336 Expanding Multidisciplinary Collaboration In Burn Care To Improve Patient Outcomes

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Multidisciplinary collaboration and communication are essential to maximize outcomes for burn survivors. However as patients move through the continuum of care, real time collaboration becomes challenging. The purpose of this report is to highlight the importance of ongoing dialogue and involvement in nontraditional settings to improve outcomes. This is a case report of a 20 year old female with a history of 95% TBSA thermal injury at 4 years of age. She had a recalcitrant elbow flexion contracture, requiring multiple contracture releases of same area with dermal substitutes and autologous graft. The initial surgical plan was to release a 90 degree elbow flexion contracture with autologous graft placement at the new available range acquired. Per protocol a splint would be applied in the same position as the release and graft placement. Therapy was present in the OR to assess the patient and noted bicipital tightness limitations. In consultation with the surgeon an alternate plan was developed, specifically serial casting to increase range of motion (ROM) prior to graft placement. Post release, the surgeon noted tissue stretch end-feel and no apparent traction to neurovascular structures at 60 degrees of elbow flexion. The treatment plan was finalized following contracture release and ROM, the case was placed at 40 degrees elbow flexion and correct tightness and elbow extension limitations. Post-operatively, therapy stretched the patient and cast was applied two times a day for three days. The final cast prior to surgey was applied at 5 degrees of elbow flexion. The day of autografting surgery repeat ROM was performed by the therapist in the operating suite. Autologous grafts were laid on the antecubital fossa and a post operative cast was applied at the previously achieved 5 degrees of elbow flexion. Post-op Day 3 the patient was again stretched and placed into a cast at full elbow extension in the operating room. This position was maintained until discharge with no subsequent graft loss. Subsequent ROM after graft adherence was provided by therapist prior to discharge. By having therapy present in the OR to facilitate real-time communication and modification of surgical plan, this patient was able to achieve full elbow extension at the time of discharge through serial casting and delayed autologous graft placement. Serial casting is a common intervention that therapists use, with this intervention the patient gained 60 degrees of further elbow extension and, more significantly, full functional range. Multidisciplinary communication is an essential element of comprehensive burn care. Therapists and surgeons in collaboration can provide optimal functional outcomes.