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

Abstract

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.