RESUMO
BACKGROUND: Heat-press hand burn leads to complex and severe lesions, with potentiation of thermal burn by the crushing mechanism. Management remains poorly codified, and the surgical strategies found in the literature remain contradictory. The objective of our study is to report our experience and define the first burn excision delay through functional evaluation with a Quick-DASH questionnaire. METHODS: We carried out a retrospective study of 20 burned hands by heat-press managed in our burn unit between 2002 and 2021. Following data were collected, at least one year after the accident: Quick-DASH score, which was our primary endpoint, injury assessment according to the Tajima's classification, overall surgical management, and impact on their professional activity. A descriptive statistical analysis of these data was performed followed by a univariate analysis to assess the correlation between delay to first surgical excision and the long-term functional result (Quick-DASH score and time before return to work). RESULTS: Burns were Tajima grade 1 (supra-fascial dermal burn) in 35 % of cases, grade 2 (exposure of subfascial structures) in 45 % and grade 3 (bone or joint exposure) in 20 %. There were no cases of bone fractures. We received 18 out of 20 questionnaires with no significant differences between those who send back or not. The median QuickDash score was 7.15 [IQR 0-52.25]. The first surgical excision was performed with a median of 8 days after the accident [min: 0; max: 20]. The median time before return to work was 24 weeks [IQR 17-42.25]. Only 11 patients (55 %) were able to go on the initial employment. Spearman test found a strong trend for a negative correlation between the time to the first excision and the QuickDash score (ρ = -0.46; r2 = 0.087; p = 0.053). CONCLUSION: According to observations made in our unit and in agreement with Tajima, who first described heat-press injury, the first surgical excision should be performed approximately one week after the accident. Subsequent excisions may be performed to reassess the lesions and complete the debridement, with reconstruction to follow. Multidisciplinary management is still necessary, including early and intensive physiotherapy, psychological support, and assessment by an occupational physician.
Assuntos
Queimaduras , Traumatismos da Mão , Humanos , Estudos Retrospectivos , Temperatura Alta , Queimaduras/cirurgia , Traumatismos da Mão/cirurgia , Inquéritos e QuestionáriosRESUMO
Most hospitals use protocols for surgical antibioprophylaxis (ABP). Despite SFB's 2009 recommendations promoting ABP in burn patients and stating the molecules to be used, wide variations exist within hospitals and among French hospitals, in cases of skin grafting and use of dermal substitutes. We contacted surgeons in 12 French Burn Centres (BCs) via email and questioned them about ABP in cases of skin grafting (thin and total) as well as in the use of dermal substitutes, in acute and sequelae settings. Eight BCs answered. In the acute phase, 3 BCs (37.5%) always use ABP in skin grafts, 2 (25%) use ABP on suspicion of wound infection and 3 (37.5%) never use ABP. When installing skin substitute, 5 BCs (62.5%) use ABP, one (12.5%) does so if the wound is suspected of being infected and 2 (25%) never use ABP. For sequelae, 5 BCs (62.5%) use ABP whatever the surgery, while 3 (37.5%) never use it. Infection onset after skin graft or use of dermal substitute is frequent. Our study shows wide variations in the use of ABP in these surgeries. A multi-centre evaluation of the implementation of SFB's 2009 recommendations and their role in preventing postoperative infections after skin grafting and skin substitute use, both in acute and sequelae phases, could help harmonize practices in BCs.