Godleski Matthew, Holden Mary Sullivan, Luby Darcie, Weitzenkamp David, Boimbo Sandra, Lindberg Gordon
From the *Department of Physical Medicine and Rehabilitation, University of Colorado Denver; †Burn/Trauma ICU, University of Colorado Hospital, Aurora; ‡Department of Physical Therapy, University of Colorado Hospital, Aurora; §Department of Biostatistics and Informatics, University of Colorado Denver; and ║University of Colorado Burn Unit, Department of Gastroenterology, Tumor and Endocrine Surgery, University of Colorado Denver.
J Burn Care Res. 2014 Nov-Dec;35(6):e379-86. doi: 10.1097/BCR.0000000000000038.
Preventing scar contracture after burn injury is a critical goal during recovery. Although the need for intervention is well-understood, data on specific techniques are limited. The study's objective is to provide data for the use of a foam abduction wedge in terms of safety, effectiveness, and patient and caregiver satisfaction through a prospective, single-arm trial. All patients presenting with a burn injury that required grafting in the axillary region and placed them at risk for shoulder joint contracture were offered inclusion. Patient outcomes were recorded for the duration of their burn intensive care unit admission. Ten subjects completed the protocol with a mean duration of wedge use of 41.5 ± 32.5 days. At discharge, the mean shoulder abduction was 132° ± 38° on the left and 118° ± 22° on the right. The mean shoulder flexion was 132° ± 31° on the left and 123° ± 29° on the right. As much as 90% of the subjects had greater than 90° of shoulder abduction and flexion at discharge. There were no observations of worsening burn injury wounds, graft failure, or new pressure-related wounds. One patient was found to have an upper-extremity peripheral nerve injury that was not clearly associated with the splint. Patient and nursing surveys indicated areas of satisfaction as well as areas for potential improvement. This study illustrates the anticipated clinical outcomes and care issues associated with the use of a specific contracture prevention method used in the burn intensive care unit setting as well as identifying areas for future research.
预防烧伤后瘢痕挛缩是康复期间的一个关键目标。尽管干预的必要性已得到充分理解，但关于具体技术的数据有限。本研究的目的是通过一项前瞻性单臂试验，提供关于泡沫外展楔形支具在安全性、有效性以及患者和护理人员满意度方面的数据。所有因烧伤需要在腋窝区域进行植皮且有肩关节挛缩风险的患者均被纳入研究。在患者烧伤重症监护病房住院期间记录其预后情况。10名受试者完成了该方案，楔形支具的平均使用时长为41.5±32.5天。出院时，左侧肩关节平均外展角度为132°±38°，右侧为118°±22°。左侧肩关节平均前屈角度为132°±31°，右侧为123°±29°。多达90%的受试者在出院时肩关节外展和前屈角度大于90°。未观察到烧伤创面恶化、植皮失败或新的压力性创面。发现1例患者有上肢周围神经损伤，但与支具无明显关联。患者和护理人员的调查表明了满意度以及有待改进的方面。本研究阐述了与烧伤重症监护病房中使用的一种特定挛缩预防方法相关的预期临床结果和护理问题，同时也确定了未来的研究方向。
