Clinical Outcomes From a Foam Wedge Splinting Program for Axillary Contracture Prevention in the Intensive Care Unit

Abstract

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.

490 Outcomes of End of Range Axilla Splinting in Children Following Burn Injury

“…The patient seeks a position of comfort and shows a tendency to hold burned extremities in flexion and adduction, therefore facilitating the position of contracture. 13,50 Immobilisation to promote graft adherence can further contribute if the joint is not positioned with the graft in a lengthened position, as close to end of range as possible. 8,51 In the paediatric population, strategies to prevent BSC are particularly important, due to the years of growth ahead and the inability of scarred skin to accommodate growth likely to result in contracture development over time.…”

“…All have reported short term results only, with the longest follow-up 12 weeks post hospital discharge. To date, two prospective RCTs, 76,77 a retrospective cohort study 50 and two prospective case series 78,79 have investigated outcomes of axilla splinting post burn. Mixed results have been reported, a RCT found no significant difference between subjects treated with and without an axilla splint, commencing on admission and continuing until 12 weeks postburn.…”

“…76 In comparison, a case series reported full axilla ROM at hospital discharge (mean 2 weeks postburn), following splinting between 90-160 shoulder abduction in children. 78 All studies involved axilla splinting at 90 shoulder abduction in adults 50,76,77,79 except for a case series of children, which positioned the axilla at greater degrees of shoulder abduction (90-160). 78 All reported short term results, ranging from mean 2 weeks postburn 78 to 12 weeks post hospital discharge.…”