Outcomes of post burn flexion contracture release under tourniquet versus tumescent technique in children. Issue 3 (May 2018)

• Record Type: Journal Article
• Authors: Bashir, Muhammad Mustehsan; Sohail, Muhammad; Wahab, Ahmad; Iqbal, Umar; Qayyum, Rehan; Jan, Saadia Nosheen
• Is Part Of: Burns. Volume 44:Issue 3(2018)
• Page Start: 678
• Page End: 682
• Publication Date: 2018-05
• Subjects: Hand -- Burn -- Contracture -- Tumescent -- Tourniquet; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2017.10.005
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Release and reconstruction of flexion contractures of the hand after burn are mostly performed under tourniquet control. Although tourniquet provides a bloodless operative field, it may produce devastating complications. Tumescent technique also provides comparable bloodless operative field and avoids tourniquet-related complications. Comparison of flexion contractures after burn release using these two techniques in children has not been performed. Use of the tumescent technique improved graft take, reduced pain scores, and decreased analgesic requirements. Abstract: Objective: To compare the clinical outcomes of release of flexion contractures after burn of the hand in children using tourniquet or tumescent technique in terms of operative time, postoperative pain score, and percentage of graft take. Methods: Patients aged 3 to 12 years who required release of post-burn flexion contractures involving volar aspect of palm and fingers were enrolled from outpatient clinic. Patients were randomized in 1:1 ratio to the use of either tumescent technique or tourniquet during contracture release. Duration of procedure, postoperative pain score, percentage of graft take, and any complications were assessed and analyzed in both groups by a blinded observer. Results: Of the 160 patients randomized in the study (80 in each group), 84 (52.5%) were males. The mean ± SD age of participants was 7.84 ± 3.49 years, with no statistically significant difference in gender and age distribution between the groups. Similarly, there was no statistically significant difference in duration of surgery in both groups. However, there was a statistically significant difference in percentage of graft take at the 14th postoperative day; significantly more graft take was noted in the tumescent group (8.97 ± 3.7 cm vs. 7.26 ± 2.6 cm; P = 0.001). Mean analgesia consumed in the tumescent group was significantly less than that of the tourniquet group (6.26 ± 1.9 mg vs. 9.41 ± 2.2 mg; P ≤ 0.001). Similarly, statistically significant difference in the mean FLACC pain score was noted, with remarkably low pain score in the tumescent group. Conclusion: We found that the use of the tumescent technique for the release of flexion contracture resulted in better graft take, lower pain scores, and lesser consumption of analgesic than the use of tourniquet.