Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines.

The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.

Harnessing the Transparent Face Orthosis for facial scar management: a comparison of methods.

The Transparent Face Orthosis (TFO) is widely used in the treatment of facial burns to minimize hypertrophic scarring and maintain the contours of the face against deforming scars. Compression of the TFO is achieved with forces provided by the harness system (straps and anchors) used to secure the TFO on the face. A variety of harness system designs are used clinically yet none have been described or compared in the literature. The purpose of this study was to compare seven common methods of TFO harnessing including cost, time, and ease of fabrication. Results showed that harness systems vary in cost from $0.22 to 96.45 and take 2-49 min to fabricate. The 4-point harness was the least expensive and the easiest harness to fabricate. The Beanie Cap harness was the most complex system to make, while the Open Mask Stabilizer was the most expensive. The systems resulted in varying distributions of compression when depicted with three-dimensional laser scanned images. This description and comparison of fabrication materials and methods for TFO harnessing can guide clinicians within the burn community worldwide who have varying skills and resources for facial scar management.

Practice guidelines for early ambulation of burn survivors after lower extremity grafts.

The objective of this review was to systematically evaluate the available clinical evidence for early ambulation of burn survivors after lower extremity skin grafting procedures so that practice guidelines could be proposed. It provides evidence-based recommendations, specifically for the rehabilitation interventions required for early ambulation of burn survivors. These guidelines are designed to assist all healthcare providers who are responsible for initiating and supporting the ambulation and rehabilitation of burn survivors after lower extremity grafting. Summary recommendations were made after the literature, retrieved by systematic review, was critically appraised and the level of evidence determined according to Oxford Centre for Evidence-Based Medicine criteria. A formal consensus exercise was performed to address some of the identified gaps in the literature which were believed to be critical building blocks of clinical practice.

Methods and tools used for the measurement of burn scar contracture.

After burn injury, scar contracture can cause significant impairment and functional deficit. Many studies have investigated the treatment and prevention of burn scar contracture, but few studies have focused on the methods for measuring contracture. The purpose of this study was to determine whether consistent and objective methods of measurement are used to quantify scar contracture in the clinical evaluation of burn patients and in burn research. A survey was administered to 407 burn therapists to determine the methods and tools used clinically to measure scar contracture, while a review of recent burn literature was conducted to determine the methods and tools used in burn research. The results of the survey indicate that there is a lack of consensus in the methods and tools used for the measurement of scar contracture, both clinically and in research. Instead, a variety of measurement methods was reported, each with varying degrees of objectivity. Clinically, the methods are rarely checked for reliability or performance competency. In burn research, the methods and tools vary, and contracture data obtained are often reported in an inconsistent manner. If the measurement of scar contracture is not done objectively and consistently, then it is difficult to determine reliability, validity, and responsiveness of the measurement methods. Development of standard protocols with reliable measures of scar contracture would improve the quality of burn care and research.

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.

Laser Doppler imaging of cutaneous blood flow through transparent face masks: a necessary preamble to computer-controlled rapid prototyping fabrication with submillimeter precision.

A paradigm shift in management of postburn facial scarring is lurking "just beneath the waves" with the widespread availability of two recent technologies: precise three-dimensional scanning/digitizing of complex surfaces and computer-controlled rapid prototyping three-dimensional "printers". Laser Doppler imaging may be the sensible method to track the scar hyperemia that should form the basis of assessing progress and directing incremental changes in the digitized topographical face mask "prescription". The purpose of this study was to establish feasibility of detecting perfusion through transparent face masks using the Laser Doppler Imaging scanner. Laser Doppler images of perfusion were obtained at multiple facial regions on five uninjured staff members. Images were obtained without a mask, followed by images with a loose fitting mask with and without a silicone liner, and then with a tight fitting mask with and without a silicone liner. Right and left oblique images, in addition to the frontal images, were used to overcome unobtainable measurements at the extremes of face mask curvature. General linear model, mixed model, and t tests were used for data analysis. Three hundred seventy-five measurements were used for analysis, with a mean perfusion unit of 299 and pixel validity of 97%. The effect of face mask pressure with and without the silicone liner was readily quantified with significant changes in mean cutaneous blood flow (P < .5). High valid pixel rate laser Doppler imager flow data can be obtained through transparent face masks. Perfusion decreases with the application of pressure and with silicone. Every participant measured differently in perfusion units; however, consistent perfusion patterns in the face were observed.