. Int Wound J 2017; 14:849-855. [PMID: 28220597 DOI: 10.1111/iwj.12720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022] Open
Abstract
Nearly 80% of all burns include the hands of affected individuals. Skin grafting is the gold standard in burns treatment, but in the case of the burn wound bed, it may require the necessity of utilising skin substitutes to facilitate closure. The aim of this study is to assess the impact of a porcine-derived wound dressing (Oasis™) for application to hand burns compared to a synthetic dressing (Suprathel™). Comparative assessments were made, including the time to heal, quality of healing and pain intensity. A retrospective, unblinded, matching pair case-control of hand burns was performed. A control group of 24 patients was treated with Suprathel dressing, and a study group of six patients underwent application of the Oasis dressing. The wound healing process was evaluated by taking histopathological specimens and also utilising the Bates-Jensen Wound Assessment Tool. A 10-cm Visual Analogue Scale (VAS) was used for pain assessment. Other parameters measured included dressing loss because of infection and the need of rehabilitation. The progress of wound healing on the fourth day in the study group was 30%. A decrease in the level of pain was recorded on the fourth day after surgery. There was a decrease of 5% in the risk of rehabilitation in the treatment group.
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Affiliation(s)
- Justyna Glik
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Chronic Wounds Management Organization, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marek Kawecki
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland.,Department of Health Sciences, Technical-Humanistic Academy, Bielsko-Biała, Poland
| | - Diana Kitala
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | | | - Wojciech Łabuś
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marek Grabowski
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Agata Durdzińska
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Mariusz Nowak
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Marcelina Misiuga
- Dr Stanisław Sakiel Center for Burns Treatment, Siemianowice Śląskie, Poland
| | - Aleksandra Kasperczyk
- Department of Biochemistry, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Zabrze, Poland
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16
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Sinha I, Zhu D, Ojomo K, Gfrerer L, Sawh-Martinez R, Patel A, Chan RK, Watkins JF. Functional and subjective assessment of burn contracture release in a mission setting. Burns 2016; 42:466-70. [PMID: 26778704 DOI: 10.1016/j.burns.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/26/2015] [Accepted: 07/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Burns and subsequent contractures are common in developing nations. Contracture release is performed to treat such patients with functional limitations. The aim of this study is to evaluate post-operative functional and psychosocial outcomes following contracture release in a mission setting. METHODS During a surgical mission in Mumbai, India, 39 patients burn contractures underwent surgical release. A total of 31 patients (64% female, mean age 27 years) chose to participate in the study. Patients were scored preoperatively and postoperatively using a SF-36 validated survey and AMA impairment guideline assessment. RESULTS Thirty-one patients completed questionnaires pre-operative and 6-weeks post operatively. Twenty-four patients completed a survey 3-months post operatively (77.4%). Among those enrolled, 67% were women with the majority sustaining <20% total body surface area burns (70.7%) but had multiple contractures (80.6%). SF-36 physical component score increased from a mean score of 49.8 preoperatively to 55.6 by 3 months following contracture release (P<0.001). The SF-36 mental component score similarly increased from 38.8 to 51.1 by 3 months (P<0.001). AMA Whole Person Impairment (WPI) scores improved from 40.3% impairment pre-operative to 26.6% at 6-weeks post-operative (P<0.001). CONCLUSIONS Patients SF-36 and WPI scores improved following burn contracture release, confirming both functional and psychologic improvement following surgery. During the acute post-operative period, this study suggests that contracture release in a mission setting is of benefit to patients.
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Affiliation(s)
- Indranil Sinha
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States; Division of Trauma and Burn Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States.
| | - Dagny Zhu
- Department of Ophthalmology, University of Southern California, Los Angeles, CA 90089, United States
| | - Kristin Ojomo
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States; Division of Trauma and Burn Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Lisa Gfrerer
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Rajendra Sawh-Martinez
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Anup Patel
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Rodney K Chan
- Clinical Division and Burn Center, San Antonio Military Medical Center, San Antonio, TX 78234, United States
| | - James F Watkins
- Division of Trauma and Critical Care, VA Eastern Colorado Healthcare System, Denver, CO 80220, United States
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Sunil NP, Ahmed F, Jash PK, Gupta M, Suba S. Study on Surgical Management of Post Burn Hand Deformities. J Clin Diagn Res 2015; 9:PC06-10. [PMID: 26435994 PMCID: PMC4576587 DOI: 10.7860/jcdr/2015/13316.6347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/20/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. AIM The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. SETTINGS AND DESIGN It's a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. MATERIALS AND METHODS Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. RESULTS Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. CONCLUSION Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases.
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Affiliation(s)
| | - Firdos Ahmed
- Professor and Head of Department, Department of Plastic Surgery, Medical College, Kolkata, India
| | - Prabir Kumar Jash
- Associate Professor, Department of Plastic Surgery, Medical College, Kolkata, India
| | - Madhumita Gupta
- Assistant Professor, Department of Plastic Surgery, Medical College, Kolkata, India
| | - Santanu Suba
- Resident, Department of Plastic Surgery, Medical College, Kolkata, India
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Gupta RK, Jindal N, Kamboj K. Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome. J Clin Orthop Trauma 2014; 5:215-20. [PMID: 25983501 PMCID: PMC4263997 DOI: 10.1016/j.jcot.2014.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/28/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND No study has ever evaluated the causes and effect of neglect on the outcome of post burns contractures of hand in children. METHODS 66 hands in 61 children (mean age 12.22 years) with a mean neglect of 11.6 years (range 5-17 years) were assessed for the causes of neglect and the outcome of surgery. Average follow up was 6.6 years. The results were assessed in two groups of 5-10 years neglect as group I and >10 years neglect as group II. RESULTS In a total number of 134 contracted rays in 66 hands, the surgical procedures included local Z/V-Y flap (51 rays), cross finger flap (48 rays), full thickness graft (35 rays). Additional external fixator with a distracter was used in 3 patients treated at a delay of 14, 16 and 17 years. 50 (81.96%) patients belonged to rural and slum areas. The reasons for delayed treatment included poverty - 33 patients, lack of awareness of surgical treatment - 16 patients; and indifference of parents - 12 patients. 44 (72.13%) children were illiterates. With treatment the average DASH score improved from 65.10 to 36.90 (p < .000) and from 68.14 to 45.93 (p < .000) in group I and II respectively. The results were significantly superior in group I (p < .000). CONCLUSION The main factors for neglect in treatment of post burns contracture include poverty, lack of awareness and illiteracy. All the patients showed significant improvement in function after the surgery. Contractures with higher neglect had significantly inferior outcome.
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Affiliation(s)
- Ravi Kumar Gupta
- Professor, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Nipun Jindal
- Senior Resident, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India,Corresponding author. Tel.: +91 9780042438.
| | - Kulbhushan Kamboj
- Senior Resident, Department of Orthopaedics, Government Medical College and Hospital, Sector 32, Chandigarh, India
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Mohaddes Ardebili F, Manzari ZS, Bozorgnejad M. Effect of educational program based on exercise therapy on burned hand function. World J Plast Surg 2014; 3:39-46. [PMID: 25489523 PMCID: PMC4236988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/05/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Hands burn was associated with significant functional disorders that severely affected patient's quality of life. The aim of this study was to examine the effect of educational program based on exercise therapy on burned hand function. METHODS This experimental research was conducted in a period of ten months in 2010-2011 in Mottahari Hospital in Tehran in Iran. The sample included 60 patients, who were randomly assigned into experimental and control groups, half in intervention and half in control group. Educational program was implemented on experimental group. The data collection tools were two observational checklists about determining of hand function. RESULTS Both groups were matched in characteristic of demographic and burn injury. Subjects in experimental group demonstrated significant improvements in range of motion and hand function balance from admission to discharge. CONCLUSION In order to reduce the hand functional impairment caused by burns, it is recommended that special attention be paid to patient education about exercise therapy.
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Affiliation(s)
- Fatemeh Mohaddes Ardebili
- Medico-Surgical Group, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Sadat Manzari
- Medico-Surgical Group, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehri Bozorgnejad
- Medico-Surgical Group, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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20
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Choi JS, Mun JH, Lee JY, Jeon JH, Jung YJ, Seo CH, Jang KU. Effects of modified dynamic metacarpophalangeal joint flexion orthoses after hand burn. Ann Rehabil Med 2011; 35:880-6. [PMID: 22506218 PMCID: PMC3309381 DOI: 10.5535/arm.2011.35.6.880] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/21/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures. METHOD We enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks. RESULTS The 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05). CONCLUSION The modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.
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Affiliation(s)
- Ji Soo Choi
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Seoul 150-719, Korea
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