Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling

Staruch, Robert; Beverly, Anair; Lewis, Darren; Wilson, Yvonne; Martin, Niall

doi:10.1136/jramc-2015-000438

Cited by 1 publication

(1 citation statement)

References 45 publications

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“…Partial amputation of the hand, particularly in multiple-limb amputees where donor sites are sparse, may involve the use of the palmar skin as local coverage for the remaining parts of the hand 239 . Early surgical limb amputation (within 24 hours of burn) reduces fluid resuscitation requirements 240 considerably when modeled using Lund and Browder 95 charts and computer software. Amputation rates are perhaps highest in severe electrical burns 52 …”

Section: Resultsmentioning

confidence: 99%

Acute Management of Thermal Hand Burns in Adults

et al. 2021

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Introduction Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. Results An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. Discussion The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. Conclusions More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.

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Section: Resultsmentioning

confidence: 99%