Uses of Coban self-adherent wrap in management of postburn hand grafts: case reports.

Coban wrap is a durable, elastic, self-adherent gauze that applies snugly without loosening. Coban does not stick to underlying tissue, making it excellent for early postoperative management of split- and full-thickness hand grafts. The wrap protects new grafts and decreases postoperative edema, permitting earlier mobility and facilitating accurate measurements for fitting of pressure garments. Wounds are judged suitable for Coban when the grafts are largely adherent and vascularized. Coban can be wrapped (1) directly over the graft, (2) over an ointment/adaptic dressing, or (3) over gauze padding for extra protection, or use as a "soft splint." Because of its inherent elasticity, Coban can be used to passively encourage desirable joint positions. The wrap is changed daily, and family members readily learn its use. Coban appears to encourage early, protected, active range of motion and early use of custom-fit pressure garments.

Evaluation of topical therapeutic ultrasound to improve response to physical therapy and lessen scar contracture after burn injury.

This study compared results of patients who received standard burn physical therapy and topical ultrasound with patients who received standard care alone to investigate the effect of topical therapeutic ultrasound on range of motion and pain in patients with burns. Fourteen burned extremities were studied. Eight joints were randomized to treatment with ultrasound followed by 10 minutes of passive stretching. Six joints received placebo ultrasound treatments and stretching. All treatments were performed every other day throughout a 2-week study period. Joint range of motion was measured before and after each treatment, and patients estimated the pain of the procedure. Patients and therapists were blinded to the treatment group. Analysis of the data revealed no differences in range of motion or perceived pain between the two groups. The effect of ultrasound on range of motion and pain was not predictable. We conclude that patients are not likely to improve from ultrasound treatment at our protocol parameters.

Influence of pressure supports on joint range of motion.

Burn patients often complain of restricted mobility following application of elasticized nylon anti-burn-scar supports. This study was designed to analyse the influence of this type of pressure garment on joint range of motion (ROM). Data were compiled from 80 burn-affected joints of 17 burn patients placed in a support for the first time. Joint ROM was measured directly prior to, and again immediately following, the donning of the pressure support. ROM was measured using standard goniometric techniques. Range of motion increased in 26 joints (32.5 per cent), decreased in 26 joints (32.5 per cent) and showed no change in 28 joints (35 per cent) after application of the pressure garment. There were no correlations between ROM results and age, time postburn and per cent TBSA in this population. Patients were also asked if movement felt any different after the support was applied. Their varied comments, such as movement felt easier or more difficult, were consistent with the actual ROM data. It appears that there is no predictably detrimental change in joint ROM due to the application of pressure garments.

Grease burns at fast-food restaurants. Adolescents at risk.

Intermountain Burn Center and Utah State Insurance Fund industrial records were reviewed to determine the incidence and consequences of grease burns among teenagers employed at fast-food restaurants. Burn center records reveal that 10 patients were admitted between 1977 and 1985, and that nine patients required surgery with mean burn care costs of $7389 per patient. State Insurance Fund records demonstrate that 81 grease-burn injuries were reported from 1982 through 1985, at an average burn care cost of $660 per patient. Causes of burn wounds included adding, filtering, or removing hot grease, dropping objects into hot grease, slipping on the floor, cleaning the grill or fryer, and splashing hot grease during cooking. Those treated as outpatients were off from work for as long as 10 days. These data identify an adolescent population at risk for work-related burn injury in fast-food restaurants.

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.

Prosthetic use in patients with burns and associated limb amputations.

A review of 11 patients who sustained burns that were complicated by limb amputation was completed to determine their eventual ability to use prosthesis. Amputations included six below-elbow, four above-elbow, three below-knee, and three above-knee amputations. Ten of the 11 patients (91%) had open wounds on the stump limbs and nine patients (82%) required skin grafting procedures on the amputated limbs. Delays in prosthetic fitting because of continued surgeries, open wounds, skin grafts on the stump limb, and breakdown of the stump were identified. However, eight of these patients (73%) were eventually able to wear prosthetic devices. Fisher's exact test was used to test the influence of the number and site of the amputations and skin grafting on the stump on successful prosthesis use. None of these tested items were found to be significant. The results demonstrate that most patients with burns who require limb amputation can achieve successful prosthesis use.

Sensory loss over grafted areas in patients with burns.

We studied loss of cutaneous sensibility after grafting in 60 patients with burns who had applied for impairment assessment. Fifty-eight patients (97%) demonstrated markedly diminished or absent responses to sharp/dull, hot/cold, and light touch stimuli over grafted areas. However, all but one patient had intact perception over donor areas and over areas of healed (ungrafted) partial-thickness burns. Deep touch sensation was intact over both grafted and ungrafted areas in all patients. Loss of sensation was not related to patient age, burn size, or type of burn; nor did sensory loss correlate with the impairment rating received. Depth of burn injury appears to be the best predictor of altered sensation, and some abnormalities in patients appear inevitable after skin grafting. Patients should be counseled about possible outcomes. However, the decrease in sensation that was observed rarely contributed significantly to the long-term impairment rating of these burn victims.