Die Verbrannte Hand – Neuheiten und aktuelle Forschung

Zusammenfassung

Eine funktionierende Handmotorik ist im täglichen Leben und in der Arbeitswelt unverzichtbar. Selbst kleinere Verbrennungen können selbige entweder direkt oder durch Narbenbildung wesentlich einschränken. Erhalt und Wiederherstellung der Handfunktion sind essenziell für das körperliche und seelische Wohlbefinden von Verbrennungspatienten, zumal eine Einschränkung zu sozialer Isolation und Berufsunfähigkeit führen kann. Obwohl eine Hand nur 3 % der gesamten Körperoberfläche repräsentiert, werden Handverbrennungen als schwere Verbrennung eingestuft und zählen zu den primären Indikationen zur Behandlung in einem Verbrennungszentrum. Bei mehr als 80 % aller schweren Verbrennungen sind die Hände beteiligt und zählen somit zu den am häufigsten betroffenen Körperregionen. Unabhängig von der Schwere der gesamten Verbrennung ist den Händen höchste Priorität beizumessen.

Weiterentwicklungen in der Akut- und Langzeitbehandlung von Brandverletzungen der Hand sollten zum Ziel haben, eine langfristige Verbesserung der funktionellen und ästhetischen Ergebnisse zu erlangen. Zudem soll auch bei schwerer Handverbrennung die Wiedereingliederung in Alltag und Berufsleben angestrebt werden. Der Zweck dieser Übersichtsarbeit ist es, die aktuelle Forschung auf dem Gebiet der Handverbrennung aufzuzeigen und Teilbereiche zu identifizieren, in denen in Zukunft intensivere Forschung betrieben werden sollte. Wir fassen in dieser Arbeit relevante Original- und Übersichtsarbeiten der letzten Jahre auf dem Gebiet der Handverbrennung zusammen. Neuheiten zu Akutbehandlung, Nachbehandlung, Rekonstruktion, der Verletzung durch E-Zigaretten sowie zur Funktionsbeurteilung werden vorgestellt und in Kontext zu bewährten Methoden gestellt. Die Problematik mangelnder Forschungsprojekte und potenzielle Forschungsideen werden aufgezeigt.

Abstract

Hand function is crucial for everyday and professional life. Even small burns can have a great impact on hand function, either from the injury itself or from scar contractions. Preservation and restoration of hand function are essential for mental and physical well-being of burn survivors. Reduced hand function can lead to social isolation and occupational invalidity. Even though one hand represents only 3 % of the total body surface area, hand burns are categorized as severe burn injuries and are a primary indication for treatment in a dedicated burn center. Hands are involved in more than 80 % of all severe burn injuries, making them the most affected body part. Independent of the severity of the overall burn, hand injuries need to be treated with highest priority.

Novel approaches in acute and long-term care of burned hands should aim for long-term improvement in functional and aesthetic outcomes. All burn patients with hand involvement should be able to be reintegrated into society, perform activities of everyday life and return to their profession. The purpose of this review is to highlight recent advancements in research of the burned hand and to identify areas in which further research is needed. We summarized all relevant and recent original and review articles on hand burns; including acute treatment, aftercare, reconstruction, injuries due to E-cigarettes and methods for assessment of hand function. These findings were put into context of established methods in order to provide an outlook on possible future innovations.

Schlüsselwörter

Forschungsupdate - Handverbrennung - Handrekonstruktion nach Verbrennung

Key words

Research update - hand burns - Hand reconstruction after burns

• Literatur

• 1 Green M, Holloway GA, Heimbach DM. Laser Doppler monitoring of microcirculatory changes in acute burn wounds. J Burn Care Rehabil 1988; 9: 57-62
• 2 Holland AJA, Martin HCO, Cass DT. Laser Doppler imaging prediction of burn wound outcome in children. Burns 2002; 28: 11-17
• 3 Niazi ZB, Essex TJ, Papini R. et al. New laser Doppler scanner, a valuable adjunct in burn depth assessment. Burns 1993; 19: 485-489
• 4 Kloppenberg FW, Beerthuizen GI, ten Duis HJ. Perfusion of burn wounds assessed by laser doppler imaging is related to burn depth and healing time. Burns 2001; 27: 359-363
• 5 Shin JY, Yi HS. Diagnostic accuracy of laser Doppler imaging in burn depth assessment: Systematic review and meta-analysis. Burns 2016; 42: 1369-1376
• 6 Hop MJ, Stekelenburg CM, Hiddingh J. et al. Cost-Effectiveness of Laser Doppler Imaging in Burn Care in The Netherlands: A Randomized Controlled Trial. Plast Reconstr Surg 2016; 137: 166e-176e
• 7 Khatib M, Jabir S, Fitzgerald O’Connor E. et al. A systematic review of the evolution of laser Doppler techniques in burn depth assessment. Plast Surg Int 2014; 2014: 621792
• 8 Burke-Smith A, Collier J, Jones I. A comparison of non-invasive imaging modalities: Infrared thermography, spectrophotometric intracutaneous analysis and laser Doppler imaging for the assessment of adult burns. Burns 2015; 41: 1695-1707
• 9 Jaspers MEH, van Haasterecht L, van Zuijlen PPM. et al. A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential. Burns 2019; 45: 261-281
• 10 Holland AJA, Ward D, La Hei ER. et al. Laser doppler line scan burn imager (LDLS-BI): sideways move or a step ahead?. Burns 2014; 40: 113-119
• 11 Parvizi D, Giretzlehner M, Wurzer P. et al. BurnCase 3 D software validation study: Burn size measurement accuracy and inter-rater reliability. Burns 2016; 42: 329-335
• 12 Kamolz L-P, Kitzinger HB, Karle B. et al. The treatment of hand burns. Burns 2009; 35: 327-337
• 13 Gurfinkel R, Rosenberg L, Cohen S. et al. Histological assessment of tangentially excised burn eschars. Can J Plast Surg 2010; 18: e33-36
• 14 Klein MB, Hunter S, Heimbach DM. et al. The Versajet water dissector: a new tool for tangential excision. J Burn Care Rehabil 2005; 26: 483-487
• 15 Edmondson S-J, 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: 1721-1737
• 16 Kakagia DD, Karadimas EJ. The Efficacy of Versajet Hydrosurgery System in Burn Surgery. A Systematic Review. J Burn Care Res 2018; 39: 188-200
• 17 Hyland EJ, D’Cruz R, Menon S. et al. Prospective, randomised controlled trial comparing Versajet hydrosurgery and conventional debridement of partial thickness paediatric burns. Burns 2015; 41: 700-707
• 18 Rappl T, Regauer S, Wiedner M. et al. Klinische Erfahrungen mit dem Versajet-System in der Verbrennungsbehandlung – Indikationen und Anwendungen. Handchir Mikrochir Plast Chir 2007; 39: 308-313
• 19 Legemate CM, Goei H, Middelkoop E. et al. Long-term scar quality after hydrosurgical versus conventional debridement of deep dermal burns (HyCon trial): study protocol for a randomized controlled trial. Trials 2018; 19: 239
• 20 Rosenberg L, Lapid O, Bogdanov-Berezovsky A. et al. Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report. Burns 2004; 30: 843-850
• 21 Fischer S, Haug V, Diehm Y. et al. Feasibility and safety of enzymatic debridement for the prevention of operative escharotomy in circumferential deep burns of the distal upper extremity. Surgery 2019; 165: 1100-1105
• 22 Schulz A, Shoham Y, Rosenberg L. et al. Enzymatic Versus Traditional Surgical Debridement of Severely Burned Hands: A Comparison of Selectivity, Efficacy, Healing Time, and Three-Month Scar Quality. J Burn Care Res 2017; 38: e745-e755
• 23 von Wild T, Namdar T, Stollwerck PL. et al. Die repetitive thermische Selbstverletzung im Rahmen der Borderline-Persönlichkeitsstörung. Handchir Mikrochir Plast Chir 2011; 43: 302-306
• 24 Cuadra A, Correa G, Roa R. et al. Functional results of burned hands treated with Integra. J Plast Reconstr Aesthet Surg 2012; 65: 228-234
• 25 Min JH, Yun IS, Lew DH. et al. The use of matriderm and autologous skin graft in the treatment of full thickness skin defects. Arch Plast Surg 2014; 41: 330-336
• 26 Greenwood JE, Schmitt BJ, Wagstaff MJD. Experience with a synthetic bilayer Biodegradable Temporising Matrix in significant burn injury. Burns Open 2018; 2: 17-34
• 27 Gravante G, Sorge R, Merone A. et al. Hyalomatrix PA in burn care practice: results from a national retrospective survey, 2005 to 2006. Ann Plast Surg 2010; 64: 69-79
• 28 Perrot P, Dellière V, Brancati A. et al. Hyalomatrix PA in skin substitutes. About 10 cases. Ann Chir Plast Esthet 2011; 56: 107-111
• 29 Callcut RA, Schurr MJ, Sloan M. et al. Clinical experience with Alloderm: a one-staged composite dermal/epidermal replacement utilizing processed cadaver dermis and thin autografts. Burns 2006; 32: 583-588
• 30 Sobti N, Liao EC. Surgeon-Controlled Study and Meta-Analysis Comparing FlexHD and AlloDerm in Immediate Breast Reconstruction Outcomes. Plast Reconstr Surg 2016; 138: 959-967
• 31 Peters DA, Verchere C. Healing at home: Comparing cohorts of children with medium-sized burns treated as outpatients with in-hospital applied Acticoat to those children treated as inpatients with silver sulfadiazine. J Burn Care Res 2006; 27: 198-201
• 32 Uhlig C, Rapp M, Dittel K-K. Neue Strategien zur Behandlung thermisch geschädigter Hände unter Berücksichtigung des Epithelersatzes Suprathel. Handchir Mikrochir Plast Chir 2007; 39: 314-319
• 33 Choi YM, Nederveld C, Campbell K. et al. A Soft Casting Technique for Managing Pediatric Hand and Foot Burns. J Burn Care Res 2018; 39: 760-765
• 34 Lee JO, Herndon DN, Andersen C. et al. Effect of Exercise Training on the Frequency of Contracture-Release Surgeries in Burned Children. Ann Plast Surg 2017; 79: 346-349
• 35 Ghalayini G, O’Brien L, Bourke-Taylor HM. Recovery in the first six months after hand and upper limb burns: A prospective cohort study. Aust Occup Ther J 2019; 66: 201-209
• 36 Hundozi-Hysena H, Martinaj M, Muçaj S. et al. Physiotherapy Approach to a flexor contracture in a Burned Hand after 30 years. Materia Socio-Medica 2010; 22: 172
• 37 Rrecaj S, Hysenaj H, Martinaj M. et al. Outcome of physical therapy and splinting in hand burns injury. Our last four years’ experience. Mater Sociomed 2015; 27: 380-382
• 38 Nam H-S, Seo CH, Joo S-Y. et al. The Application of Three-Dimensional Printed Finger Splints for Post Hand Burn Patients: A Case Series Investigation. Ann Rehabil Med 2018; 42: 634-638
• 39 Jang KU, Seo CH, Kim MK. et al. The distribution analysis of orthotics in burn rehabilitation. J Korean Burn Soc 2004; 7: 98-103
• 40 Chen Y-J, Lin H, Zhang X. et al. Application of 3D-printed and patient-specific cast for the treatment of distal radius fractures: initial experience. 3 D Print Med 2017; 3: 11
• 41 Smith MA, Munster AM, Spence RJ. Burns of the hand and upper limb – a review. Burns 1998; 24: 493-505
• 42 Germann G, Funk H, Bickert B. The fate of the dorsal metacarpal arterial system following thermal injury to the dorsal hand: A Doppler sonographic study. J Hand Surg Am 2000; 25: 962-968
• 43 Lister GD, McGregor IA, Jackson IT. The groin flap in hand injuries. Injury 1973; 4: 229-239
• 44 Rasheed T, Hill C, Riaz M. Innovations in flap design: modified groin flap for closure of multiple finger defects. Burns 2000; 26: 186-189
• 45 Harrison CA, MacNeil S. The mechanism of skin graft contraction: an update on current research and potential future therapies. Burns 2008; 34: 153-163
• 46 Brown M, Chung KC. Postburn Contractures of the Hand. Hand Clin 2017; 33: 317-331
• 47 Sabapathy SR, Bajantri B, Bharathi RR. Management of post burn hand deformities. Indian J Plast Surg 2010; 43: S72-S79
• 48 Bhattacharya S. Avoiding unfavorable results in postburn contracture hand. Indian J Plast Surg 2013; 46: 434-444
• 49 Van der Spuy L. Complications of the arterial tourniquet. South Afr J Anaesth Analg 2012; 18: 14-18
• 50 Lalonde DH, Wong A. Dosage of Local Anesthesia in Wide Awake Hand Surgery. J Hand Surg Am 2013; 38: 2025-2028
• 51 Thomson CJ, Lalonde DH, Denkler KA. et al. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg 2007; 119: 260-266
• 52 Prasetyono TOH. Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique. Arch Plast Surg 2013; 40: 129-133
• 53 Bashir MM, Sohail M, Wahab A. et al. Outcomes of post burn flexion contracture release under tourniquet versus tumescent technique in children. Burns 2018; 44: 678-682
• 54 McKee DE, Lalonde DH, Thoma A. et al. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg 2013; 131: 811-814
• 55 Lian Z, Chuanchang D, Jiasheng D. Reconstruction of the first web space in severely burned hand by the reverse posterior interosseous flap. Eur J Plast Surg 2008; 31: 293-297
• 56 Askari M, Cohen MJ, Grossman PH. et al. The use of acellular dermal matrix in release of burn contracture scars in the hand. Plast Reconstr Surg 2011; 127: 1593-1599
• 57 Yuste V, Delgado J, Agullo A. et al. Development of an integrative algorithm for the treatment of various stages of full-thickness burns of the first commissure of the hand. Burns 2017; 43: 812-818
• 58 Hudson DA, Renshaw A. An algorithm for the release of burn contractures of the extremities. Burns 2006; 32: 663-668
• 59 Choi JE, Oh GN, Kim JY. et al. Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat 2014; 25: 299-303
• 60 Issler-Fisher AC, Fisher OM, Smialkowski AO. et al. Ablative fractional CO2 laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort. Burns 2017; 43: 573-582
• 61 Issler-Fisher AC, Waibel JS, Donelan MB. Laser Modulation of Hypertrophic Scars: Technique and Practice. Clin Plast Surg 2017; 44: 757-766
• 62 Makboul M, Makboul R, Abdelhafez AH. et al. Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar. J Cosmet Dermatol 2014; 13: 169-179
• 63 Poetschke J, Dornseifer U, Clementoni MT. et al. Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach. Lasers Med Sci 2017; 32: 1031-1040
• 64 Lee S-J, Suh D-H, Lee JM. et al. Dermal Remodeling of Burn Scar by Fractional CO2 Laser. Aesthetic Plast Surg 2016; 40: 761-768
• 65 Majid I, Imran S. Fractional Carbon Dioxide Laser Resurfacing in Combination With Potent Topical Corticosteroids for Hypertrophic Burn Scars in the Pediatric Age Group: An Open Label Study. Dermatol Surg 2018; 44: 1102-1108
• 66 Clayton JL, Edkins R, Cairns BA. et al. Incidence and management of adverse events after the use of laser therapies for the treatment of hypertrophic burn scars. Ann Plast Surg 2013; 70: 500-505
• 67 Żądkowski T, Nachulewicz P, Mazgaj M. et al. A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: An observational study. Medicine (Baltimore) 2016; 95: e5168
• 68 Negenborn VL, Groen J-W, Smit JM. et al. The Use of Autologous Fat Grafting for Treatment of Scar Tissue and Scar-Related Conditions: A Systematic Review. Plast Reconstr Surg 2016; 137: 31e-43e
• 69 Trottier V, Marceau-Fortier G, Germain L. et al. IFATS collection: Using human adipose-derived stem/stromal cells for the production of new skin substitutes. Stem Cells 2008; 26: 2713-2723
• 70 Condé-Green A, Marano AA, Lee ES. et al. Fat Grafting and Adipose-Derived Regenerative Cells in Burn Wound Healing and Scarring: A Systematic Review of the Literature. Plast Reconstr Surg 2016; 137: 302-312
• 71 Byrne M, O’Donnell M, Fitzgerald L. et al. Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand: Technique, hand function assessment and aesthetic outcomes. Burns 2016; 42: 356-365
• 72 Soto CA, Albornoz CR, Peña V. et al. Prognostic factors for amputation in severe burn patients. Burns 2013; 39: 126-129
• 73 Kennedy PJ, Young WM, Deva AK. et al. Burns and amputations: a 24-year experience. J Burn Care Res 2006; 27: 183-188
• 74 Eberlin KR, Leonard DA, Austen WG. et al. The volar forearm fasciocutaneous extension: a strategy to maximize vascular outflow in post-burn injury hand transplantation. Plast Reconstr Surg 2014; 134: 731-735
• 75 Dalla Pozza E, Bassiri Gharb B, Papay FA. et al. Procurement of Extended Vascularized Skin Flaps from the Donor Enables Hand Transplantation in Severe Upper Extremity Burns: An Anatomical Study. Plast Reconstr Surg 2018; 142: 425-437
• 76 Goniewicz ML, Zielinska-Danch W. Electronic cigarette use among teenagers and young adults in Poland. Pediatrics 2012; 130: e879-885
• 77 Seitz CM, Kabir Z. Burn injuries caused by e-cigarette explosions: A systematic review of published cases. Tobacco prevention & cessation 2018; 4
• 78 Corey CG, Chang JT, Rostron BL. Electronic nicotine delivery system (ENDS) battery-related burns presenting to US emergency departments, 2016. Inj Epidemiol 2018; 5: 4
• 79 Kite AC, Le BQ, Cumpston KL. et al. Blast Injuries Caused by Vape Devices: 2 Case Reports. Ann Plast Surg 2016; 77: 620-622
• 80 Satteson ES, Walker NJ, Tuohy CJ. et al. Extensive Hand Thermal and Blast Injury From Electronic Cigarette Explosion: A Case Report. Hand (NY). 2017 1558944717744333
• 81 Archambeau BA, Young S, Lee C. et al. E-cigarette Blast Injury: Complex Facial Fractures and Pneumocephalus. West J Emerg Med 2016; 17: 805-807
• 82 Vaught B, Spellman J, Shah A eta l. Facial trauma caused by electronic cigarette explosion. Ear Nose Throat J 2017; 96: 139-142
• 83 Cason DE, Morgan DE, Pietryga JA. Injuries From an Exploding E-Cigarette: A Case Report. Ann Intern Med 2016; 165: 678-679
• 84 Khairudin MN, Mohd Zahidin AZ, Bastion M-LC. Front to back ocular injury from a vaping-related explosion. BMJ Case Rep 2016; 2016
• 85 Paley GL, Echalier E, Eck TW. et al. Corneoscleral Laceration and Ocular Burns Caused by Electronic Cigarette Explosions. Cornea 2016; 35: 1015-1018
• 86 Brooks JK, Kleinman JW, Brooks JB. et al. Electronic cigarette explosion associated with extensive intraoral injuries. Dent Traumatol 2017; 33: 149-152
• 87 Colaianni CA, Tapias LF, Cauley R. et al. Injuries Caused by Explosion of Electronic Cigarette Devices. Eplasty 2016; 16: ic9
• 88 Norii T, Plate A. Electronic Cigarette Explosion Resulting in a C1 and C2 Fracture: A Case Report. J Emerg Med 2017; 52: 86-88
• 89 Cowan AC, Stegink-Jansen CW. Rehabilitation of hand burn injuries: current updates. Injury 2013; 44: 391-396
• 90 van de Ven-Stevens LA, Munneke M, Terwee CB. et al. Clinimetric properties of instruments to assess activities in patients with hand injury: a systematic review of the literature. Arch Phys Med Rehabil 2009; 90: 151-169
• 91 Giladi AM, Chung KC. Measuring Outcomes in Hand Surgery. Clin Plast Surg 2008; 35: 239-250
• 92 Kowalske K. Outcome assessment after hand burns. Hand Clin 2009; 25: 557-561
• 93 Bindra RR, Dias JJ, Heras-Palau C. et al. Assessing outcome after hand surgery: the current state. J Hand Surg Br 2003; 28: 289-294
• 94 Szabo RM. Outcomes assessment in hand surgery: when are they meaningful?. J Hand Surg Am 2001; 26: 993-1002
• 95 Cai L, Lippi J, Dumanian J. et al. Development of International Outcomes Instrument for Hand and Upper Extremity Burn Scar Contracture Release. J Burn Care Res 2017; 38: e395-e401
• 96 NIH U. S. National Library of Medicine. Effects of Virtual Reality-Based Rehabilitation on Burned Hands. Im Internet: https://clinicaltrials.gov/ct2/show/NCT03865641 Stand: 15.4.2019