Safety of Early Postoperative Range of Motion in Burn Patients With Newly Placed Hand Autografts: A Pilot Study

Abstract

<jats:title>Abstract</jats:title> <jats:p>Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection. Recent practice at our burn center includes an early range of motion (EROM) following hand grafting to limit unnecessary immobilization. The purpose of this study was to determine whether EROM is safe to perform after hand grafting and if there is any clinical benefit. This retrospective, matched case–control study of adults compared patients who received EROM to subjects who received the standard 3 to 5 days of postoperative immobilization. Patients were evaluated for graft loss and range of motion. Seventy-one patients were included in this study: 37 EROM patients and 34 matched controls. Six patients experienced minor graft loss, three of these were not attributable to EROM. All graft loss was less than 1 cm and none required additional surgery. Significantly more patients who received EROM achieved full-digital flexion by the first outpatient visit (25/27 = 92.6% vs 15/22 = 68.2%; P = .028). Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow-up. Additional prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas.</jats:p>

Early Escharotomy of the Hand and Forearm in Electrical Burn: A Case Report

“…They started early ROM on POD 1 or 2 after skin grafting. In this report, this method was safe without increased incidence of skin graft loss [13]. In addition, there was no graft loss due to early postoperative exercises (Fig.…”

“…Notably, the exercises of the hand and forearm are important [13]. Usually, active and passive exercises of the hand and forearm are initiated after the uptake of skin grafts.…”

“…However, in our study, the patients started exercising around POD 5. Recently, few authors have recommended early exercise after skin grafting [13]. They insisted that standard post-operative immobilization was not necessary under supervised therapy during the immediate postoperative period.…”

Acute Burn Care

“…133 Similarly, protocolized early range of motion for dorsal hand grafts may improve functional recovery without impacting graft take. 134 The popularization of negative-pressure wound therapy as a bolster dressing has improved outcomes over high-mobility areas, 135 in both meshed and sheet autografts, 136 using both commercial devices or more cost-effective alternatives. 137 Some centers are demonstrating the safety and costeffectiveness of outpatient burn surgery, 138 and incorporating home negative-pressure wound where graft loss from small hematomas or seromas will have significant functional or aesthetic consequences, allograft can be used to stage a closure between excision and sheet autografting.…”

Techniques and strategies for regional anesthesia in acute burn care—a narrative review

“…Inability to achieve burn rehabilitation goals Decades of research have demonstrated the benefits of early splinting followed by aggressive mobility and range of motion therapy for healed burns/grafts near joints [ 36 ]. Recent literature indicates that early mobilization after grafting to the lower extremities and the hand is not associated with a significant increase in graft shear/graft loss [ 37 ]. Therefore, while peripheral nerve blocks in the extremities have the ability to completely anesthetize the area, this needs to be weighed against early mobility/therapy goals.…”