The morbidity associated with paediatric burn wound escharotomies.
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
22
07
2021
received:
30
05
2021
accepted:
08
08
2021
pubmed:
25
8
2021
medline:
3
11
2021
entrez:
24
8
2021
Statut:
ppublish
Résumé
An escharotomy is an effective surgical procedure for the rapid decompression of a constricting and unyielding eschar, to permit restoration of blood flow. However, an escharotomy is also a full-thickness incision, which adds additional scarring to the burn injury area. The cosmetic and functional morbidity of escharotomy scarring in children is poorly characterised. Children who required a burn wound escharotomy at the Queensland Children's Hospital (QCH) between May 2011 and May 2020 were included. Demographics of these children were described. In addition, the number of operations for revision of escharotomy scars was recorded as an indicator of functional or cosmetic concern. A total of 19 patients required an escharotomy after a burn injury. Children with 1% to 96% TBSA burns required an escharotomy, with a median of 28% (IQR 10-39%) TBSA. Two patients (81% and 96% TBSA) died. Seventy-one percent (12/17) of survivors had operative revisions of their escharotomy scars. The median time from burn to first scar intervention was 35 weeks (IQR 19-70 weeks). There is substantial morbidity associated with escharotomies in children. Further investigation of the current methods of decompression after burn injury, and the long-term morbidity of escharotomy, is required.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2139-2144Informations de copyright
© 2021 Royal Australasian College of Surgeons.
Références
Brown RL, Greenhalgh DG, Kagan RJ, Warden GD. The adequacy of limb escharotomies-fasciotomies after referral to a major burn center. J Trauma. 1994;37:916-20. https://doi.org/10.1097/00005373-199412000-00008.
Butts CC, Holmes JH, Carter JE. Surgical Escharotomy and Decompressive therapies in burns. J Burn Care Res. 2020;49:263-9. https://doi.org/10.1093/jbcr/irz152.
Pruitt BA, Dowling JA, Moncrief JA. Escharotomy in early burn care. Arch Surg. 1968;96:502-7. https://doi.org/10.1001/archsurg.1968.01330220018003.
De Barros MEPM, Coltro PS, Hetem CMC, Vilalva KH, Farina JA. Revisiting Escharotomy in patients with burns in extremities. J Burn Care Res. 2017;38:e691-8. https://doi.org/10.1097/BCR.0000000000000476.
Hussain A, Dunn KW. Predicting length of stay in thermal burns: a systematic review of prognostic factors. Burns. 2013;39:1331-40. https://doi.org/10.1016/j.burns.2013.04.026.
Meshulam-Derazon S, Nachumovsky S, Ad-El D, Sulkes J, Hauben DJ. Prediction of morbidity and mortality on admission to a burn unit. Plast Reconstr Surg. 2006;118:116-20. https://doi.org/10.1097/01.prs.0000221111.89812.ad.
Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet. 2016;388:1427-36. https://doi.org/10.1016/S0140-6736(16)31406-4.
Finlay V, Burrows S, Burmaz M, Yawary H, Lee J, Edgar DW, et al. Increased burn healing time is associated with higher Vancouver scar scale score. Scars Burn Heal. 2017;3:1-10. https://doi.org/10.1177/2059513117696324.
Oosterwijk AM, Mouton LJ, Schouten H, Disseldorp LM, van der Schans CP, Nieuwenhuis MK. Prevalence of scar contractures after burn: a systematic review. Burns. 2017;43:41-9. https://doi.org/10.1016/j.burns.2016.08.002.
Oosterwijk AM, Mouton LJ, Akkerman M, Stoop MM, van Baar ME, Scholten-Jaegers SMH, et al. Course of prevalence of scar contractures limiting function: a preliminary study in children and adolescents after burns. Burns. 2019;45:1810-8. https://doi.org/10.1016/j.burns.2019.05.003.
ANZBA, Tracy LM, McInnes J, Gong J, Karunakaran R, Gabbe BJ. Burns Registry of Australia and New Zealand 9th Annual Report. Melbourne; Monash University; 2019.
NSW Statewide Burn Injury Service. Clinical Guideline: Escharotomy for Burn Patients V2.0. 2019.
Rosenberg L, Krieger Y, Bogdanov-Berezovski A, Silberstein E, Shoham Y, Singer AJ. A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT. Burns. 2014;40:466-74. https://doi.org/10.1016/j.burns.2013.08.013.
Fischer S, Haug V, Diehm Y, Rhodius P, Cordts T, Schmidt VJ, et al. Feasibility and safety of enzymatic debridement for the prevention of operative escharotomy in circumferential deep burns of the distal upper extremity. Surg. 2019;165:1100-5. https://doi.org/10.1016/j.surg.2018.11.019.
Gravante G, Delogu D, Esposito G, Montone A. Versajet hydrosurgery versus classic escharectomy for burn débridment: a prospective randomized trial. J Burn Care Res. 2007;28:720-4. https://doi.org/10.1097/BCR.0B013E318148C9BD.
Esposito G, Gravante G, Filingeri V, Delogu D, Montone A. Use of hyaluronan dressings following dermabrasion avoids escharectomy and facilitates healing in pediatric burn patients. Plast Reconstr Surg. 2007;119:2346-7. https://doi.org/10.1097/01.prs.0000261076.40549.cf.
Salibian AA, del Rosario AT, Severo LDAM, Nguyen L, Banyard DA, Toranto JD, et al. Current concepts on burn wound conversion-a review of recent advances in understanding the secondary progressions of burns. Burns. 2016;42:1025-35. https://doi.org/10.1016/j.burns.2015.11.007.
Hyland EJ, D'Cruz R, Menon S, Chan Q, Harvey JG, Lawrence T, et al. Prospective, randomised controlled trial comparing Versajet™ hydrosurgery and conventional debridement of partial thickness paediatric burns. Burns. 2015;41:700-7. https://doi.org/10.1016/j.burns.2015.02.001.
Edmondson SJ, Ali Jumabhoy I, Murray A. Time to start putting down the knife: a systematic review of burns excision tools of randomised and non-randomised trials. Burns. 2018;44:1721-37. https://doi.org/10.1016/j.burns.2018.01.012.
Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Prim. 2020;6:11. https://doi.org/10.1038/s41572-020-0145-5.
Greenhalgh DG. Commentary: enzymatic escharotomy: a step backward? Surg. 2019;165:1106-7. https://doi.org/10.1016/j.surg.2018.12.010.
Wang XQ, Mill J, Kravchuk O, Kimble RM. Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients. Burns. 2010;36:1254-62. https://doi.org/10.1016/j.burns.2010.05.018.