78 Optimising Compression for the Management of Acute Hand Burn Edema

Abstract

Abstract Introduction Compression, a common treatment of choice for the management of edema, is one intervention which is applied with little objective understanding of the optimal parameters of application or efficacy in a patient with an acute burn wound. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The hypothesis tested was: in alert acute hand burn injury patients, application of cohesive bandage will reduce edema faster than an off the shelf compression glove. Methods A randomized control study of 100 patients presenting with hand burn injury. Compression was randomized to one of three methods of application - 1) spiral application of cohesive bandage to fingers, figure of eight to hand and wrist; 2) pinch application or cohesive bandage to fingers, spiral application to hand and wrist; or 3) an off-the-shelf compression glove (control condition). Repeated volume measures of the hand were recorded using water displacement volumetry. The results were analysed using multi-level mixed effects regressions. Outcome measures were hand and wrist active range of movement, pain VAS and QuickDASH. ROM measures were collected with and without compression in situ. Patients were provided with a home exercise program including standardized exercises to optimize venous and lymphatic outflow, and exercises tailored depending on the location of the patients’ injury. Standard instruction to patients was to continue using their hand with the compression in situ, and to elevate at rest and overnight. Results One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods (10.0–14.5mL, p< 0.001). There was no evidence of difference between methods of compression for managing edema. All ROM measures improved, with significant improvement in hand composite finger flexion (p=0.001), hand span (p=0.022) and wrist flexion (p=0.022). QuickDASH decreased between sessions (p< 0.001) indicating reduced upper limb disability. There was no evidence of differences in ROM measures between compression methods. Conclusions There is no evidence of difference between these methods of compression for managing acute hand burn edema. ROM improves with reductions in hand burn edema. Applicability of Research to Practice For the management of acute edema following hand burn injury, this study demonstrates that compression can be applied by therapists of different experience, using methods they are familiar with, to positively influence edema following hand burn injury.