The Effect of Positioning Devices and Pressure Therapy on Outcome After Full-Thickness Burns of the Neck

Abstract

The postoperative management of full-thickness burns of the neck can be a challenge for burn therapists despite the availability of many treatment modalities to minimize scar hypertrophy and contracture. Interventions include pressure appliances, massage, exercise, and positioning devices. The objective of this study was to identify factors associated with the development of neck contractures and optimal treatment strategies for their prevention. We performed a retrospective chart review of all patients admitted to our pediatric burn center between 1989 and 2003 with acute full-thickness neck burns. Rehabilitation protocols used for each patient were examined. The necessity of a reconstructive procedure was analyzed, as well as time from initial grafting to that procedure. We identified 49 eligible subjects. Patients ranged in age from 0.6 to 14.2 years at the time of injury. The number of factors present which inhibited both positioning and application of pressure to the neck was found to be significantly related to the need for neck reconstruction (P < .01). Patients who had tracheostomies had a mean time to neck reconstruction of 20.3 months compared with 43.4 months in patients without tracheostomies (P < .05). Also, although not statistically significant, greater than 80% of patients who were discharged with reduced range of motion of the neck required reconstruction compared with fewer than 65% of patients with normal neck range. Delayed pressure and positioning of the neck after skin grafting result in an earlier and more frequent need for neck reconstruction.

The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis

“…Secondly, the effectiveness of PT in HS prevention and treatment remains controversial. Some studies showed that PT could promote HS maturation, restrain its formation, improve its appearance, minimize itch and pain1020. However, others indicated that PT not only left the ultimate outcome of burn wounds unchanged but also increased the incidence of overheating, pruritus, blistering, wound breakdown and abnormal bone growth718.…”

Methods and Tools Used for the Measurement of Burn Scar Contracture

“…Six of the studies (75%) reported numeric values (degrees or length) but did not indicated the methods or tools used for measurement. [55][56][57][58][59][60] Two of these studies referenced normative values for neck ROM. The remaining two studies (25%) simply described outcome in subjective terms, such as "no functional problems," or "result was satisfactory from the functional as well as the aesthetic point of view."…”

The benefits of early surgical treatment of deep cervical burns in children

“…Косметический результат после лечения глубокого ожога в области подчелюстного треугольника шеи: а -мальчик Г., 5 лет, после раннего хирургического лечения (гиперпигментация трансплантата, роста рубцовой ткани нет); б -девочка А., 4 раннего хирургического лечения глубоких ожогов шеи, что подтверждают показатели Ванкуверской шкалы рубцов. По данным Sharp, в хирургической коррекции послеожоговых деформаций шеи нуждались 69 % пациентов, при этом не были указаны сроки и методы восстановления кожных покровов в остром периоде [16]. В нашем исследовании необходимость в хирургическом лечении в отдаленном периоде возникла у 32 (43 %) пациентов, причем в основном (n = 20, 63 %) это были дети после этапного лечения ожоговых ран, что сопоставимо с данными Voinchet [17].…”