1/46. The use of the brachioradialis muscle flap for the coverage of burns of the acute elbow joint.Early coverage of deep burns of the elbow is vital to preserving the range of motion. Although various methods are used for coverage of this site, the brachioradialis muscle flap provides good coverage after debridement, with minimal donor site morbidity.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/46. Burn injury resulting in mutilation in childhood.We present 3 cases of boys aged 5, 11 and 12 years who sustained very deep burn injury of their extremities. Their future lives were extremely limited. All the 3 boys had a strong emotional reaction to the injury. Two of them sustained amputation of upper extremities as a result from electrical injury, the youngest boy survived without the feet and with mutilated fingers on his hands. To encourage their survival and sense of life we admitted their mothers. Our aim was not only to secure psychological support to the patients but also to prepare the family to accept the sequelae of the injury. This accompaniment in the ward was very useful for both. The mothers were able to watch the progress in the treatment. In this way they were involved in the future care and they coped with the problems from a realistic point of view. The mothers helped the boys with physiotherapy under supervision. All the families were well prepared for discharge of their boys from the hospital without any fear of the following care. The significance of the family member influence upon the patient's resocialization we saw in early acceptance of the child to the society.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/46. Correction of axillary burn scar contracture with the thoracodorsal perforator-based cutaneous island flap.Axillary scar contracture is observed frequently after severe burn insult and is usually accompanied by injuries to the adjacent area. Although many therapeutic methods, including skin grafting, Z-plasties, local flaps, island flaps, and free flaps, have been established, each technique has its own advantages and disadvantages in specific situations. The decision regarding which technique to use can only be made after consideration is given to the merits of the individual case. We applied thoracodorsal perforator-based cutaneous flaps to 5 patients with axillary burn scar contractures and damaged adjacent tissues. In 1 patient both axillae were involved. Elevated flaps as large as 11 x 27 cm in size were used. All flaps survived completely even when raised in scar tissue. The donor sites were closed primarily except one, which needed a skin graft. Three patients obtained satisfactory release with more than 160 deg shoulder abduction. In 2 patients, release was incomplete with only 110 deg shoulder abduction, but neither one required a second release. The range of motion in terms of shoulder abduction was improved preoperatively (30-90 deg) to postoperatively (110-170 deg). The thoracodorsal perforator-based cutaneous flap presents a very useful reconstructive method for the treatment of axillary defects.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/46. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
5/46. Reconstruction of burn scar of the upper extremities with artificial skin.The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the food and Drug Administration, artificial skin (Integra) has been available in taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skin were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental skin turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available skin for a full-thickness skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/46. An alternative dressing for skin graft immobilization: negative pressure dressing.The key difficulty of skin grafting is keeping the graft immobilized on uneven surfaces involved with motion, such as the nuchal area, axilla, web spaces, and the perineal area. This study reports the development of a new idea of negative pressure dressing (NPD) to maintain good immobilization of the skin graft and, at the same time, not cause any significant distress in the patient's daily life. Furthermore, the components of this dressing are available in ordinary hospitals. In this report, there are eight cases of skin grafts which were applied by this method, and the average success rate was approximately 97%. Therefore, use of negative pressure dressings to safeguard immobilization of the skin graft is an appropriate alternative method for grafts on uneven or mobile surfaces.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/46. Effect of 3M Coban Self-Adherent Wraps on edema and function of the burned hand: a case study.edema and limited function are common acute problems associated with hand burns. This case study examined the effects of 3M Coban Self-Adherent Wraps on edema and function in a 59-year-old male (46% TBSA flame injury) with newly skin grafted dorsally burned hands. At the time of each dressing change, circumferential measurements were taken of both hands and weekly active range of motion and grip strength measurements were recorded. The nine-hole peg test was used to appraise dexterity. During the 4-week study period, there was less edema, greater active range of motion and grip strength, and greater dexterity in the hand with 3M Coban Self-Adherent Wraps as compared with the control hand. This case study suggests that 3M Coban Self-Adherent Wraps were effective in reducing edema in the skin-grafted hand after skin grafting. It further appeared that the reduced edema may have contributed to improved hand function and that 3M Coban Self-Adherent Wraps as a compressive dressing do not impede hand function- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/46. Management of an unusual extreme extension contracture of the wrist: role of a custom-designed exercise program in achieving a good range of movement and prevention of recontraction.An extreme extension contracture of wrist with dorsal contracture of fingers 15 years after burn injury is described. Shortening of extensor tendons, secondary lengthening of flexor tendons, contracted wrist joint capsule, unusual dislocation of carpals, dorsal dislocation of metacarpophalangeal joints of fingers, and provision of sufficient amount of good-quality skin were some of the issues that had to be addressed in treatment. The contracture was released, the carpals and metacarpophalangeal joint dislocations were corrected and fixed with K wires, and the resulting defect was covered with a sheet split-thickness skin graft. An exercise program was designed that consisted of isotonic, isokinetic, and isometric resistance exercises and passive, active, and active-assistive range of motion exercises. These exercises were pursued with the intention of increasing dynamic strength, endurance, and overall functional recovery of the flexor muscles by exploiting the immature nature of early scar tissue. The resultant enhanced flexor muscle power from exercises along with the dynamic splint helped in lengthening of extensor tendons, wrist joint capsule, and split-thickness skin graft. It also helped in resisting the recontracting tendency, with further recovery of good range of wrist and fingers movements, obviating the need of tendon-lengthening surgery and flap coverage. One and half years of follow up didn't show any sign of recontracture, and the patient was able to perform his routine activities. Postburn wrist contractures of such magnitude have been seldom described. Emphasis is put on simple contracture release and a postoperative exercise program.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/46. Unique considerations in caring for a pediatric burn patient: a developmental approach.Treatment of the child with a burn injury is a dynamic and complex process incorporating pediatric physiology, cognition, and emotional development. An understanding of child development and the importance of the family plays a key role in the child's recovery at all ages. An account of a teenager's burn injury is depicted through the voices of the teenager and his nurse. This article explores that experience and provides a comprehensive look at the role of the burn team, family, and community in his recovery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/46. STARplasty for reconstruction of the burned web space: introduction of an alternative technique for the correction of dorsal neosyndactyly.INTRODUCTION: Significant hand burns frequently result in dorsal neosyndactyly, despite appropriate wound care, excision/grafting, and occupational therapy. patients often develop limited abduction, tethered flexion/extension, intrinsic tightness, and inversion of the web space. We present a new technique for neosyndactyly release: the STARplasty (syndactyly Treatment After Release), named after the appearance of the reconstructed web. methods: We performed a retrospective review of 25 patients who underwent 66 web space reconstructions by a single surgeon, from January 2002 to December 2003. The STARplasty was developed prior to the study period, with the following goals: to use local tissue, negate the need for a skin graft, and permit early range of motion. Combined with longitudinal, transverse, and oblique releases, STARplasty uses a single volar flap, harvested from each sidewall of both proximal phalanges, with 30-degree corners. STARplasty simultaneously deepens and widens the web space while correcting the angle of inclination. RESULTS: Sixteen patients (mean age: 34 years; range: 3-62 years) underwent a total of 33 STARplasties, an average of 37 months after burn injury. Mean area resurfaced per web was 5.2 cm, which contrasts with the 33 non-STARplasty reconstructions, which were used to resurface a mean area of 19.4 cm (P < 0.05) and included 5-flap z-plasties (17), full-thickness skin graft (10), 2-flap z-plasties (3), and advancement flaps (3). No complications occurred in the STARplasty group, including infection, flap loss, dehiscence, nerve injury, or recurrent contracture. All patients had improved function (mean follow-up: 6.7 months; range: 1-18 months). CONCLUSIONS: STARplasty is a new, safe, and efficacious technique to correct dorsal neosyndactyly and reconstruct the web space after burn injury.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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