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- Title
485 Impact of Serial Casting on Surgical Reconstruction in Pediatric Hand Burns.
- Abstract
Introduction: Rehabilitation of pediatric hand burns can be formidable. Burn scars can be unyielding, and contractures can develop quickly with devastating impact. On average, pediatric patients who demonstrate a need for early surgical intervention will require 3 reconstructive surgeries. Reconstructive surgery within the first year may extend scar formation timelines ultimately leading to development of increased scar tissue, making early surgical correction problematic. Despite the ramifications of surgical intervention, there is a lack of high level evidence for best practice in treating these injuries. The purpose of this report is to describe our methods and results utilizing serial casting prior to planned surgical interventions. Methods: This is a case series of 5 patients. A standard casting protocol was utilized. Results: A total of 5 patients who sustained hand burns have been treated using serial casting. Average age at time of injury was 1.6 years ± 1 year, mechanisms of injury included contact (2), flame/scald/chemical burns (1 each). Average TBSA was 8.6%, length of stay 26 days, and mean number of surgeries during the initial hospitalization was 4.8/patient. Serial casting was initiated on an outpatient basis, the average length of time for serial casting was 49 days and average number of cast applications was 13.2. Four of the patients were compliant with their treatment plans; of this group 2 have not required surgical intervention and are 1 and 2 years post-date of injury(DOI) respectively. One patient's first surgery occurred 1 year post DOI with no subsequent surgeries and the final patient in the compliant group is 6 months post DOI and with no current indications for reconstructive surgery. In contrast, the noncompliant patient required surgery 4 months post DOI. There was no breakdown, significant skin reaction, tissue necrosis, circulatory compromise, or signs/symptoms of infection due to casting. Conclusions: Our data suggests that serial casting for at least 8 weeks may delay surgical reconstruction 6 months or more with compliant patients. Potential benefits of serial casting for pediatric patients include reductions in anesthetic events, hospital admissions/stays, fear/anxiety, and financial burden. Further research is needed to fully evaluate the safety and efficacy of this intervention. Applicability of Research to Practice: Serial casting can delay or eliminate the need for surgical contracture release in pediatric patients with hand burns.
- Subjects
CHEMICAL burns; UNITED States. Dept. of the Interior; PLASTIC surgery; SCARS; LENGTH of stay in hospitals; BURN patients; HOSPITAL admission &; discharge
- Publication
Journal of Burn Care & Research, 2019, Vol 40, pS217
- ISSN
1559-047X
- Publication type
Abstract
- DOI
10.1093/jbcr/irz013.378