Hand Burns Research Articles

Design and manufacture of a utility artificial hand for a burned child by three-dimensional printing technology and its application

In May 2015, a child with absence of most of the five fingers with scar formation after healing of a left hand burn wound hospitalized in our burn ward. According to the free online design program for making artificial limbs using three-dimensional printing technology on the internet, a utility artificial hand, most of which made of plastic parts, was designed for the child and printed by a three-dimensional printer. The child was instructed to wear and use the utility artificial hand, including driving the finger part of the utility artificial hand to make a grasping action by flexing the wrist joint. On the first day of using the utility artificial hand, the time the right hand and the utility artificial hand took to finish the Nine-Hole Peg Test (NHPT) was 24 and 325 s, respectively. After training, the child could grab some light and rough objects. After 3 months of follow-up, the child could use the utility artificial hand to cooperate with the upper limb of the healthy side to make the movements of picking up the basketball and keeping the balance of body on the bicycle. The time the right hand and the utility artificial hand took to finish NHPT was 21 and 193 s, respectively. The time the utility artificial hand took increased by 40.6% compared with the initial period. By assembling the three-dimensionally printed utility artificial hand, the partial appearance image of the child was restored, and some of the hand functions were compensated, which improved the self-care ability of the child in daily life and was beneficial to his physical and mental development.

Attribution bias underlying burns-induced anxiety symptoms

IntroductionBurn injuries are a debilitating cause of morbidity and mortality associated with the long-term impact of psychological factors on quality of life. Accurate assessment of the differential impact of burn sequelae and anxiety is often complicated by the overlap between psychological and somatic symptoms in burns patients. The Beck Anxiety Inventory (BAI) is one validated psychometric tool for anxiety assessment. The primary objective of this study is to investigate whether utilising the BAI as a tool to assess for anxiety in burns patients is biased due to the confounding of symptoms of anxiety with the physical sequelae of a burn injury. MethodsThis is a single-centre, prospective, cross-sectional study. The study was conducted in accordance with the UK Good Clinical Practice guidelines (CAPP reference number 506). Patients were recruited over a three-month period from November 2016 to February 2017 and were offered a modified BAI questionnaire to complete. Patients were asked to indicate to what degree they attributed each symptom to their physical injury or their psychological state on a visual analogue scale (VAS). Results50 patients, comprising 33 females (66%) and 17 males (34%), participated in the study with a median age of 33.5 years (range: 20–88). Date of injury spanned May 1991 to January 2017. Percentage of the total body surface area (% TBSA) affected by burn ranged from 1 to 86%. Patients attributed eight of the 21 self-report items within the BAI as being more physical than psychological in origin. The results reveal a statistical significant difference in patient VAS scores between physical (mean: 34.16, 95% CI: 29.04–39.28) and psychological (mean: 61.2, 95% CI: 56.33–66.17) BAI items, with p<0.0001. In addition, patients with a facial burn injury were more likely to report ‘face flushed’ (Mann–Whitney U Test, Z=−2.11, p<0.05) and patients with a hand burn injury were more likely to report ‘hands trembling’ (Mann–Whitney U Test, Z=−2.52, p<0.05). ConclusionsThis feasibility study found preliminary evidence suggesting that the BAI may, in part, represent misattributed symptoms of cutaneous injury from burns. However, whilst our findings suggest an attribution bias, there is not enough evidence from this data to comment on whether its use should be restricted in burns patients. Further research is needed to formally quantify convergent and divergent validity through structured interviews. In addition, further research using other self-report tools of anxiety in burns patients would be useful to corroborate the prospect of biased and confounded anxiety scores.

Using ESSENCE to Detect Bomb-Making Activity: What’s Appropriate?

ObjectiveTo describe a novel application of ESSENCE by the Saint Louis County Department of Public Health (DPH) in preparation for a mass gathering and to encourage discussion about the appropriateness of sharing syndromic surveillance data with law enforcement partners.IntroductionIn preparation for mass gathering events, DPH conducts enhanced syndromic surveillance activities to detect potential cases of anthrax, tularemia, plague, and other potentially bioterrorism-related communicable diseases. While preparing for Saint Louis to host a Presidential Debate on October 9, 2016, DPH was asked by a partner organization whether we could also detect emergency department (ED) visits for injuries (e.g., burns to the hands or forearms) that could possibly indicate bomb-making activities.MethodsUsing the Electronic Surveillance System for the Notification of Community-Based Epidemics (ESSENCE), version 1.9, DPH developed a simple query to detect visits to EDs in Saint Louis City or Saint Louis County with chief complaints including the word “burn” and either “hand” or “arm.” A DPH epidemiologist reviewed the results of the query daily for two weeks before and after the debate (i.e., from September 25, 2016 to October 23, 2016). If any single ED visit was thought to be “suspicious” – if, for example, the chief complaint mentioned an explosive or chemical mechanism of injury – then DPH would contact the ED for details and relay the resulting information to the county’s Emergency Operations Center.ResultsDuring the 29 day surveillance period, ESSENCE detected 27 ED visits related to arm or hand burns. The ESSENCE query returned a median of 1 ED visit per day (IQR 0 to 2 visits). Of these, one was deemed to merit further investigation – two days before the debate, a patient presented to an ED in Saint Louis County complaining of a burned hand. The patient’s chief complaint data also mentioned “explosion of unspecified explosive materials.” Upon investigation, DPH learned that the patient had been injured by a homemade sparkler bomb. Subsequently, law enforcement determined that the sparkler bomb had been made without any malicious intent.ConclusionsDPH succeeded in using ESSENCE to detect injuries related to bomb-making. However, this application of ESSENCE differs in at least two ways from more traditional uses of syndromic surveillance. First, conventional syndromic surveillance is designed to detect trends in ED visits resulting from an outbreak already in progress or a bioterrorist attack already carried out. In this case, syndromic surveillance was used to detect a single event that could be a prelude to an attack. The potential to prevent widespread injury or illness is a strength of this approach. Second, conventional syndromic surveillance identifies potential outbreak cases or, in the case of a bioterrorist attack, potential victims. In this case, syndromic surveillance was used to identify a potential perpetrator of an attack. While public health and law enforcement agencies would ideally coordinate their investigative efforts in the wake of an attack, this practice has led to conversations within DPH about the appropriateness of routinely sharing public health surveillance data with law enforcement.

Epidemiology of Hand Burn in Albania 2011-2016.

INTRODUCTION:Hand burns occur commonly both as part of larger burn injuries as well as isolated injuries.AIM:To give an overview of epidemiologic features and outcome of burn hand patients who admitted to our Service. This study was performed at University Hospital Center “Mother Teresa” Tirana which is the only tertiary hospital in Albania.MATERIAL AND METHODS:This prospective study included all patients who had combustion of the hands solely or hands accompanied with burns to other areas of the body, treated and followed up at our service during the years 2011-2016.RESULTS:Of the 333 included burn patients, 64% were males. The median age of patients is 25.9 years. About half of patients belong to the age group 20-60 years (49.5%) and only 10.2% belong to the age of 60 years. In most of the cases (73.6%), the burn of hands is associated with the burn of the other anatomical region, mostly forearm.CONCLUSION:The surgical treatment is used for less 30% that of patients. The undesirable results of the burn of hands are presented in the 33% of the patients. The contractures were the main unfavourable outcome of the burned hand.

Versatility of Dorsal Metacarpal Artery Flaps for Hand Burns.

Burns to the hands can be devastating injuries and early debridement and coverage can prevent these chronic problems. Reconstructive options for these defects include skin grafts; local, regional, and distant flaps; and free flaps. In this series, they set out to demonstrate the versatility, durability, and effectiveness of dorsal metacarpal artery (DMCA) flaps for primary soft tissue coverage. This study involves a review of all consecutive patients who underwent acute soft tissue coverage using DMCA flaps at their institution from December 2014 to December 2017. Four patients were identified, two underwent reverse DMCA flaps, and two others underwent first DMCA flaps. Three patients were males and one female whose age ranged from 33 to 74 (mean 48 years old). Follow-up ranged from 6 to 43 days. One of the four flaps had de-epithelialization of the distal flap with loss of the most distal tip left to heal by secondary intention. The remainder of the flaps survived without incident, and a full thickness skin graft had 100% take onto the index finger donor site. At the final follow-up, all flaps had healed completely and patients had return of almost complete active range of motion. Flaps based on the DMCA have been proven to be versatile and reliable methods for primary hand burn reconstruction.

435 Being Female and Having Hand Burns May Be Predictors of Lower Quality of Life in Burn-Injured Youth

Quality of life (QoL) is an important construct that considers a youth’s physical health, psychological state, independence level, social relationships, and their connection to their environment. QoL is more comprehensive than “subjective well-being” as it more closely reflects the details that define the good life. This study sought to determine whether gender, location of scars, large TBSA, ethnicity or causation affected burn-injured youth’s self-reported quality of life. Burn-injured youth, with parental permission, voluntarily completed the self-report, 16-item, YQoL (for youth ages 11–17) produces a QoL profile for adolescents across four domains (Self, Relationships, Environment, and General QoL. Participants rated each statement on how closely it described them. Example: “I feel my life has meaning” from 1(not at all) to 10 (very much). All 16 items contribute equally to the total YQoL score. Participants included pediatric burn survivors (n=144) mean age 13.9 years, male (n=64) female (n=80). Cause of burn was Fire/flame (41%), Scald (39%) and Other (20%), average age at burn of 5.9 years with (78%) reporting visible scars. A t-test revealed that youth with hand burn scars (n=30) reported a lower QoL (76.1) than those with facial scars (n=14) QoL (82) and neither hands nor facial scars (82.3) (p=.05). Their scores were also significantly lower on the Sense of Self (p=.05) and Culture (p=.03) subscales. Girls reported a lower QoL score (79.9) than boys (83.5) trending towards significance (p=.08). No notable differences were reported for hidden vs. visible burns, causation, ethnicity or TBSA ≥ 50%. This study endorses the findings of others which have revealed lower QoL scores for both burn-injured girls and children with hand burns. Diminished QoL in those with hand burns, 2 years post-injury, has been attributed to impaired fine/gross motor skills and appearance. This study group averaged 8 years post-injury. Results indicate that psycho/social problems in hand burn patients may be chronic. Girls reported lower QoL, also supporting prior findings that females are at greater risk for poorer psychological and social outcomes. Both groups should be monitored for psycho/social problems and have access to interventions that can improve their long-term emotional recovery from burn injury. Burn care professionals should be educated regarding the increased vulnerability for poorer quality of life outcomes in female and hand burn survivors. These groups may benefit from targeted and longer-term psycho/social interventions.

345 The Impact of Early Autografting on Functional Range of Motion of the Hand

The treatment of hand burns requires a comprehensive, collaborative treatment plan, to maximize functionality and independence. The optimum timing of autografting has not been clearly established. Key motions that should be optimized during therapy include composite fist, metacarpophalangeal(MCP) flexion, thumb flexion, wrist flexion, and wrist extension. The purpose of this study was to evaluate the correlation between the time interval between injury and autograft to time functional range of motion (ROM) was achieved. This was a retrospective chart review of patients with hand burns requiring autografting from June 2015 - June 2016. Range of motion data were documented for the MCP and wrist joints, as well as composite fist throughout each patient’s physical and occupational therapy. These were compared to each patient’s autograft timeline to determine whether a statistical relationship existed. Data were analyzed using Spearman’s correlation. Of the 364 patients who presented with hand burns over the study period, 52 (14%) received autografts. On average patients were autografted 19.54 days after their initial injury. There was a moderate, positive correlation between the time to autografting and time of composite fist (r (25) =.418, p = .038). The time to achieve functional thumb flexion was also significant (r (6) = .829, p = .042). Finally, the time to functional wrist ulnar deviation, while not statistically significant, showed a positive trend (r (27) =.358, p=.067). For patients with hand burns, reestablishment of a functional range of motion is essential to independent daily living. This study suggests that, in patients with hand burns, early autografting leads to earlier return to normal hand functioning across some parameters. In an effort to further investigate the role of early autografting and its resultant functional recovery, follow on research with larger patient enrollment numbers would be beneficial to further elucidate trends in this patient population. The timing of autograft repair for burn injuries is a decision central to the development of care plans for burn patients. The data above provide evidence that earlier autografting may benefit patients by reestablishing a functional range of motion earlier in their post-burn recovery.

474 Pediatric Hand Burns: Review of a Single Institution Experience

Hand burns are common in the pediatric population. During the healing process development of scar contracture can be particularly morbid and severely limit sensation and mobility. The goal of our study was to retrospectively review our pediatric hand burn population with a specific focus on the length of time between injury date and intervention for scar contractures. With IRB approval a retrospective chart review of all patients less than 18 years old treated for hand burns between Jan 2013 and December 2016 was performed. Demographics, burn characteristics, treatments, hospital course, and follow up were recorded. Descriptive statistical analysis was performed; all medians reported with interquartile range. 140 patients were reviewed, the population was predominately male (86 patients, 59%), white (98 patients, 68%), with a median age of 2 years (IQR 1, 6.5). The most common type of burns was scalding 97 patients (67%), flame burns 36 patients (25%) and electrical burns 11 patients (7.6%). Second degree burns occurred in 128 patients (89%) with a median TBSA of 1.75 (IQR 1, 4). The most common location burned on the hand was the palmar aspect with 86 patients (60%), 35 patients (24%) were burned only on the dorsal aspect of their hand and 21 patients (15%) were burned on both the dorsal and palmar aspects. The median number of digits involved in the burn was 4 (IQR 2, 5). Ninety two patients (67%) had involvement of a joint. Median days of follow up was 16 (IQR 8, 40). 21 patients (15%) required operative intervention with a median age of injury of 2 years (IQR 1, 6.5). 6 (28%) of these patients required a second intervention. 5 patients (4%) developed clinically significant contractures after the wounds had completely healed. All five required subsequent opearative intervention, three patients underwent operative excision and grafting and two underwent adjacent tissue transfer flaps. The median days to intervention was 20 (IQR 16, 100). Clinically significant contractures make up a small percentage of pediatric hand burn outcomes. Aggressive physical therapy and more superficial burns may account for these findings. Review of the presentation and progression of pediatric hand burns will lead to new strategies to care for these common burns.

335 Descriptive Analysis of the Pediatric Burned Hand

Therapists specializing in burn rehabilitation often encounter challenges associated with the severely burned hand. During the acute stage of burn care, each patient’s complex set of needs is identified by considering the anatomical structures affected and the associated impact on function. In the acute setting, therapists are limited in ways to objectively measure patient function due to the severity of hand injuries and complications due to multisystem involvement. The purpose of this descriptive study is to provide an analysis of a series of patients with complicated hand burns. This knowledge may be used in future studies to determine best practices and facilitate clinical decision making to aid therapists in selecting appropriate interventions. Methods included a descriptive case series analysis of seven patients in the pediatric burn intensive care unit with intent to describe the clinical presentation of the hands using basic statistical analysis. Subjects were chosen based on complexity of injury including multisystem involvement, multilevel digital amputations, and large total body surface area (TBSA) burns including third degree burns of the hands. The patients studied were predominantly male, with an average patient age of 10 years with a range of two to seventeen years. The average TBSA was 65% with 85% flame and15% electrical burn injuries. Patients required an average of 13 acute surgical interventions, including mixed level digital amputations, k-wire placement in at least one digit, and 30% experiencing loss of thumbs. All patients were diagnosed with infections during their acute stay with an average hospital stay of 82 days. None of the patients were able to complete a standardized functional outcome measure during their acute hospitalization due to their inability to perform required tasks. Upon transition to the outpatient rehabilitation setting, patients achieved an average scaled score of 26/73 points for the self-care domain of the Pediatric Evaluation of Disability Inventory, reflecting low capability. Patients with severe hand burns may experience multiple complicating factors making them unable to complete commonly used objective functional measures in this setting. Current available functional outcome measures may not be appropriate for patients with severe hand burns, which pose a problem for therapists’ ability to objectively measure patient progress throughout the continuum of care. Further research is needed in this area in order to aid in the selection of assessment tools and interventions. The next step will be a prospective longitudinal study looking at the use of specific outcome tools and interventions throughout the phases of burn rehabilitation.

319 Pediatric Hand Burn Reconstruction: Timing and Technique

319 Pediatric Hand Burn Reconstruction: Timing and Technique

A Soft Casting Technique for Managing Pediatric Hand and Foot Burns.

Hand and foot burns in children are difficult to dress. The authors have developed a soft casting technique to manage burns to these areas. The aim of this study is to report the outcomes using weekly dressing changes with a soft casting technique to manage pediatric hand and foot burns in the outpatient setting. A retrospective chart review was performed on children with burns to the hands or feet, who underwent dressing changes with a soft casting technique at the Children's Hospital Colorado Burn Center. Soft casting was performed by placing antibiotic ointment-impregnated nonadherent gauze over the burn wound(s), wrapping the extremity using rolled gauze, applying soft cast pad, plaster, soft cast tape, and an elastic bandage. This was changed weekly. Two hundred ninety-eight children with hand burns had a mean age of 16.8 ± 2 months. Two hundred forty-eight children had partial thickness burn injuries (83%), 50 had full thickness burn injuries (17%), and the mean total body surface area (TBSA) was 1 ± 2.4%. The mean time to heal was 10.1 ± 1.7 days for all subjects. Sixty-six children with foot burns were identified with a mean age of 24 ± 2.6 months. Forty-six children had partial thickness injuries (70%), 20 had full thickness burn injuries (30%), and the mean TBSA was 2.3 ± 2.9%. The mean time to heal was 14.1 ± 2.2 days for all subjects. Weekly dressing changes using a soft casting technique are effective for the outpatient management of pediatric hand and foot burns. This method avoids costly inpatient hospital care, reduces the number of painful dressing changes, and allows children to heal in their own environment.

Hand burns surface area: A rule of thumb

IntroductionRapid estimation of acute hand burns is important for communication, standardisation of assessment, rehabilitation and research. Use of an individual’s own thumbprint area as a fraction of their total hand surface area was evaluated to assess potential utility in hand burn evaluation. Materials and methodsTen health professionals used an ink-covered dominant thumb pulp to cover the surfaces of their own non-dominant hand using the contralateral thumb. Thumbprints were assessed on the web spaces, sides of digits and dorsum and palm beyond the distal wrist crease. Hand surface area was estimated using the Banerjee and Sen method, and thumbprint ellipse area calculated to assess correlation. ResultsMean estimated total hand surface area was 390.0cm2±SD 51.5 (328.3–469.0), mean thumbprint ellipse area was 5.5cm2±SD 1.3 (3.7–8.4), and mean estimated print number was 73.5±SD 11.0 (range 53.1–87.8, 95% CI 6.8). The mean observed number of thumbprints on one hand was 80.1±SD 5.9 (range 70.0–88.0, 95% CI 3.7), χ2=0.009.The combined mean of digital prints was 42, comprising a mean of two prints each on volar, dorsal, radial and ulnar digit surfaces, except volar middle and ring (3 prints each). Palmar prints were 15 (11–19), dorsal 15 (11–19), ulnar palm border 3, first web space 2, and second, third and fourth web spaces one each.Using the surface of the palm alone, excluding digits, as 0.5% of total body surface area, the area of one thumbprint was approximated as 1/30th of 1%. ConclusionsWe have demonstrated how thumbprint area serves as a simple method for evaluating hand burn surface area.

Thermal injuries from exploding electronic cigarettes

IntroductionThere are an estimated 2.75 million electronic cigarette (EC) users in the United States. ECs have become the most commonly used nicotine-containing product in young adults ages 18–24 years. Thermal, blast, and missile injuries from EC explosions has grown rapidly in recent years. Burn surgeons must remain up to date regarding management and treatment of burn injuries related to EC device ignition. MethodsAn IRB approved retrospective review of all patients admitted to the Massachusetts General Hospital Burn Center from January 2015 to April 2017 was performed. Fourteen patients with injuries associated with EC use were identified. Patient demographics, injury location, size and degree of burn, treatments required, length of stay (LOS), time to 95% closure, associated complications and injuries, and the circumstances that led to the injury were identified. ResultsThe mean age was 28.6±8.6 years with a range of 19–50 years (n=14). EC burns occurred in males 93% (13/14) of the time. The majority of EC explosions caused 2nd and 3rd degree burns (57%) within the same wound bed, followed by deep 2nd degree (29%), and superficial 2nd degree (14%). The average TBSA from EC burns was 4.7±2.4% with a range of 1–10%. The most common location of the device or battery at the time of the injury was a pant pocket 86% (12/14), followed by 7% hand (1/14) and 7% purse (1/14). Isolated lower extremity burns occurred in 43% (6/14) of patients, while lower extremity and hand burns occurred in 21% (3/14) of patients. Nine of 14 patients required an operating room encounter under general anesthesia. Eight of 14 patients required skin grafting for definitive wound closure. The mean hospital length of stay was 6.6±4.7 days with a range of 0–15 days. Time to 95% wound closure was 18.4±10.8 with a range of 8–40 days. ConclusionThermal and blast injuries associated with EC device failure tend to cause small TBSA burns that are deep 2nd and 3rd degree wounds. The most common location for EC device storage among males was the front pants pocket. EC device users should be made aware of the dangers associated with EC use and advised to carry EC devices away from their body in dedicated carrying cases without loose metallic items.

소방관 안전장갑의 열 보호성능 평가를 위한 손 화상예측 화염마네킹 개발

소방관 안전장갑의 열 보호성능 평가를 위한 손 화상예측 화염마네킹 개발

Epidemiology of hand burns among children in Zaria, Northwestern Nigeria

BACKGROUND: The events leading to hand burns injuries in a child are a complex relationship between the child, heat source, mechanism, and the environment where the event occurs. Preventing hand burns in children needs an understanding of its epidemiology. OBJECTIVES: To describe the etiology, pattern, mechanism, and the environmental setting in childhood hand burn injuries. MATERIALS AND METHODS: The study was a retrospective study of all children who sustained burns injury to the hand over a 5-year period (January 2011–December 2015). The study was conducted at the Plastic Surgery Unit of the Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika, Zaria. Recorded information included age, gender, agent of burns, pattern of injury, mechanism of injury, and the setting at the time of injury. A descriptive analysis of the data was performed using SPSS version 21. RESULTS: A total of 47 children sustained burn injuries to the hand. The mean age was 2.17 years, a standard deviation of ±2.15, and age range of 0 to 13 years. There were 26 children

Effects of the length and texture discrimination tasks on rehabiltiation of the burned hand: A case study

목적: 손은 화상 위험이 가장 많이있는 부위이며 적절한 관리는 손의 최적 기능 회복이 이루어 지도록 보장하는 데 필수적이다. 이 사례 연구의 목적은 태어난 손의 재활에 대한 길이 및 질감의 차별 작업의 효과를 조사하는 것이다. 방법: 화상 진료소에서 1 주일에 1 번 치료를 하였다. 집에서 길이와 재질을 구별하는 훈련을 퇴원 후 5 개월동안 일주일에 3 번씩 50 분의 시간으로 프로그램하였다. 통증과 흉터의 완화, 구축 및 일상생활활동의 기술의 회복을 목표로 실시하였다. 결과: 길이 및 재질을 구별하는 치료 프로그램 후, 나무토막옮기기 검사에서는 사전 검사에서 31개, 사후 검사에서 70개을 옮겼다. 수정된 바텔 척도에서는 사전 검사에서 78점, 사후 검사에서 100점이 나타났다. 관절가동범위에서는 MP관절에서 굽힙 56도, PIP관절에서 굽힙 70도, DIP관절에서 굽힙 20로 향상되었으며. 몇 가지 손 기능 기술도 향상되었다. 결론: 이 사례 연구는 화상환자의 손의 재활에 대한 길이및 재질의 차이 구별 훈련을 통한 근거를 제공한다.Hands are the most frequent sites of burn injury, and proper management is essential for functional recovery of hand. The objective of this case study is to investigate the effect of the length and texture discrimination tasks on rehabilitation of the hand with burn injury. In case of deep 2~3 (PBD over 6 weeks), the injury was treated in burn clinic once a week. The length and texture discrimination tasks were to be done at home 50 minutes of one session each, three times per weeks for five months following discharge. Such tasks are expected to help Due to relief of pain and scar, contracture, and to promote recovery of ADL skills. After the length and texture discrimination task program, BBT showed 31 block before the test and 70 block after the test. MBI scored 78 before the test, and scored 100 after the test. ROM increased to 56 degrees in MP Flex, to 70 degrees in PIP Flex, and to 20 in DIP Flex. Several hands functional skills were also improved. This case study provides effect of the length and texture discrimination tasks on rehabilitation of in the hand burn injury

Effect of burn rehabilitation program on improving quality of life (QoL) for hand burns patients: a randomized controlled study

Burn injuries, including hands are one of the most devastating injuries. Hand burns do not often play a major role in the mortality. But, they represent a huge problem that may eventually lead to chronic disabilities, lifelong impairment, and significant functional and occupational limitations. These comorbidities can negatively affect a patient’s quality of life (QoL) besides, making re-integration into society is difficult. This study aims to investigate the effect of our designated burn rehabilitation program on improving quality of life of hand burns patients. A randomized controlled study was conducted for 12 months at Mansoura University Burn Center. It included 60 adult patients with hand burns who were randomly divided and assigned to a study and control groups. Both groups underwent basic rehabilitation. A newly designed program was implemented for the study group. Data were collected using three tools; bio-socio demographic characteristics, the Burn Health Knowledge Questionnaire, and the Burn Specific Health Scale-Brief (BSHS-B). The quality of life of patients with hand burns was evaluated three times. One month and three months after implementing the burn rehabilitation program, the total mean scores for the QoL of patients in the study group improved from 31.1 ± 11.3 to 118.5 ± 21.3 and 135.4 ± 24.3, respectively (P < 0.001). In addition, the changes in QoL of the patients in the control group significantly improved from 24.8 ± 12.1 to 57.6 ± 19.1 and 87.5 ± 23.8, respectively (P < 0.001). Despite this steady improvement in the control group, the mean scores on the QoL sub-scales and total mean scores remained lower than those in the study group. Based on the results obtained in the current study, the design and implemention of a burn rehabilitation programme based on clinical knowledge improves the quality of life of patients with burns. Therefore, this program is recommended for use early as a part of the treatment process for patients with burns. Level of Evidence: Level I, risk/prognostic study.

Comparison of non-surgical methods for the treatment of deep partial thickness skin burns of the hand

This paper describes a randomized, controlled, parallel-group, single-center clinical trial designed to compare non surgical treatment methods of deep partial thickness skin burns of the hand.All patients were scanned with the Laser Doppler Imaging device to determine the depth of the burn wound. Viable keratinocytes sites were determined according to the established Perfusion Units (PU) measurement system. The trial enrolled 87 patients with hand burn wounds in the section of 260–600PU.Hand burn patients were divided into the following four groups: treated with hydrocolloid dressings; treated with mechanical debridement of monofilament polyester fibers pad and then applying silver sulfadiazine; treated with gauze dressings containing enzymatic collagenase preparation. The fourth group of patients was treated with silver sulfadiazine and gauze dressings. This group was considered as the control group. The wound healing status was assessed after 3, 7, 14 and 21 days. Burn scars and injured extremity function were assessed after six months according to the Vancouver Scar Scale and Disabilities of the Arm, Shoulder and Hand Outcome Measure.The fastest epithelialization of hand burn wounds was observed in the patients group treated with hydrocolloid dressings (15, 7 days, p<0,05). The patients of this group also had less scars and a better hand function.

Evaluation of scar quality after treatment of superficial burns of the hands and face with Dressilk or Biobrane—An intra-individual comparison

IntroductionThe aesthetic outcome after burn of exposed areas such as the hand and face is of high importance. A number of wound dressings used for the treatment of superficial and partial thickness burns promise rapid wound healing and reduced scarring. Previously, wound healing of hands and faces with superficial burns treated with Dressilk® compared to Biobrane® was evaluated intra-individually with similar results. Nevertheless, up to date objective information regarding the scarring after superficial burns treated with Dressilk® does not exist. MethodsTherefore, 30 patients with superficial burns of the hand and face that were treated with Dressilk® and Biobrane® simultaneously were included in the study. An objective scar evaluation was performed analyzing melanin and erythema levels, skin elasticity, trans-epidermal water loss and scar perfusion three and six and 12 months after injury. Furthermore, a subjective scar evaluation was performed with the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS). ResultsDressilk® and Biobrane® both lead to an aesthetic pleasing outcome after superficial burns of the hands and faces. Regarding the objective scar evaluation only trans-epidermal water loss of burned hands after 6 months showed significant differences between the two dressings. However, these differences were not detected in the 12-month follow up examination. In the subjective scar evaluation no statistical differences could be found between the dressings. All patients stated high satisfaction of scar quality. ConclusionDressilk® is an interesting alternative to Biobrane® for the treatment of superficial burns of aesthetic and functional important areas.

Patterns of skin substitute use in isolated face and hand burns

Non-medical factors may influence a wide variety of medical care. This study uses a large national database to examine potential factors influencing the use of skin substitutes in patients with face and hand burns. A total of 2847 patients with isolated 3rd degree hand and face burns from the NBR were identified from the NBR. Of those 2847 patients, 2299 (81%) had autografting alone. 143 patients (5%) had heterografting followed by autografting, 318 (11%) had homografting followed by autografting, and 87 patients (3%) had a dermal regenerative graft followed by autografting. Findings indicated that race and insurance status may influence the use of skin substitutes in isolated face and hand burns. Dermal regenerative grafts are more likely to be used in white patients with commercial insurance (p<0.001), whereas homografting is more likely to be used in non-white patients with commercial insurance (P<0.001). Potential factors contributing to these findings are not all available in this large national database, but awareness of these trends is important when deciding on an operative plan in patients with face and hand burns.