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A Study On Post-Burn Healing: Optimising Scar Outcome Through The Use Of A Silicone-Based Film-Forming Wound Dressing, Fiona Poelchow

Theses

Introduction

The development of scarring is a normal physiological response during burn wound healing for any except the most trivial of injuries. Burn scarring can cause considerable functional and psychological anguish in burn survivors. Prolonged wound healing has been shown to affect scarring outcomes. Superficial cutaneous wound injuries carry a risk of scarring and altered pigmentation after the wound has healed. The primary aim of this study was to explore the effects of topical silicone on the rate of wound healing in superficial wounds. Secondary aims included investigation of scar and pain outcomes.

Methods

This thesis presents two studies which …

Delirium In Hospitalised Adults With Acute Burns – A Systematic Review, Guy H.M Stanley, Angus R.J Barber, Aoife M. O'Brien, Cheryl Hamill, Glenn Boardman, Cody C. Frear, Dale W. Edgar, Hannah Seymour, Fiona M. Wood

IHR Papers and Journal Articles

Introduction: Delirium is a potentially modifiable, acutely altered mental state, commonly characterised as a hospital-acquired complication. Studies of adult inpatients with acute burns with and without delirium identify causative risks related to the injury or treatment and outcomes related to the patient and healthcare system. We compare patients with and without delirium, providing a high-level quantitative synthesis of delirium risks and outcomes to inform guidelines and future research.

Methods: A systematic review, meta-analysis and GRADE evaluation of risks and outcomes associated with delirium in adults with acute burns was conducted using PRISMA guidelines and PROSPERO protocol CRD42021283055. The Newcastle-Ottawa Scale …

The Efficacy Of Resistance Training In Addition To Usual Care For Adults With Acute Burn Injury: A Randomised Controlled Trial, Paul M. Gittings, Benedict M. Wand, Dana A. Hince, Tiffany L. Grisbrook, Fiona M. Wood, Dale W. Edgar

Physiotherapy Papers and Journal Articles

Resistance training immediately after a burn injury has not been investigated previously. This randomised, controlled trial assessed the impact of resistance training on quality of life plus a number of physical, functional and safety outcomes in adults with a burn injury. Patients were randomly assigned to receive, in addition to standard physiotherapy, four weeks of high intensity resistance training (RTG) or sham resistance training (CG) three days per week, commenced within 72h of the burn injury. Outcome data was collected at six weeks, three and six months after burn injury. Quality of life at 6 months was the primary endpoint. …

Quantification Of The Negative Impact Of Sedation And Inotropic Support On Achieving Early Mobility In Burn Patients In Icu: A Single Center Observational Study, Lauren Bright, Lisa Van Der Lee, Dana Hince, Fiona M. Wood, Dale W. Edgar

IHR Papers and Journal Articles

Introduction: Early rehabilitation for burns survivors in the intensive care unit (ICU) is arguably more challenging than the general population. Early achievement of functional verticality milestones (FVMs) has the potential to ameliorate the detrimental effects of bed rest and immobility observed in ICU patients and reduce healthcare costs. However, the time to achieving FVMs after burn injury is influenced by factors such as sedation practices, cardiovascular stability, mechanical ventilation, acute skin reconstruction and length of stay (LOS) during the acute intensive care period.

Objectives/Aims: The aims of this study were to identify the association between early achievement of FVMs and …

Outcomes Of Resistance Exercise Training In Adults With Acute Burn Injury, Paul M. Gittings

Theses

Decreased quality-of-life and impairments in physical function, muscle strength and muscle volume are known complications of a burn injury. As such, rehabilitation is an important aspect of the burn care journey. Rehabilitation of burn injury is currently hampered by a lack of tools to reliably measure muscle strength and lower limb function, as well as an incomplete understanding of the effect of resistance training after a burn injury. Specifically, there is currently no data on the safety or efficacy of resistance training immediately after a burn injury.

The series of studies presented in this thesis aimed to: 1) systematically review …

Efficacy Of Acupuncture In Treating Scars Following Tissue Trauma, Cathy Tuckey, Susan Kohut, Dale Edgar

Physiotherapy Papers and Journal Articles

Introduction: Anecdotally, acupuncture is used in the treatment of scar tissue in order to improve scar quality and reduce symptoms of pain and pruritus. Unlike conditions such as lower back pain, knee osteoarthritis and migraines, there are no systematic reviews to confirm treatment efficacy. This systematic literature review aims to assess the current level of evidence for the use of acupuncture for treating abnormal scars such as hypertrophic or other symptomatic scars.

Methods: A comprehensive database search was performed followed by reviewing reference lists, grey literature databases and Google Scholar. Study quality was assessed using the Oregon CONSORT STRICTA instrument …

Increased Risk Of Blood Transfusion In Patients With Diabetes Mellitus Sustaining Non-Major Burn Injury, Linda Mai, Katrina Spilsbury, Dale W. Edgar, Aaron Berghuber, Fiona M. Wood

Health Sciences Papers and Journal Articles

Background: Due to the increased mortality and morbidity associated with blood transfusion, identifying modifiable predictors of transfusion are vital to prevent or minimise blood use. We hypothesised that burn patients with diabetes mellitus were more likely to be prescribed a transfusion. These patients tend to have increased age, number of comorbidities, infection risk and need for surgery which are all factors reported previously to be associated with blood use.

Objective: To determine whether patients with diabetes mellitus who have sustained a burn ≤20% total body surface area (TBSA) are at higher risk of receiving red blood cell transfusion compared to …

Genetic Influence On Scar Height And Pliability After Burn Injury In Individuals Of European Ancestry: A Prospective Cohort Study, Hilary J. Wallace, Gemma Cadby, Phillip E. Melton, Fiona M. Wood, Sian Falder, Margaret M. Crowe, Lisa J. Martin, Karen Marlow, Sarah V. Ward, Mark W. Fear

Medical Papers and Journal Articles

After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium^® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic …

Grip And Muscle Strength Dynamometry In Acute Burn Injury: Evaluation Of An Updated Assessment Protocol, Paul M. Gittings, Dana A. Hince, Benedict M. Wand, Fiona M. Wood, Dale W. Edgar

Physiotherapy Papers and Journal Articles

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry.

Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum …

Resistance Training For Rehabilitation After Burn Injury: A Systematic Literature Review And Meta-Analysis, P Gittings, T Grisbrook, Dale Edgar, F Wood, B Wand, N O'Connell

Physiotherapy Papers and Journal Articles

Background/aim: Resistance training is beneficial for rehabilitation in many clinical conditions, though this has not been systematically reviewed in burns. The objective was to determine the effectiveness of resistance training on muscle strength, lean mass, function, quality of life and pain, in children and adults after burn injury.

Methods: Medline & EMBASE, PubMed, CINAHL and CENTRAL were searched from inception to October 2016. Studies were identified that implemented resistance training in rehabilitation. Data were combined and included in meta-analyses for muscle strength and lean mass. Otherwise, narrative analysis was completed. The quality of evidence for each outcome was summarised and …

Increased Burn Healing Time Is Associated With Higher Vancouver Scar Scale Score, Vidya Finlay, Sally Burrows, Maddison Burmaz, Hussna Yawary, Johanna Lee, Dale Edgar, Fiona M. Wood

Physiotherapy Papers and Journal Articles

Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesized that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area – burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account …

The Development And Impact Of Heterotopic Ossification In Burns: A Review Of Four Decades Of Research, Rachel Kornhaber, Nichola Foster, Dale Edgar, Denis Visentin, Elad Ofir, Josef Haik, Moti Harats

Physiotherapy Papers and Journal Articles

Introduction: Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury.

Methods: The review was …

Bioimpedance Spectroscopy - Can It Be Used As A Tool For Monitoring Fluid Shifts In Burns?, Pippa Kenworthy

Theses

Large fluid shifts and oedema are features of burn injuries. Oedema hampers burn wound healing and is directly related to the size and depth of the burn. The degree of oedema in burns covers a broad spectrum: Minor burns cause localised or peripheral oedema, whilst major burns may result in a systemic inflammatory response which can be life threatening and necessitates formal fluid resuscitation. Acute burn fluid resuscitation is paramount in decreasing patient morbidity and mortality but can contribute to already large amounts of oedema. There is currently no single clinically applicable, non-invasive and accurate outcome measure to titrate fluid …

The Telehealth Skills, Training, And Implementation Project: An Evaluation Protocol, Andrew Bonney, Patricia Knight-Billing, Judy Mullan, Michelle Moscova, Stephen Barnett, Don Iverson, Daniel Saffioti, Elisabeth Eastland, Michelle Guppy, Kathryn Weston, Ian Wilson, Judith Nicky Hudson, Dimity Pond, Gerard Gill, Charlotte Hespe

Medical Papers and Journal Articles

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry.

Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum …