Charles D. Quick

Burn rehabilitation and research: proceedings of a consensus summit.

Burn rehabilitation is an essential component of successful patient care. In May 2008, a group of burn rehabilitation clinicians met to discuss the status and future needs of burn rehabilitation. Fifteen topic areas pertinent to clinical burn rehabilitation were addressed. Consensus positions and suggested future research directions regarding the physical aspects of burn rehabilitation are shared.

A clarion to recommit and reaffirm burn rehabilitation.

Burn rehabilitation has been a part of burn care and treatment for many years. Yet, despite of its longevity, the rehabilitation outcome of patients with severe burns is less than optimal and appears to have leveled off. Patient survival from burn injury is at an all-time high. Burn rehabilitation must progress to the point where physical outcomes parallel survival statistics in terms of improved patient well-being. This position article is a treatise on burn rehabilitation and the state of burn rehabilitation patient outcomes. It describes burn rehabilitation interventions in brief and why a need is felt to bring this issue to the forefront. The article discusses areas for change and the challenges facing burn rehabilitation. Finally, the relegation and acceptance of this responsibility are addressed.

Military Return to Duty and Civilian Return to Work Factors Following Burns With Focus on the Hand and Literature Review

Functional recovery and outcome from severe burns is oftentimes judged by the time required for a person to return to work (RTW) in civilian life. The equivalent in military terms is return to active duty. Many factors have been described in the literature as associated with this outcome. Hand function, in particular, is thought to have a great influence on the resumption of preburn activities. The purpose of this investigation was to compare factors associated with civilian RTW with combat injured military personnel. A review of the literature was performed to assimilate the many factors reported as involved with RTW or duty. Additionally, a focus on the influence of hand burns is included. Thirty-four different parameters influencing RTW have been reported inconsistently in the literature. In a military population of combat burns, TBSA burn, length of hospitalization and intensive care and inhalation injury were found as the most significant factors in determining return to duty status. In previous RTW investigations of civilian populations, there exists a scatter of factors reported to influence patient disposition with a mixture of conflicting results. In neither military nor civilian populations was the presence of a hand burn found as a dominant factor. Variety in patient information collected and statistical approaches used to analyze this information were found to influence the results and deter comparisons between patient populations. There is a need for a consensus data set and corresponding statistical approach used to evaluate RTW and duty outcomes after burn injury.

Incidence and severity of combat hand burns after All Army Activity message.

BACKGROUND Operations Enduring Freedom and Iraqi Freedom have resulted in severe burns to the hands. Because of the frequency and severity of hand burns, an All Army Activity (ALARACT) message was distributed emphasizing the importance of hand protection (HP). Our purpose was to assess the effectiveness of the ALARACT in reducing the incidence and severity of hand burns. METHODS A retrospective review of the US Army Institute of Surgical Research Burn Registry for active duty personnel with hand burns 17 months before and after the ALARACT was conducted. Data include percentage total body surface area (% TBSA), % full-thickness injury, depth of hand burn, and ratio of hand burn to TBSA. Statistical analysis was performed using Mann-Whitney U test. RESULTS Four hundred fifty-one military personnel were admitted during the 34-month period: 257 (56.9%) pre-ALARACT; 194 (43.1%) post-ALARACT. Two hundred thirty-nine (52.9%) sustained hand burns: 138 (53.7%) pre-ALARACT; 101 (52.1%) post-ALARACT (p = NS). Mean TBSA: 21.5% pre-ALARACT; 28.8% post- ALARACT (p = 0.01). Mean full-thickness TBSA: 14.5% pre-ALARACT; 21.9% post-ALARACT (p = 0.02). Mean hand TBSA: 3.2% pre-ALARACT; 3.2% post-ALARACT (p = NS). Mean ratio, hand burn to TBSA: 36% pre-ALARACT; 25% post-ALARACT (p < 0.001). DISCUSSION Post-ALARACT, the incidence of hand burns remained unchanged. Despite an increase in burn severity, ratio of hand burn to TBSA decreased, suggesting a possible relationship between increased awareness and use of HP and decreased injury. Based on the data collected, the impact of the ALARACT is unclear. The importance of HP remains a priority. The fact that the incidence of hand burns remains unchanged demands our continued awareness and increased efforts.

Opposition Splint for Partial Thumb Amputation: A Case Study Measuring Disability before and after Splint Use

STUDY DESIGN Case report. INTRODUCTION A combined burn and a partial amputation can be extremely debilitating as the thumb constitutes 40% of the entire hand when evaluating functional impairment. PURPOSE OF THE STUDY Measure disability with and without opposition splint use after partial thumb amputation due to a burn. METHODS Impairment and disability measures were completed at discharge from the hospital and subsequently during outpatient follow-up visits while wearing and not wearing a thumb opposition splint at 3, 6, 8, and 15 months. Comparisons between disability and impairment scores were assessed over time. RESULTS The difference between DASH scores with and without using the splint were 25 at 3 months, 16 at 6 months, 10 at 8 months, and 12 at 15 months. CONCLUSIONS Splint use in this case demonstrated clinically significant changes over time with minimal changes in impairment indicating enhanced function and improved patient perception of disability. LEVEL OF EVIDENCE 4.

A review of compression glove modifications to enhance functional grip: A case series

A common complaint among patients with burns is their inability to grasp items while wearing compression gloves. Recent technological innovations permit the addition of grip-enhancing material to garment fabric. The purpose of this case series was to describe the course of development of compression gloves with enhanced grip modifications. Five different types of grip modifications were made during a period of 18 months. Five subjects who were prescribed compression gloves tested each type of glove. The gloves were fabricated with grip-enhancing material on the palmar surface in five ways: 1) rectangular rubber tabs; 2) honeycomb pattern silicone; 3) wave-like pattern silicone; 4) line pattern silicone beads; 5) line pattern silicone beads embedded into the fabric. Each glove was evaluated on a three-point Likert scale (0 = poor, 1 = moderate, 2 = good) for grip-enhancing qualities and durability. All five subjects reported similar experiences with each glove type: 1) the rectangular rubber tabs demonstrated poor grip and moderate durability; 2) the honeycomb pattern provided good grip but poor durability; 3) the wave pattern had good grip and moderate durability; 4) the silicone beads adhered to the fabric had moderate grip but poor durability; 5) the silicone beads embedded into the fabric had moderate grip and good durability. The wave pattern provided the best gripping capability and silicone embedded into the fabric demonstrated the best durability. A wave-like pattern silicone material embedded into the fabric seems to provide the best combination of grip and durability to enhance activities of daily living performance.

Two simple leg net devices designed to protect lower-extremity skin grafts and donor sites and prevent decubitus ulcer

Burn therapists routinely are tasked to position the lower extremities of burn patients for pressure ulcer prevention, skin graft protection, donor site ventilation, and edema reduction. We developed two durable and low-maintenance devices that allow effective positioning of the lower extremities. The high-profile and low-profile leg net devices were simple to fabricate and maintain. The frame was assembled using a three-quarter-inch diameter copper pipe and copper fittings (45 degrees, 90 degrees, and tees). A double layer of elasticized tubular netting was pulled over the frame and doubled back for leg support to complete the devices. The devices can be placed on any bed surface. The netting can be exchanged when soiled and the frame can be disinfected between patients using standard techniques. Both devices were used on approximately 250 patients for a total of 1200 treatment days. No incidence of pressure ulcer was observed, and graft take was not adversely affected. The devices have not required repairs or replacement. Medical providers reported they are easy to apply and effectively maintain proper positioning throughout application. Neither device interfered with the application of other positioning devices. Both devices were found to be an effective method of positioning lower extremities to prevent pressure ulcer, minimize graft loss and donor site morbidity, and reduce edema. The devices allowed for proper wound ventilation and protected grafted lower extremities on any bed surface. The devices are simple to fabricate and maintain. Both devices can be effectively used simultaneously with other positioning devices.