Rehabilitation of the Burned Hand

Moore, Merilyn L.; Dewey, William S.; Richard, Reg

doi:10.1016/j.hcl.2009.06.005

Cited by 43 publications

(18 citation statements)

References 31 publications

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“…Poslijeoperacijska skrb nakon operacijskog zahvata na šaku i prste aplicira se neljepljiva mrežica ili obloga, deblji sloj povoja od gaze i imobilizacija. Prvo prematanje treba planirati već idući dan radi evakuacije mogućih hematoma ili seroma ispod transplantata, a sljedeća prema lokalnom statusu (21).…”

Section: Sustav Liječenja Rana Negativnim Tlakomunclassified

Paediatric hand burns

Barčot¹,

Kralj²,

Barčot³

2019

Paediatr Croat

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Pravilnim konzervativnim ili operacijskim pristupom njihovom liječenju uz fizikalnu terapiju mogu se izbjeći ili smanjiti funkcijske i estetske posljedice. Neurovaskularna ugroza jedna je od najtežih komplikacija cirkumferentnih i dubokih opeklina šake i zahtijeva hitnu dekompresiju. Površne opeklinske ozljede i veći dio opeklina djelomične debljine kože dobro zacjeljuju uz pomoć različitih obloga za epitelizaciju. Dio opeklina djelomične i sve opekline pune debljine kože, zbog opsežnosti gubitka tkiva, zahtijevaju kirurški pristup i primjenu autolognih kožnih transplantata, kožnih režnjeva ili dermalnih regeneracijskih predložaka. Ekscizija u blijedoj stazi nožem ili hidrokirurškim sustavom, dobra hemostaza, transplantati djelomične debljine kože s vlasišta ili bedra, uz potporu kondicionirane plazme obogaćene trombocitima i uređaja za cijeljenje rana negativnim tlakom pristup su koji u pravilu daje dobre rezultate liječenja u djece. Dostupni dermalni regeneracijski predlošci svojom građom i potporom cijeljenju kvalitetnije nadomještaju dermalni sloj uz jednake ili bolje konačne funkcijske i estetske rezultate. U nedostatku periosta ili tetivnih ovojnica nakon debridmana opeklinske rane šake izbor je primjena kožnih režnjeva. Unutar prva 24 sata nakon opeklinske ozljede treba započeti s fizikalnom terapijom aktivnim i pasivnim vježbama. Ožiljci i kontrakture nakon liječenja opeklina šake mogu dovesti do djelomičnog gubitka funkcije šake. Osim kirurškog, multimodalni pristup uključuje primjenu masaže, silikonskih preparata, kompresivnih rukavica i laserske tretmane PDL i CO 2 frakcijskim ablacijskim laserom. Najčešće tehnike plastične kirurgije kod operacijskih korekcija opeklinskih ožiljaka na dječjoj šaci su lokalni transpozicijski i klizni režnjevi te transplantati pune debljine kože.

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Section: Sustav Liječenja Rana Negativnim Tlakomunclassified

Paediatric hand burns

Barčot¹,

Kralj²,

Barčot³

2019

Paediatr Croat

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“…Hand elevation, as well as elastic edema wraps can be utilized to promote absorption of the edema fluid. Furthermore, early range of motion exercises in a patient who is able to participate once surgically appropriate, is imperative to prevent stiffening [24]. During the phase of operative recovery and in the unconscious patient, splinting of the hand in anti-deformity position during which the ligamentous structures are taut is critical in order to counteract the forces of wound bed contraction.…”

Section: Treatment Of Hypertrophic Scarsmentioning

confidence: 99%

Scar Management of the Burned Hand

2017

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Unimpaired hand function is critical in almost all activities of daily living. Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Initial algorithms of acute burn management involve early debridement and skin grafting and early mobilization to prevent formation of hypertrophic scarring and ultimately digit contractures. While non-operative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated in order to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation with several modalities that address scar texture, color, pruritis and thickness. These can be utilized in conjunction with local corticosteroid treatment and other emerging modalities to modulate the scar and achieve optimal hand function. These treatment tools provide an effective resource for the reconstructive surgeon to treat hypertrophic hand scars.

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“…In the subacute phase the focus should be directed to establish an optimal wound healing environment in order to achieve physiologic healing. Silicone sheeting and compression garments are frequently employed to reduce tissue edema and to off-load tension from the wound which is thought to be the culprit in formation of hypertrophic scarring [49]. Furthermore, if extremities are involved, elevation and early range of motion are critical to avoid contractures.…”

Section: Preventionmentioning

confidence: 99%

Heterotopic Ossification and Hypertrophic Scars

Agarwal

Sorkin

Lévi

2017

Clinics in Plastic Surgery

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Burns and trauma lead to extensive superficial and deep soft tissue wounds which are unable to heal perfectly to the pre-injury state. Typically wound healing requires proliferation of cells capable of differentiating into the injured tissue type. As part of the structural requirements for tissue, these cells lay down extracellular matrix (ECM) often in the form of collagens. However, dysregulated cellular proliferation and collagen deposition often leads to wound pathology. Two conditions – heterotopic ossification (HO) and hypertrophic scarring – present a substantial challenge in the management of patients with large surface-area burns. HO is the pathologic formation of ectopic osseous lesions causing severe pain, non-healing wounds, and restricted range of motion. Current treatment strategies aimed at HO include prophylactic radiation therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates; ultimately patients who have developed HO may require surgical excision followed by prophylactic measures to reduce recurrence risk. Hypertrophic scars in contrast are non-osseous lesions caused by excessive collagen deposition. Similar to HO, hypertrophic scars are often painful, functionally limiting, and aesthetically displeasing. Treatment strategies include CO2 laser application, steroid injections, and excision with skin grafting. Here we review the biology, diagnosis, and treatment and outcomes associated with both forms of pathologic wound healing.

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Rehabilitation of the Burned Hand

Cited by 43 publications

References 31 publications

Paediatric hand burns

Paediatric hand burns

Scar Management of the Burned Hand

Heterotopic Ossification and Hypertrophic Scars

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