Hand Burn- HTS Keloids PDF

Hand Burn  Introduction  Common.  Impairment after burn injury.  Post Burn Edema.  Hand Deformities 1) Claw Hand Deformity  It occurs in the early post injury period as a result of edema, tendon injury, or scar contracture. ...

Hand Burn  Introduction  Common.  Impairment after burn injury.  Post Burn Edema.  Hand Deformities 1) Claw Hand Deformity  It occurs in the early post injury period as a result of edema, tendon injury, or scar contracture.  MP - Hyperextension.  IP - Flexion.  Hand Deformities (2)Boutonnie`re Deformity  is more likely with a deep burn involving the dorsum of the hand, fingers, or thumb.  Hand Deformities  It involves the extensor apparatus at the PIP joint level.  PIP – Flexion.  DIP – Extension.  Hand Deformities (3) Mallet and Swan- Neck Deformities Thermal injury to the terminal slip of the extensor tendon – Tendon Ischemia. PIP – Hyperextension DIP – Flexion  Hand Deformities  (4) Nail Deformity.  dorsal scarring over  DIP.  It Limits finger stability with pinching, fine motor dexterity and Cosmetically disabling.  Goal Setting for Hand Burn Rehabilitation Short-term goal: To  Long-term goal: maintain and gradually increase the range of  All + to restore the ability motion (ROM) in the of hand function uninjured and injured areas, to reduce edema and pain, to improve muscle strength and endurance, to prevent contracture, and to minimize scar formation. Concerns of Hand Burn Rehabilitation Muscle atrophy and reduced muscle strength, endurance, balance and coordination due to immobilization. Reduced ROM caused by deposition of fibrous tissues and adhesion of soft tissue around joints due to immobilization. Deformity caused by hypertrophic scarring or contraction of soft tissues such as scar, tendons, capsules of joints and muscles due to immobilization. Decreased ADL, learning and working abilities after injury. Social and psychological disorders caused by burns.  Management  Initial Treatment  Management  Pain Control  Splinting : The splint should keep the wrist in 20° of extension, the MCP joints in 70° of flexion, and the IP joints as straight as possible.  Estimating the depth of the burn. Splinting ROM Ex. Scar Management Hypertrophic Scar and Keloids  Hypertrophic scars and keloids result from an abnormal fibrous wound healing process in which tissue repair and regeneration- regulating mechanism control is lost. Comparison Hypertrophic Scar Keloid Develop soon after surgery. May develop months after the trauma. Usually improve with time. Rarely improve with time. Remain within the confines of the wound. Spread outside the boundaries of the initial lesion. Occur when scars cross joints Occur predominantly on the ear or skin creases at a right angle. lobe, shoulders, sternal notch, rarely develop across joints. Improve with appropriate surgery. Are often worsened by surgery. Are of frequent incidence. Are of rare incidence. Have no association with skin  Are associated with dark skin color. color.  Prevention  Avoiding all unnecessary wounds.  All surgical wounds should be closed with minimal tension, incisions should not cross joint spaces.  Mid-chest incisions should be avoided. , and incisions should follow skin creases whenever possible.  A traumatic operation technique should be used, followed by efficient hemostasis, and wound closure should include eversion of the wound edges.  Treatment  1- Intra-lesional corticosteroid injection decreases fibroblast proliferation, collagen synthesis, and glycosaminoglycan synthesis and suppresses pro-inflammatory mediators.  2- Pressure Therapy.  Treatment  3- Laser Therapy  Carbon dioxide laser -used for skin resurfacing.  Pulsed dye laser (PDL) - standard for vascular lesions.  4- Surgery  HTS : simple excision : is the therapy of choice. Scar revision as a treatment achieves two aims: excision and narrowing of scars as done for wide- spread scars and Z- or W-plasty designed to change the direction of the scar.  Keloids:  Simple total excision of a keloid stimulates additional collagen synthesis, thus sometimes prompting quick recurrence of a keloid even larger than the initial one.  For this reason, intra-marginal surgical excision of keloid tissue is recommended in order not to stimulate additional collagen synthesis. Surgical excision of a keloid alone is associated with a high recurrence rate. THANK YOU