Effectiveness of hand reconstruction techniques for the treatment of postburn contractures of the hand: A systematic review

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2024-10-03 DOI:10.1016/j.burns.2024.10.002

Christos Vosinakis , Simona Ippoliti , Efthimios Samoladas , Anna-Bettina Haidich , Irene E. Gamatsi , Lee Smith , Chryssa Pourzitaki

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引用次数: 0

Abstract

Introduction

Despite the multitude of preventative methods, postburn hand contractures are poorly controlled and often require surgery. However, there is no consensus on which hand reconstruction technique is most efficacious. This systematic review aims to compare the efficacy of available postburn hand contracture reconstruction techniques over the long term and to evaluate the quality of current literature. Effectiveness is assessed with functional improvement, increase of skin surface area, and scar quality/enhanced cosmesis.

Material and methods

Four medical databases/registries were searched (PubMed/MEDLINE, Scopus, Cochrane, EMBASE) alongside grey literature sources from December 2012 to November 2022 for randomized controlled trials and observational studies with ≥ 15 participants and ≥ 3-month follow-up. Exclusion criteria were acute burn management, non-burn/non-hand contractures, non-surgical management, other burn sequelae, non-English studies, and outcomes reports, reviews, communications, editorials, letters, case reports, and non-human studies. Quality was assessed with the Joanna Briggs Institute checklist and GRADE.

Results

Seven observational studies (1310 patients) were eligible; three with a pre-/post-operative design and four comparative cohorts. Functional and aesthetic/scar quality outcomes for skin grafting and random or defined-vascularization flaps, complication rates and rehabilitation modalities were reported. No studies on dermal substitutes or utilising skin surface area measurements were identified. Significant risk of bias, indirectness and imprecision were noted in all studies, deriving from absence of randomization, blinding, or independent control groups; confounding; missing data; and subpar reporting. Owing to heterogeneity in outcome measures, meta-analysis was not possible.

Conclusions

No consensus remains on the superiority of a single reconstruction technique. Meticulous preoperative planning and intensive rehabilitation are vital. A stepwise approach, considering individual patient and contracture characteristics and the limitations of each technique, should be followed. Well-designed and conducted future studies, utilizing reliable and validated contracture description methods and outcome assessment, are now imperative.

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治疗烧伤后手部挛缩的手部重建技术的有效性：系统综述。

简介：尽管有多种预防方法，但烧伤后手部挛缩的控制效果不佳，通常需要进行手术治疗。然而，对于哪种手部重建技术最有效还没有达成共识。本系统性综述旨在比较现有烧伤后手部挛缩重建技术的长期疗效，并评估现有文献的质量。评估疗效的标准包括功能改善、皮肤表面积增加以及疤痕质量/外观改善：从 2012 年 12 月到 2022 年 11 月，对四个医学数据库/登记处（PubMed/MEDLINE、Scopus、Cochrane、EMBASE）以及灰色文献来源进行了检索，以查找参与人数≥ 15 人且随访时间≥ 3 个月的随机对照试验和观察性研究。排除标准包括急性烧伤处理、非烧伤/非手部挛缩、非手术治疗、其他烧伤后遗症、非英语研究以及结果报告、综述、通讯、社论、信件、病例报告和非人类研究。研究质量采用乔安娜-布里格斯研究所（Joanna Briggs Institute）核对表和 GRADE 进行评估：共有七项观察性研究（1310 名患者）符合条件，其中三项采用术前/术后设计，四项采用比较性队列。报告了植皮和随机或确定血管皮瓣的功能和美学/瘢痕质量结果、并发症发生率和康复方式。没有发现关于皮肤替代物或利用皮肤表面积测量的研究。所有研究都存在严重的偏倚、间接和不精确风险，原因包括缺乏随机化、盲法或独立对照组；混杂因素；数据缺失；以及报告质量欠佳。由于结果测量存在异质性，因此无法进行荟萃分析：结论：单一重建技术的优越性尚未达成共识。缜密的术前规划和强化康复治疗至关重要。应采取循序渐进的方法，考虑患者个体和挛缩特点以及每种技术的局限性。利用可靠、有效的挛缩描述方法和结果评估，精心设计和开展未来的研究势在必行。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.