Hand Burns Research Articles

117 Allocation of Therapist Time: Mobilization of CFU’s in Hand w/Burn Injury

Abstract Introduction Movement of the hands and digits are used to perform communication and activities for IADL’s and competitive employment. Following a second or third degree to the hand(s), there is a potential for the development of burn scar contracture(s) (BSC), which decreases hand skills creating the potential for decreased quality of life. The ABA data base identifies that 70% of burns are sustained to the upper torso, UE, hands. One ABA verified burn center created a study to identify the time required for the burn therapist to elongate hand CFU’s to pre-burn movement. Methods The one-year retrospective study included unilateral and bilateral hand burns with LOS of 2 days or greater or had an outpatient OT session within one week of the burn. Co-author created the Passive Motion Scoring Grid (PMSG), using a number score with higher number indicating greater passive movement. Education was provided to the OT’s to complete the PMSG at the beginning and end of each hand CFU elongation session. Otherwise, there was no change in the OT burn hand therapy treatment. The study included (5) OT’s with mean of 6 years of experience (3-46). Results There were 50 patients, average age was 48.91 years with majority male and African American. All burns were secondary to thermal with burns of 2nd and 3rd degree. There were 33 unilateral hand burns with an average TBSA of 7.02% and 17 patients sustained bilateral hand burns with an average TBSA of 21.3%. Unilateral hand burns had an average number of CFU’s of 39.4 (11-68) and hand CFU’s accounted for 87.1% of the CFU’s. Average number of CFU’s in bilateral hand burns was 90.3 (8-196) with hand CFU’s accounting of 83.4% of the CFU’s. A total of 539 OT sessions were provided to those with unilateral hand burns with an average of 18 OT sessions (3-36). Bilateral hand burns received a total of 487 OT sessions with average of 24.4 OT sessions (4-67) Therapist time for hand CFU elongation to pre-burn status: unilateral hand burns, 43.5 minutes (SD=24.7) and bilateral hand burns was 53.5 minutes (SD=32.2). The minutes only reflect CFU elongation not the entire therapy time. Conclusions Hand burns result in a small number for TBSA, however it results in a greater number of CFU’s than other body locati8ons. The greater number of CFU’s involved, indicates greater potential for development of BSC. At the completion of the burn OT therapy, no patient exhibited BSC. Providing education and information to funding sources regarding CFU’s in hand burns, equating that to potential BSC development and time required for therapist direct hands-on techniques to obtain pre-burn movement can positively influence authorization for therapy. Applicability of Research to Practice Can assist with allocating therapist time with hand burns. Can positively influence funding authorization for therapy.

Rehabilitation interventions after hand burn injury in adults: A systematic review

The aim of this review was to summarise the current evidence regarding the effectiveness of rehabilitation interventions in improving hand function, range of motion (ROM), hand strength, scar outcome, return to work, level of impairment/disability, level of burn knowledge and decreasing edema following hand burns in adult burn survivors. This review provides evidence-based support for the use of rehabilitation interventions for burn rehabilitation professionals. The following data sources were searched: MEDLINE, EMBASE and CINAHL from their inception up to February 2021, reference lists from all the included full-text articles were screened for additional relevant publications and monthly Google Scholar searches until December 23rd 2021 to make sure all new pertinent published articles after February 2021 would be included.Thirty-five studies were included in this review including 14 RCTs. Most of the included studies were Level 4 (46%; 16/35) and Level 2 (40%; 14/35) evidence. Only four studies were classified as Level 3 (14%; 5/35) evidence and none were considered Level 1. Most studies received a score of 5-9 (54%; 19/35) (Moderate quality). Fourteen studies received a score of ≥10 (40%; 14/35) (High quality) and only 2 studies received a score of<5 (6%; 2/35) (Low quality). Articles were categorized according to the primary outcome targeted by the intervention. Clinical recommendations on higher-level evidence interventions are presented. This review supports the clinical practice of the following interventions: 1) The use of adhesive compression wraps for patients who have increased edema to increase hand function and ROM; 2) The use of compression (adhesive compressive wrap, compression bandage or intermittent compression pump) to decrease hand edema following burn injury; 3) Participating in general rehabilitation to increase hand function and patient perceived level of disability; 4) The use of an orthosis to increase ROM and a dynamic MCP orthosis to increase hand function; 5) If available, incorporate the use of VR based rehabilitation to increase hand function and hand strength; 6) The use of paraffin to increase hand PROM; 7) The use of gels to reduce hand scar thickness; 8) The use of an education component in rehabilitation to increase the level of burn knowledge. The limitations of this study are also discussed. Further research with robust methodology is needed to investigate the potential benefits of treatment interventions included in this review.

SEQUELAE OF HAND BURN: EPIDEMIOLOGICAL AND THERAPEUTIC ASPECTS IN MOROCCAN STUDY

Hand burns can result in both aesthetic and functional sequelae, which are often intertwined, ranging from simple dyschromia to multidigital amputation. They can be minor, requiring medical treatment, or major, requiring surgical treatment consisting of skin grafting or various flaps and plasties. To study the epidemiological, clinical, therapeutic, and evolutionary characteristics of burned hand sequelae, we conducted a retrospective study at the Plastic and Burn Surgery Department of the Mohammed VI University Hospital Center in Marrakech, from January 2013 to December 2017. The study collected 104 cases, including patients with burn sequelae in at least one hand. This work shows that almost one in two patients hospitalized for burns has a burn on at least one hand. The study also shows the frequency of young adult injuries (42%) and children under six years old (33%) in domestic accidents (76%), the frequency of burns to the dorsal surface of the hands from butane flames in the Hand-Face Syndrome in adults, and the frequency of burns to the palmar surface in children. Concerning the sequelae phase, our study shows the frequent association of major sequelae (contractures, retraction, pathological scars) and minor sequelae (dyschromia, itching, scar fragility, cutaneous hyperesthesia). The sequelae were dominated by digital and digito-palmar retractions (65.5%). A functional deficit was observed in more than two-thirds of cases. Various means of reconstruction were used depending on the location and type of sequelae local plasties were performed in 84.6% of cases, and excision-grafts in 76.9% of cases. The most commonly used local plasties were the Z plastie (65.5% of cases) and the trident plasty (26.5% of cases). 78% of the grafts used to treat sequelae were full-thickness skin grafts. The evolution was marked by a satisfactory result for most treated patients. The management of burned hands is multidisciplinary, requiring cooperation between surgeons, physicians, rehabilitators, physiotherapists, and psychologists.

Modified Colson flap with subcutaneous liposuction for one-stage donor site removal: A case series

The aim of this study was to evaluate the functional and cosmetic results of an innovative procedure for modified Colson flap-graft consisting of immediate defatting of the flap by a liposuction cannula. A cross-sectional study was performed among patients with deep hand burns requiring a modified Colson flap between 2018 and 2021. Outcomes included functional and cosmetic assessment of the hand through a quality-of-life questionnaire, a sensitivity scale and a scar assessment scale. During this period, 7 patients were operated on using our technique. One patient was lost to follow-up; 7 patients with a median age of 44 years were included, with a total of 10 burned hands. The burns were thermal in 5 out of 7 cases and the coverage concerned the whole hand in 50% of the cases. The flaps all received cannula defatting. The median time to flap weaning was 23 days (20 to 30 days). The median follow-up was 16 months. One case required remote flap weaning. The median POSAS (Patient and Observer Scar Assessment Scale) per patient was 4 and 2 per observer. The median BMRCSS (British Medical Research Council Sensory Scale) was 122. One case had recovered S2 sensitivity, the other cases had S3 or S4 sensitivity. Immediate defatting is one of the factors in tegumental quality allowing rapid functional recovery of the hand. The cannula defatting technique does not appear to require additional defatting time. The use of the liposuction cannula allows a one-step, homogeneous, and easier defatting, with a lower risk of devascularization.

Pay more attention to the management of burn wounds of special causes and sites

The treatment of burn wounds of special causes and sites is a very challenging clinical work. In this paper, we briefly discussed the incidence rates of chemical burns, electric burns, facial burns, hand burns, and perineal burns, as well as the complexity and severity of pathological injury of the corresponding wound tissue. In addition, we briefly discussed the main principles and methods of clinical treatment, as well as the difficult problems to be solved. It is hoped to attract attention and provide reference for further improving the overall treatment ability of burns.

Burn Injury Cutaneous Functional Units: Allocating Occupational Therapy Resources and Influencing Practice.

Burn injury severity is currently determined by estimating the total body surface area (TBSA) burned, but this method fails to capture the severity of subsequent functional consequences. Alternatively, cutaneous functional units (CFUs)--skin segments that accommodate for movement and commonly become contracted--can be used to more accurately estimate burn severity based on functional consequences. Bilateral hands account for 81.3% of the body's CFUs, though only account for 5% of TBSA. However, hand burn survivors can have worse physical outcomes (ie, contractures, deformities) after burn injury, leading to subsequent loss of function, global occupational participation deficits, and poor psychosocial outcomes. This study, conducted at a verified American Burn Association burn center, explores how CFU involvement among adult burn survivors with uni and bilateral hand and upper extremity burns influenced occupational therapy practice in regards to time spent completing scar and soft tissue elongation techniques from the elbow to the digit tips per patient. The data showed, on average, burn occupational therapists require 0.8 minutes per CFU for an average total of 38.7 (SD = 29.5) minutes each session to complete scar and soft tissue elongation techniques to the upper extremities. The results of this study can be used to educate burn centers on the clinical utility of CFUs, burn occupational therapists regarding best-practice in terms of utilization of therapist time and resources, as well as support the justification for increasing occupational therapy services for patients with upper extremity and hand burns, and increasing staffing to meet patient need.

Clinical study of early rehabilitation training combined with negative pressure wound therapy for the treatment of deep partial-thickness hand burns.

This study aims to explore the clinical effect of early rehabilitation training combined with negative pressure wound therapy (NPWT) for treating deep partial-thickness hand burns. Twenty patients with deep partial-thickness hand burns were randomly divided into an experimental group (n = 10) and a control group (n = 10). In the experimental group, early rehabilitation training combined with NPWT was performed, including the proper sealing of the negative pressure device, intraoperative plastic brace, early postoperative exercise therapy during negative pressure treatment, and intraoperative and postoperative body positioning. Routine NPWT was conducted in the control group. Both groups received 4 weeks of rehabilitation after wounds healed by NPWT with or without skin grafts. Hand function was evaluated after wound healing and 4 weeks after rehabilitation, including hand joint total active motion (TAM) and the brief Michigan Hand Questionnaire (bMHQ). Twenty patients were involved in this study, including 16 men and 4 women, aged 18-70 years, and the hand burn area ranged from 0.5% to 2% of the total body surface area (TBSA). There was no significant difference in TAM and bMHQ scores between the two groups after negative pressure removal. After 4 weeks of rehabilitation training, the TAM scores and bMHQ scores were significantly improved in both groups (p < 0.05); among them, those of the experimental group were both significantly better than those of the control group (p < 0.05). The application of early rehabilitation training combined with NPWT to treat deep partial-thickness hand burns can effectively improve hand function.

Treatment of Pediatric Upper Extremity Burns

Pediatric upper extremity burns are common. There is significant literature outlining the treatment of surgical hand burns; however, the appropriate treatment of nonoperative burns is less well described. Options for treatment are plentiful, and choosing an ideal strategy requires consideration of numerous factors. At our center, pediatric upper extremity burns are managed using a multidisciplinary approach. This topical review outlines the management of pediatric upper extremity burns. We focus on the management of nonoperative burns, but additional information is provided outlining the indications for and techniques of operative management for more severe burns.

Z-plasty in post-burn contracture of hand among pediatric patients.

Objective: To find out the frequency of hand burn and the effectiveness of Z-plasty in post-burn hand contractures. Study Design: Descriptive Cross-sectional study. Setting: Department of Pediatric Surgery, Khawaja Muhammad Safdar Medical College, Sialkot. Period: January to December 2021. Material &amp; Methods: A preformed proforma was used, consisting of 4 parts, the first part including demographic data like age and gender, second part consist of patient’s history, consisting of presenting complaint, its duration, past history of any medical or surgical illness or comorbidity. Third part consisted of physical clinical examination of the hand (fingers and palm) while fourth part was for post-operative complications of reconstructive procedure, Z-plasty. The data was analyzed by using Statistical Package for Social Sciences (SPSS) version-20. Results: The most commonly affected age group was less than 6 years of majority of them, 53.3%, were male. The most common cause was thermal burns as compared to electrical burns. Among 91.1% of the participants, the right hand was affected more. Majority of the cases (48.9%) reported single finger burn, followed by multiple fingers (31.1%) and very few (20%) were having palm burns. Segregating the single figure, results showed that little finger was affected in 20% of cases No post-operative complications, like skin necrosis, wound dehiscence, hematoma or infection, were noted. Conclusion: It can be concluded that post-burn hand contractures and hand deformity was common among children. Z-plasty with/without skin grafting is an ideal surgical management to subside the contracture of hand.

Effectiveness of early rehabilitation in hand burns.

Hand burn trauma occurs quite commonly and the outcome of hand burns can significantly impact self-care daily function, work and employment, leisure activities, and overall health-related quality of life. The overall goal of the management of hand burn trauma is to optimize hand function. Rehabilitation and restoration of hand function are critical for the patient's independence and re-integration into society and work. The purpose of this study is to present our experience with 105 hand burn trauma patients admitted and treated in our burn center and to show the efficacy of early rehabilitation on their ability to return to their prior social life and work. In our study, we included that 105 patients with acute severe hand burn trauma were hospitalized in Gulhane burn center between 2017 and 2021. They underwent rehabilitation program daily sessions. Patients with hand burns are evaluated by ranges of motions (ROM), grip strength, Cochin Hand Function Scale (CHFS), and Michigan Hand Questionnaire (MHQ) 12 months after the injury. Overall, mean digital total active motion were >180°. The mean values for grip strength of dominant hand for men were 27.2±9.3 kg, for women were 22.0±8.8 kg and non-dominant hand for men were 24.05±13.8 kg, for women were 17.8±10.3 kg. Total score of 5 items was 19.0 in CHFS. The mean overall score on the MHQ was 62.3±27.4. All obtained data were within normal or accepted functional ranges. Spearman correlation coefficient indicates a negative correlation between MHQ and CHFS (p≤0.01). A comprehensive rehabilitation program is essential in helping patients to regain optimal function after hand burn trauma. Physiotherapy and occupational therapy is most beneficial when started at the time of admission.

Bromelain-based enzymatic debridement in hand burns – an easier way to manage a difficult patient: case report

Introduction. Bromelain-based enzymatic debridement may be considered the standard in patients with upper extremity burns management, regarding the low risk of bleeding, wound infections, reduction of surgical timing, and the decreased risk of compartment syndrome development. Case presentation. We present the case of hand and face burns in a patient presenting deep venous thrombosis of the lower limb extended to the level of the vena cava, and bilateral pulmonary embolism. The enzymatic debridement reduced periprocedural bleeding and allowed a faster recovery and therefore the resumption of oral anticoagulation and antiplatelet medication in a patient with important cardiac, arterial, and renal comorbidities. Conclusion. Bromelain-based enzymatic debridement use is recommended in patients presenting upper limb deep burns, especially in anatomically challenging areas, like hand fingers, and especially in those with a previous medical history that predisposes them to periprocedural bleeding and increased risk of poor healing.

A Single Institution's Recent Experience With Pediatric Hand Burns.

Children are at risk for sustaining hand burns due to their innate curiosity, slow withdrawal reflexes, and thin palmar epidermis. We sought to summarize our recent experience managing pediatric hand burns, focusing on injuries that required surgical management. This was a retrospective review of children with burn-injured hands managed at a quaternary referral children's hospital between 2016 and 2020. Demographics and mechanisms of injury were collected for all patients. Initial management of all wounds included pain control, deflation of blisters, and mechanical debridement. Wounds were then dressed, and a plaster-backed soft cast was applied for positioning if the swelling was controlled. Wounds were reassessed in 4-7 days, at which time a nonadherent dressing with antifungal ointment or a bismuth dressing was applied to partial-thickness wounds, vs an active silver dressing for deep partial-thickness burns. For patients who underwent split-thickness or full-thickness skin grafting, additional wound care, operative, and short-term outcomes data were collected. A total of 3715 children were seen for burn injuries during the study period, of which 2100 (56.5%) were seen for hand burns. In total, 123 (5.8%) required a skin graft an average of 11.7 days from the date of their burn injury. Surgical complications were minimal with 5 (4.1%) incomplete graft takes, though none required reoperation, and 1 (0.8%) experiencing a postoperative wound infection. Pediatric hand burns are common. A multidisciplinary treatment approach, including standardized wound care and adept therapeutic interventions, will lead to spontaneous healing in approximately 95% of patients.

A Prospective Study of Reconstructive Procedures For Post Burn Hand Contractures

Objective: The hand is among the most frequent sites of burns contracture deformity. It represents a common problem and a difficult challenge for many reconstructive surgeons. It is important to restore length, function, and provide good quality skin cover. Our aim is to evaluate the different surgical procedures for resurfacing after release of post burn hand contractures in terms of functional recovery and aesthetic outcome. Methods: Totally 30 cases of post burn hand contractures were reconstructed between May 2018 and November 2019 according to site and type of contracture with individualization for each case. All cases were followed up with physiotherapy and splinting devices, functional and aesthetic outcome for each procedure. Results were analyzed as per successful reconstruction, type of procedure, complications, functional and aesthetic outcome. 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 and acceptable appearance. Conclusion: Postoperative physiotherapy and splinting are must for better outcome in all cases.

Effect of exoskeleton manipulator on hand function rehabilitation for postburn patients

Purpose Patients with scar contracture deformities caused by hand burns were treated with an exoskeleton manipulator system, which was equipped with games to explore its clinical application value. Methods Twenty patients who were treated for post-burn scars of bilateral hands between October 2020 and June 2021 were selected (ChiCTR2000036232). The patients were divided into two groups: control, 10 patients (traditional outpatient treatment); and experimental, 10 patients (exoskeleton manipulator system treatment). We compared the change in the total active motion (TAM) value, grip strength, scar improvement, and postoperative pain improvement. Results After 3 months of rehabilitation training, the improvement of thumb TAM was 33.80 ± 11.38 ° in the experimental group and 23.2 ± 6.13 ° in the control group. With respect to the index finger TAM, the improvement in the experimental and control groups was 84.50 ± 30.96 ° and 54.80 ± 15.89 °, respectively. The middle finger TAM of the experimental and control groups improved by 86.75 ± 32.85 ° and 60.25 ± 17.97 °, respectively. However, improvement of grip strength, scar score, and pain score were similar between the two groups. Conclusions The exoskeleton manipulator system has excellent effects in improving burned hand joint movement, which is suitable for hand burn patients and has beneficial clinical effects. Implications for rehabilitation Exercise is an effective means to improve the hand function of burn patients. The application of mechanical devices in the rehabilitation of burned hands can effectively help patients exercise. The A5 Hand Function Training System is an exoskeleton mechanical device that can exercise the small joints of the hand. It assists patients in using different computer games during treatment.

The Effect of Implementing a Rehabilitation Nursing Program on Hand Burn Patients’ Daily Functioning: A Randomized Clinical Trial

Background: The physical problems associated with burns can cause patients various difficulties and negatively affect their independence as well as participation in daily life activities. Objectives: This study aimed to evaluate the effect of a rehabilitation nursing program on hand burn patients’ daily functioning. Methods: The present randomized clinical trial was conducted to examine 60 hand burn patients referred to the Shahid Motahari Hospital of Tehran, Iran, between November 4, 2020, and April 19, 2021. The patients were randomly divided into two groups using the block randomization method (n = 30 per group). The intervention group received a 5-week rehabilitation nursing program in two steps: during the acute stage of the disorder (i.e., the time of admission) and during the recovery stage (i.e., before discharge). Data were collected in each step using the General Activities of Daily Living (GADL) questionnaire. The control group received routine care. Inferential and descriptive statistics, such as the independent and paired t-test, as well as the chi-square test and analysis of covariance, were used to analyze the data. Results: The results showed no significant difference in the daily performance of the individuals assigned to the study groups prior to the rehabilitation program (P = 0.29). According to the results of covariance analysis, the overall performance mean scores of the two groups were significantly different after implementing the nursing rehabilitation program, with a significantly higher score (i.e., better performance) recorded for the intervention group (P &lt; 0.001). Also, the means of pre- and post-intervention performance scores were significantly different in the rehabilitation group (P &lt; 0.001), but they were not significantly different in the control group. Conclusions: It was concluded that implementing a rehabilitation nursing program improved the daily performance of patients with hand burns, which offered a valid ground for accelerating the rehabilitation of these patients and shortening the period they needed to return to society.

Impact of surgical first excision delay on function for heat-press hand injury by the Quick-DASH questionnaire: Series over 20 years

BackgroundHeat-press hand burn leads to complex and severe lesions, with potentiation of thermal burn by the crushing mechanism. Management remains poorly codified, and the surgical strategies found in the literature remain contradictory. The objective of our study is to report our experience and define the first burn excision delay through functional evaluation with a Quick-DASH questionnaire. MethodsWe carried out a retrospective study of 20 burned hands by heat-press managed in our burn unit between 2002 and 2021. Following data were collected, at least one year after the accident: Quick-DASH score, which was our primary endpoint, injury assessment according to the Tajima's classification, overall surgical management, and impact on their professional activity. A descriptive statistical analysis of these data was performed followed by a univariate analysis to assess the correlation between delay to first surgical excision and the long-term functional result (Quick-DASH score and time before return to work). ResultsBurns were Tajima grade 1 (supra-fascial dermal burn) in 35 % of cases, grade 2 (exposure of subfascial structures) in 45 % and grade 3 (bone or joint exposure) in 20 %. There were no cases of bone fractures.We received 18 out of 20 questionnaires with no significant differences between those who send back or not. The median QuickDash score was 7.15 [IQR 0–52.25]. The first surgical excision was performed with a median of 8 days after the accident [min: 0; max: 20]. The median time before return to work was 24 weeks [IQR 17–42.25]. Only 11 patients (55 %) were able to go on the initial employment. Spearman test found a strong trend for a negative correlation between the time to the first excision and the QuickDash score (ρ = −0.46; r2 = 0.087; p = 0.053). ConclusionAccording to observations made in our unit and in agreement with Tajima, who first described heat-press injury, the first surgical excision should be performed approximately one week after the accident. Subsequent excisions may be performed to reassess the lesions and complete the debridement, with reconstruction to follow. Multidisciplinary management is still necessary, including early and intensive physiotherapy, psychological support, and assessment by an occupational physician.

Rehabilitation of hand through leap motion control on burn injury patients

Burn injuries, especially severe burns, triggers immune and inflammation response, disturbances of metabolism and distributive type of shock, all of this can be said as hard to treat and may lead to cause multiple organ failure. The fact that the injury not only effects physical health but also mental health his mental health and quality of life is critical. As a result, people with burn injuries cannot be deemed recovered if wounds have healed; rather, burn injuries cause long-term fundamental changes that must be focused in order to improve quality of life. As a result, burn care providers encounter a variety of issues, including managing acute and critical care, long-term care, and rehabilitation. Hand is the most commonly injured body part out of all accidents that are work related , ranks third of all workplace injuries and necessitating surgical and lengthy recovery. Hand burns make it difficult to function. The rehabilitation process has benefited from the usage of virtual reality (VR). LMC is a form of virtual reality game that uses new technology to provide biofeedback and training for fine motor function and functional skills. According to this review paper, leap motion training will enable hand burns patient to enhance finger mobility, reduce scar thickness, and improve hand function along with enhancing quality of life of patient. Although improvement in condition depends on severity of burn but this gadget proved to be a boon for hand rehab. on burn population. . Finally in conclusion of review it can be said that leap motion training may aid patients with hand burns in increasing finger range of motion, reducing scar thickness, and improving hand function.

Saint George, Utah

Not named for the Saintwho met the princess bythe lake and with her girdleleashed the dragon. Who killed it for the people's conversion. Whose chapel in Windsor holds a part of his skull part of his arm orhis heart. In a cupof griffin's eggtwo fingers.Mormons have no saints save the pioneers. Saint George the cousin of Joseph Smith. George A Smith whom the Paiutes called Non-choko-wicher takes himselfapart after watchinghim remove his teethglasses and wig. Who did notsettle that place but called the saints to settle it. Instructed them to eat potatoes raw with skin to prevent scurvy.They called him Potato Saint.A few miles north my Englishgreat great grandmotherAgnes ate only potatoes and salt for three weeks when her husband was on a mission in Europe. Because there was no other food.I do not knowwhat her sister wifeate. When her babyfell into the fire Agnes rubbed halved potatoes onto the burned hands. Wrapped each finger separately so they would notgraft together.A finger was takenthree months later.Someone said it was corrupting the other fingers. Agnes told a story from England.A poor woman'spastor visits and asksto pray with her.As he prays she interrupts him with potatoes! potatoes!When he stopspraying she explainsGod might hear herbetween the man's words and think to send a starving woman potatoes potatoes.This is the joke.

Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: Systematic review and meta-analysis

Our objective was to compare the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was conducted to identify all Randomised Controlled Trials and non-randomised studies comparing the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. Primary outcomes included development of post-graft contracture and the necessity for surgical release. Secondary outcomes consisted of evaluation of function, cosmesis and colour, scar and feeling, hair growth, and other complaints. For the analysis, fixed effects modelling was applied. Results: ten non-randomised trials with a total of 532 grafts were found. Full thickness skin grafts exhibited a statistically significant decrease in the development of post-graft contracture (Odds Ratio [OR] = 0.35, P = 0.0001) and later surgical releases (OR = 0.06, P = 0.00001). For secondary outcomes, full thickness skin grafts outperformed split thickness skin grafts in post-operative functional ability. However, split thickness skin grafts, showed to be superior in scar, aesthetic, and colour assessments, and less hair growth was observed for split thickness skin grafts. No significant difference was seen in sensation and donor or recipient site complaints. Overall, full thickness skin grafts are a better alternative for paediatric hand burns than split thickness skin transplants because they are linked with reduced post-graft contracture and the requirement for surgical release.

Implementation of a nursing rehabilitation model to improve quality of life of patients with hand burns: A randomized clinical trial.

Burn is known as a life-threatening event in people's lives, causing numerous physical, psychological, and social harms and negatively affecting patients' quality of lives. This study was designed to evaluate the effectiveness of implementing a nursing rehabilitation model in improving the quality of life of people with hand burns. This was a randomized clinical trial conducted on 60 burn patients admitted to the Shahid Motahari Hospital, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran in 2021. The patients were randomly allocated into two groups of intervention and control (n = 30 per group). The participants of the intervention group received a 5-week nursing rehabilitation program in two phases: at the acute phase (admission) and the recovery phase (before discharge). Data were collected using the Burns Specific Health Scale Brief (BSHS-B) questionnaire before each phase. The quality of life (Qol) - was significantly different comparing the two groups before the intervention (p = 0.042). Covariance analysis showed that after the intervention, the mean quality of life score was significantly higher in the intervention than the control group, indicating a better Qol in the recent group (p <0.001). In the control group, the mean score of Qol was not significantly different before and after the intervention; however, this difference was statistically significant in the intervention group (p = 0.001). The implementation of the nursing rehabilitation model improved the Qol of patients with hand burns. So, this model seems to be an appropriate and effective strategy to accelerate the rehabilitation of patients with hand burns and their return to society.