The effect of mirror therapy on joint movement,pain and functionality in acute upper limb burns

ObjectiveMirror therapy is aimed at developing a normal proprioceptive perception for the area with pain or movement restriction by making use of the person's monitoring of the healthy side movements thanks to the mirror's reflective feature. The aim of this study is to investigate the effect of mirror therapy on joint range of motion, pain and functionality in acute upper extremity burn injuries.MethodsDemographic and burn-specific data of individuals with upper extremity burns were recorded. Individuals were divided into two groups. Standard treatment was applied to the first group, and mirror treatment in addition to the standard treatment was applied to the second group for 30 sessions, 5 days a week for 6 weeks. In the standard treatment program, passive, active-assisted and active ROM, strengthening, stretching, resistant and functional exercises were applied. In the mirror therapy group, active exercises were performed on the healthy side by covering the burn area in the mirror box. Before and after the treatment, joint range of motion(ROM) was evaluated with Universal Goniometer, pain intensity was evaluated with Visual Analog Scale and upper extremity functions were evaluated with QuickDASH.ResultsA total of 32 (23 Male, 9 Female) individuals between the ages of 18–65 were included. The mean total burn surface area was 12.93 ± 9.80 in the standard treatment and 6.12 ± 2.96 in the mirror treatment. The groups were similar in terms of ROM change (p > 0.05). The pretest/posttest pain scores of both the standard therapy and mirror therapy groups were similar (p > 0.05). There was no statistically significant difference in terms of pretest and posttest QuickDASH scores according to the groups (p > 0.05). The difference between the pretest/posttest QuickDASH scores of both Standard treatment and Mirror treatment groups was statistically significant.ConclusionThis study showed that the standard physiotherapy and rehabilitation program applied in the acute period in upper extremity burns and the mirror treatment applied in addition to this program provide similar improvements in joint range of motion and pain.     

Evolution of hematocrit in burn patients as a marker of early fluid management during acute phase

ObjectiveTo evaluate the value of hematocrit for monitoring fluid resuscitation of burn patients in the acute phase of their care.MethodWe conducted a single-center retrospective study focused on patients admitted with a burn surface of more than 20 % of the total body surface area (TBSA) from 2014 to 2021. We investigated the relationship between the change in hematocrit and the volume administered for patient resuscitation. The change in hematocrit is the difference between an admission hematocrit and a second one taken between the eighth and twenty-fourth hour.ResultsWe included 230 patients with an average burn size of 39.1 ± 20.3 % TBSA, in 94.4 % by a thermal mechanism. The management seems to be in accordance with the current recommendations, with a volume administered during the first 24 h of 4.3 ± 2.5 ml/kg/ % BSA, allowing to obtain an hourly diuresis of 0.9 ± 0.7 ml/kg/h. We did not find any correlation between the pre-hospital volume administration and the hematocrit at admission (p = 0.36). Hematocrit decreased on average to −4.5 ± 8.1 % between admission and a control performed after the 8th hour. This decrease was weakly correlated with the volumes infused between the two samples (r² =0.13, p < 0.001). A resuscitation above 5.2 ml/kg/ % Burn surface area is an independent factor for excess mortality.ConclusionHematocrit or its variations in our limited data base appears to not reliably detect over-resuscitation, therefore it is possible that it may not be a relevant marker. These conclusions should be clarified in a multi-institutional prospective or real-world analysis to validate the findings and null hypothesis.     

Transcutaneous osseointegration for amputees with burn trauma

ObjectiveTranscutaneous osseointegration for amputees (TOFA) surgically implants a prosthetic anchor into the residual limb’s bone, enabling direct skeletal connection to a prosthetic limb and eliminating the socket. TOFA has demonstrated significant mobility and quality of life benefits for most amputees, but concerns regarding its safety for patients with burned skin have limited its use. This is the first report of the use of TOFA for burned amputees.MethodsRetrospective chart review was performed of five patients (eight limbs) with a history of burn trauma and subsequent osseointegration. The primary outcome was adverse events such as infection and additional surgery. Secondary outcomes included mobility and quality of life changes.ResultsThe five patients (eight limbs) had an average follow-up time of 3.8 ± 1.7 (range 2.1–6.6) years. We found no issues of skin compatibility or pain associated with the TOFA implant. Three patients underwent subsequent surgical debridement, one of whom had both implants removed and eventually reimplanted. K-level mobility improved (K2 +, 0/5 vs 4/5). Other mobility and quality of life outcomes comparisons are limited by available data.ConclusionTOFA is safe and compatible for amputees with a history of burn trauma. Rehabilitation capacity is influenced more by the patient’s overall medical and physical capacity than their specific burn injury. Judicious use of TOFA for appropriately selected burn amputees seems safe and merited.     

认知行为护理在烧伤瘢痕整形患者中的应用效果

的 探讨对烧伤瘢痕整形患者实施认知行为护理的临床效果。方法 选择2021年1月-2023年5月湖南省人民医院/湖南师范大学附属第一医院收治的80例烧伤瘢痕整形患者,按照双色球法随机分为参照组和试验组,各40例。参照组实施常规护理,试验组在参照组基础上实施认知行为护理,比较两组负性情绪、心理弹性、瘢痕恢复效果和护理满意度。结果 试验组护理后SAS评分为（36.71±4.16）分、SDS评分为（36.75±5.23）分,低于参照组的（43.38±6.35）分、（44.45±4.49）分,差异有统计学意义（P＜0.05）;试验组护理后心理弹性评分为（71.35±12.70）分,高于参照组的（64.98±13.16）分,差异有统计学意义（P＜0.05）;试验组瘢痕恢复总有效率为95.00%,高于参照组77.50%,差异有统计学意义（P＜0.05）;试验组护理满意度为92.50%,高于参照组的75.00%,差异有统计学意义（P＜0.05）。结论 认知行为护理符合烧伤瘢痕整形患者需求,能够改善其负性情绪和心理弹性,提高患者瘢痕恢复总有效率,患者认可度、满意度较高。     

参附注射液对重度烧伤患者早期心肌损害的保护作用研究

【摘要】 目的 观察参附注射液对重度烧伤患者早期心肌损害的防治作用,并探讨其可能的机制。方法 将2014年2月~2016年2月收治的烧伤后24小时内入院的38例烧伤总面积≥50%的患者随机分为治疗组和对照组,每组各19例。两组患者入院后均进行常规治疗,治疗组在对照组治疗基础上将100mL参附注射液加入250ml 5%葡萄糖注射液中进行静脉滴注,每日1次,连用7天。于两组患者伤后1、3、5、7天分别抽取患者静脉血,检测其血浆中心肌高敏肌钙蛋白I（hscTnI）、肌酸激酶同工酶（CK MB）以及B型脑钠肽（BNP)水平,以公认的各指标正常值作参考。并对3项指标进行相关性分析。结果 两组患者各时相点hscTnI、CK MB、BNP检测值均高于正常值,两组比较,治疗组指标偏低,大部分时相点差异有统计学意义(P＜005或P＜001)。伤后24h,两组患者上述指标水平大部分均处于峰值,伤后5天,两组患者上述指标水平均逐渐下降。结论 重度烧伤后早期应用参附注射液,可以有效减轻患者心肌细胞损害,对心肌有较好的保护作用。     

Continuous erector spinae plane block for pain management of an extensive burn

Damage from extensive burn injury requires pain management that effectively treats the entire affected area. An erector plane (ESP) block has been reported to anesthetize a wide range of spinal nerves. In this time, the continuous ESP block was an effective analgesic for acute pain management for the extensive damage.     

水凝胶在放射损伤救治及辐射防护中的应用研究

水凝胶是一类具有亲水基团,能被水溶胀但不溶于水的具有三维网络结构的高分子聚合物。由于具有良好的生物相容性等多种医学特性,水凝胶已作为一种新型生物医学材料广泛应用于伤口敷料、药物载体、组织支架等多个医学领域。本文仅介绍了水凝胶在放射损伤救治及辐射防护中的应用。     

救治特重度烧伤并发顽固性高血糖症一例报告

目的：探讨湿润烧伤膏（MEBO）在救治特重度烧伤并发顽固性高血糖治疗方面的作用。方法：创面采用MEBO换药，结合胰岛素控制糖等治疗。结果：烧伤后第30天深Ⅱ度深型创面顺利愈合，停用胰岛素，血糖能维持正常水平。于伤后第56天同痊愈。结论：MEBO使深度创面顺利愈合，很好地减轻了应激，从而为控制顽固性高血糖症提供了坚实的基础。