11/46. Patterns of burn adjustment.For many years, burn professionals have attempted to assess the outcomes of different types of burn injury and the factors that are related to good patterns of coping with the aftermath of thermal injury. Most writers have attempted to use objective criteria such as return to work or preexisting psychologic problems (e.g., alcoholism) in determining the success of rehabilitation, but much controversy over the forms of assessment persists. It is agreed that antisocial personality, organic brain syndromes, and lack of social support all undermine good recovery for patients with burns. The authors have attempted to look at the subjective side of the patient's adjustment by providing representative examples of several types of burn adjustment in terms of personality features, all of which would tend to complement other approaches. The use of denial, the ways in which hostility is managed by the patient, and how he or she uses key persons in the environment are examined. The cognitive, emotional (affective), and behavioral styles of patients are examined as part of this pilot study of cluster patterns or types of adjustment.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/46. Helping the burned child to adapt.Adaptation in burned children is multifaceted and complex due not only to etiologic variables but also to age-specific developmental issues and the level of family development. Parental and peer support are identified in the literature as major contributors to higher levels of self-esteem and adaptation. The potential for these levels of adaptation is complicated by the number of burn-injured children residing in chaotic, dysfunctional families with limited ability to support psychosocial rehabilitation. Various interventions are presented as methods of addressing the social/emotional needs of higher-functioning patients and families.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
13/46. A prototype for an economical vertical microstomia orthosis.One of the complications of thermal injury is the development of scars and contractures during the healing process. This scarring can be devastating, especially when it involves the mouth. The purpose of this report is to describe the construction of an alternative vertical mouth stretching orthosis for vertical microstomia. By using thermoplastic splinting material and a long thread screw, a vertical mouth-stretching orthosis can be custom-fit to any patient's mouth. The device can be fabricated for a pediatric or adult patient for the rehabilitation of a circumferential mouth burn, especially targeting the vertical diameter. When using this device, patients gave positive feedback for comfort and ease of use, with increased mouth mobility and range of motion. This vertical orthotic device provides an economical and comfortable alternative for vertical mouth diameter enlargement to the current five devices available in the literature.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/46. The use of collagen-glycosaminoglycan copolymer (Integra) for the repair of hypertrophic scars and keloids.Integra dermal matrix (Integra life Sciences Corp., Plainsboro, NJ) was introduced in 1981, and its use in acute surgical burns is well established. However, Integra also has been found to be useful in the surgical treatment of scars. The Integra neodermis is placed at the time of scar excision and then overgrafted several weeks later with a very thin (6/1000-inch) skin graft. The stabilized matrix appears to resist recurrence better than traditional skin grafts, which have a reported recurrence rate of 59%. Many surgeons have had anecdotal success using Integra for both hypertrophic and keloidal scars. This case series presents several patients who underwent reconstructive surgery with the use of Integra to treat their debilitating scar formation. None of the patients developed significant scar morbidity at the donor site when the skin was harvested for grafting during the second stage of the procedure. All patients had documented success with improved appearance, range of motion, and skin quality.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/46. Combined Iliazarov and free flap for severe recurrent flexion-contracture release.This article discusses the treatment of recurrent flexion-contracture of the knee after circumferential burns involving the entire limb. A two-team approach to surgery is used: the orthopedic team widely excises the scar tissue and releases tendons, muscles, and adjacent soft tissue that limit joint movement. The microsurgery team covers the exposed popliteal neurovascular elements with a latissimus dorsi free flap. However, full range of the knee is still limited by the short neurovascular bundle. Therefore, the orthopedic team applies a circular hinged Iliazarov external-fixator-frame to achieve gradual correction, until full range of the knee is achieved. Intensive physiotherapy and continuing use of extension splints for additional 6 months until the scars are deemed stable compliment the treatment regimen and prevent the recurrence of contractures. Between the years 2002 and 2003, we treated four patients (totaling five knee joints) with recurrent severe flexion-contractures after circumferential burns of the entire lower extremity. A significant limitation was caused by the abnormal scarring, which left the patients confined to a wheelchair. In all our patients, previous attempts to release the flexion-contracture failed. With the aforementioned technique, within 3 months after the procedure, all patients were able to walk. We encountered one major complication (ie, drop foot). At follow-up, all patients enjoyed a full range of motion and were able to walk. The strength of our approach comes from combining a free muscle flap with an Iliazarov external fixation and a detailed postoperative rehabilitation plan.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/46. suicide attempts by burning.Setting oneself ablaze is an uncommon method of attempting suicide. Ten patients with deliberate thermal injuries had been evaluated by a consultation psychiatry service over a 15-year period. schizophrenia and major depression were the more common diagnoses, and most patients had prior psychiatric histories. When compared to 1,864 people who attempted suicide by other means, the burn subjects were older, comprised a larger percentage of african americans, and resembled those who had jumped from high places. Stresses encountered by recovering burn patients involved dependency, body image concerns, exacerbation of pre-existing depression, pain, flashbacks of the incident, and guilt intensified by their proximity to accidentally burned victims. Problems for burn unit staff included feelings of discomfort with difficult, potentially suicidal individuals, and responsibilities to perform painful procedures. Recommendations for psychiatric care include pharmacotherapy for depression or psychosis, visitation by previously self-burned individuals who serve as role models, patients' visualization of their injuries, and behavioral techniques to diminish reliance on analgesic drugs and to increase a personal sense of control. Suggestions for assisting staff include liaison support, personnel debriefing sessions, and inservice presentations on emotional aspects of burn management.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
17/46. Burn scars treated by pinhole method using a carbon dioxide laser.Many patients with burn injuries have various complications and emotional problems due to scars. Although various modalities to improve burn scars have been attempted, such as excision of scars, skin grafts, laser abrasion and silicone product usage, the cosmetic outcomes have not been satisfactory for a large portion of patients. Herein, we describe two cases which showed satisfactory cosmetic results after treatment of burns scars with the pinhole method using a carbon dioxide (CO(2)) laser that allowed us to make deep, closely set holes reaching down to the upper dermis. A 20-year-old female patient with a scar on her neck and a 25-year-old female patient with a scar on her right forearm after burn injuries are presented. As early as only a few weeks after the treatment, the scars showed relaxation of contracture, reduction of wrinkles and improvement of texture and color compared to before the treatment. Treatment of burn scars with the pinhole method can be easily performed and results in dramatic improvement in scar quality with only a few side-effects.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
18/46. Heterotopic ossification and peripheral nerve entrapment: early diagnosis and excision.Heterotopic ossification can occur in neurologic disorders, burns, musculoskeletal trauma, and metabolic disorders. In addition to producing the complications of contracture, skin breakdown, and pain, it can cause peripheral nerve entrapment. Nerve entrapment due to heterotopic ossification may be misdiagnosed, and it is difficult to evaluate and treat without recurrence. Computed tomography is especially useful in localization before surgical release of the entrapped nerve. Resection of heterotopic ossification can be successful using disodium etidronate to decrease the risk of recurrence, and resection can improve range of motion and nerve function. Two case studies of nerve entrapment due to heterotopic ossification are presented with the results of computed tomography localization, successful resection, and long-term follow-up. Clinicians should be aware of this complication and the potential for rapid nerve injury. If heterotopic ossification is causing clinically significant peripheral nerve entrapment, early surgical treatment may be indicated, and may be successful.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
19/46. Total palmar resurfacing with scapular free flap in a 26-year contracted hand.The scapular free flap offers a large-sized and well-vascularized coverage for variable defects. It is not regarded, however, as a favorite tool for palmar resurfacing because of its bulky and rigid nature. A 28-year-old man had sustained a contact dermal injury at the age of 2 years that resulted in a severely deformed hand. The total palmar defect was resurfaced by surgical intervention with a scapular free flap. After secondary procedures, the final result was promising. The present report focuses on the secondary procedures, which make a more functional and aesthetically pleasing hand after coverage with the scapular flap. Also, our result suggests that even finger joints contracted for 26 years can recover motion if they have not been directly damaged.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
20/46. rehabilitation of burn patients with concomitant limb amputation: case reports.Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might be expected to lead to chronic difficulties. Therapeutic goals following limb amputation include oedema reduction, prevention of contracture (through positioning and range of motion), stump shaping, both pre- and post-prosthetic fitting strengthening exercises of the limb and trunk, and gait training. Some patients present problems that are associated with both the burn injury and the limb amputation that cause concern among the physical therapy staff. Some of these situations include intolerance of the stump to pressure or manipulation due to remaining open wounds or fragility of newly skin grafted areas on the residual limb or delayed gait or functional training due to wounds on other body surface areas. Delays in stump preparation or other treatment aims due to continued surgical procedures can be worrisome. A review of these patients indicates the possible difficulties that rehabilitation personnel may face when treating burn victims who required amputation. Effective rehabilitation of these patients can be achieved despite the noted concerns.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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