Splinting Techniques for Burn Patients PDF

Splinting Techniques for the Burn Patient  Splints  Splint is an external device to maintain joints in optimal length.  tools made of various material to support burned extremities , maintain joint position and correct deformity. N.B leather , wood, and metal splint...

Splinting Techniques for the Burn Patient  Splints  Splint is an external device to maintain joints in optimal length.  tools made of various material to support burned extremities , maintain joint position and correct deformity. N.B leather , wood, and metal splints have been replaced with thermoplastic. Aims of applying Splints: 1- support burned extremities, 2-maintain joint position. 3-correct and prevent deformities. N.B: * Leather, wood, and metal have been replaced by thermoplastic material. (can be remodeled more than one time according to it’s response to temperature ) Characteristic of splints 1. Non toxic 2. Light in weight 3. Made from non-absorbant material 4. It is padded over bony prominence 5. Easy to be shaped 6. Firm enough 7. Fabricated from non expensive material Significance of splinting techniques The treatment of sever burn cases focuses on:- -Patient survival -The end cosmetic appearance -Functional outcomes which depends on : -Early intervention and prevent further damage, -The loss of R.O.M, -Disruption of joint integrity Splinting techniques plays important role in preserving functional out come in combination with different treatment available USES OF SPLINTS IN BURN TREATMENT: A- Acute phase: 1) In acute phase of burn injury, splinting required only when damage of tendons and joints is suspected, 2) splinting will immobilize, provide support of affected body parts. 3) If it is used, it should be non conforming and non constrictive securing should be provided due to fluctuation of edema during this phase.(moldable)  B-Wound healing phase  -Splint may prevent development of contracture and disruption of newly skin graft.  -Care must be taken to avoid interfere the splint with healing as the result of improper fit or placement as splint has appropriate length of leverage and edge rolled away from skin. C-rehabilitation phase  -Splinting is used to reduce contracture non surgically, prevent deformity, and maintain natural body contours.  -The combined treatment of splints, exercise, and pressure is required;  The ongoing process of scar development and contracture is managed by maintaining sustained stretch to scar tissue.  Exercise may Achieve normal ROM and splinting can maintain the range gained. D-Reconstructive phase  -Splints applied following the release of contractures or reconstructive procedures for restoring function and.cosmoses -Splints are molded directly to the site and should be monitored for evidence of wound maceration or break down. Aiming to restore function or ,cosmetic. splinting indications: 1) Protection of anatomical structures:  -The goal of early splinting is to stabilize the joints so that all external forces are eliminated or reduced.  -The joint should be splinted in function position as well as the tendon should be splinted in a slack position to prevent rupture of the tendons.  -Special attention for moisten dressing to exposed tendon to prevent drying as well as padding splints to prevent more rupture. Protection of anatomical structures :  -splints maintain position opposite to anticipated deformity  -splints prevent deformity through maintain R.O.M gained through exercises. 2_Preservation of skin graft integrity:  -As survival of skin graft depend on establishment of circulation between underlying wound bed and transplanted graft so splint used to prohibit motion of the joints which locate under or near the grafted area. 3) Restore of function:  The early non operative resolution of contractures provided by sustained stretch and pressure combine with serial splinting to maintain gained R.O.M  Splints should be revised to accommodate any change in R.O.M.  Requirements for All Splints 1. Proper fit *A splint too loose and without adequate contour will not maintain proper position. *A splint too tight will invite pressure necrosis or nerve compression. 2. Secure application * A splint loosely secured with dressings or straps will slide, resulting in poor positioning and possible wound maceration. *If dressings or straps are too tight, they will restrict vascular flow and encourage edema. 3.Avoidance of pressure over a bony prominence If possible, a splint should not be molded over a bony prominence. When such application cannot be avoided, construction should avoid direct contact by doming the splint section over the prominence 4) Periodic removal *Splints protecting and positioning an exposed joint or tendon should be removed for wound care only. *Prolonged static immobilization can cause joint stiffness, muscle atrophy, or a contracture opposite to the position expected 5) Daily checking and re-evaluation * Changes in edema and changes in the bulk or type of dressings may require daily splint correction in the early stages of treatment. * Splint effectiveness also changes as the patient's status changes. *A careful daily check will help to avoid splinting problems 6) Cleansing with each re-application Every time a splint is removed for wound care, exercise or for any other purpose, it should be properly cleansed with an antibacterial agent before re-application in order to prevent possible wound contamination  Types of splints Usage of static or dynamic splinting depends upon the stage of tissue healing. *During the early inflammatory stage, (static splints) are useful, while both (dynamic and serial static splints) may be indicated during the proliferative stage of tissue healing. *Although (static and dynamic splints) can be beneficial during the stage of scar maturation, serial static splints often prove superior.