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Background: Severe burn injuries result in relevant restrictions of physical capacity as well as psychological and social integrity and require a specialized rehabilitation. There is a common agreement, among national as well as international burn associations, that burn rehabilitation is a complex, dynamic process which needs an interdisciplinary and specialized treatment team. There is wide agreement that more research is needed in this field., Methods/design: The aim of the study is to examine the effectiveness and efficiency of our new ICF (International Classification of Functioning, Disability and Health)-based rehabilitation for thermal injuries. Because of ethical reasons, we have chosen a prospective non-randomized design, which takes place at two different rehabilitation centers. At center A, a newly developed ICF-based rehabilitation program was established; at rehabilitation center B, a well-established rehabilitation program has existed for 20 years and is used as reference. The primary research question addresses the "Pre-post comparison of the physical and psychological outcome measurements," secondary question I looks at the "Examination of the non-inferiority of the new treatment concept with the established concept," and secondary question II is the "Analysis of the rehabilitation process based on the rehabilitation cycle." Only patients of the two burn rehabilitation centers who are insured by workers' compensation will be asked to participate in this study to avoid outcome bias by insurance status. A physical examination (physical working capacity testing, grip strength, range of motion, and scar evaluation by Cutometer and Vancouver Scar Scale) and a standardized questionnaire battery (Burn Specific Health Scale-Brief , Short Form 36, Impact of Event Scale-Revised, the German version of the Symptom Checklist, the Freiburg Social Support Questionnaire, Patient/Client Satisfaction Questionnaire, Disabilities of the Arm, Shoulder and Hand, and Lower Extremity Functional Scale ) measure physical and psychological conditions. Data will be taken on admission, during stay, and on discharge of the rehabilitation program and at follow-up 3 and 12 months after discharge. A minimum of 162 participants will be enrolled in this clinical longitudinal, prospective, observational study., Discussion: The proof of the effectiveness of the ICF-based rehabilitation program for thermal injuries will give evidence in a comprehensive way for the first time in this field. As result, a standardized rehabilitation concept will be introduced, which can be provided to other rehabilitation institutions treating thermal injuries., Trial Registration: German Clinical Trials Register, DRKS00017702. Registered on 2 September 2019.

At the patient's bedside 24 hours a day, the nurse is at the heart of the rehabilitation management of the severely burnt patient: installation, technical dressings, supervision of postures and placement of compressors, to limit the functional consequences to the type of retractable and hypertrophic scars. The nurse takes care of the patient in this long journey leading to social reintegration; from accompaniment to autonomy and acceptance of self-image., (Copyright © 2019. Publié par Elsevier Masson SAS.)

Scar contracture after burn on the back of hand can easily lead to the limitation of flexion function of fingers, which seriously affects daily life activities. Generally, comprehensive rehabilitation treatment is adopted for scar contracture on the back of hand, among which wearing braces is an effective treatment method. However, some braces will limit the normal finger joints or must wait until all the affected fingers heal before they can be worn, and the wearing operation is quite complicated. In order to solve these problems, the author designed and made a finger flexion band, which was used to stretch the patients with limited flexion of finger caused by scar contracture after burn on the back of hand, and achieved good therapeutic effect. According to the measured hand size, the finger flexion band is cut and spliced from the fabric commonly used in daily life. The finger flexion band is designed with finger sleeve, which will not limit the normal finger joints, can interfere with the healed finger in advance, fix the corresponding fingers better, and improve the treatment comfort, especially for children who do not cooperate with the braces wearing. This finger flexion band is simple to make, cheap, convenient to use, and suitable for clinical promotion.

Objective: To explore the development trajectories of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage and the influencing factors. Methods: Totally 207 burn patients, including 157 males and 50 females, aged (40±13) years, who were in the rehabilitation treatment stage were selected by convenient sampling method from October 2016 to July 2017 in the Department of Burns of Fujian Medical University Union Hospital for this longitudinal study. At discharge and 1, 3, and 6 months after discharge, the patient's quality of life and acceptance of disability were scored using the Burn Specific Health Scale-Brief and Chinese Version of Acceptance of Disability Scale-Revised respectively. Taking the intercept, the slope, and the curve slope as latent variables, the latent second growth curve model was constructed for the quality of life and the acceptance of disability. The robust maximum likelihood estimation (MLR) method was used to estimate the mean, the variance, and the covariance, so as to analyze the discharge level, the growth rate, the acceleration, and the correlation among them. Taking the acceptance of disability, the gender, the cause of burn, the severity of burn, the existence of complications, the payment way, and the education level as covariates, the latent second growth curve model was constructed for the quality of life. The MLR method was used to estimate the influence of covariates on the discharge level, the growth rate, and the acceleration of the quality of life. Results: At discharge and 1, 3, and 6 months after discharge, the quality of life scores of patients were (102±36), (111±36), (118±37), and (122±37) points respectively, and the acceptance of disability scores were (73±17), (75±17), (77±17), and (78±18) points respectively. The estimated mean intercept of the quality of life and the acceptance of disability were 101.680 and 72.993 respectively at discharge, both of which showed a curve increasing trend in 1, 3, and 6 months after discharge (estimated mean slope=11.024, 3.086, t =15.376, 7.476, P <0.01), and the increasing rate (acceleration) gradually slowed down (estimated mean curve slope=-1.393, -0.426, t =-13.339, -4.776, P <0.01). There were significant individual differences in the discharge level and the acceleration of quality of life of patients (estimated intercept variance=1 174.527, t =9.332; estimated curve slope variance=2.379, t =6.402; P <0.01). There were significant individual differences in the discharge level, the growth rate, and the acceleration of patients' acceptance of disability (estimated intercept variance=267.017, t =9.262; estimated slope variance=32.264, t =2.356; estimated curve slope variance=0.882, t =2.939; P <0.05 or P <0.01). There was no significant correlation among the discharge level, the growth rate, and the acceleration of the quality of life and those of the acceptance of disability of patients (estimated intercept and slope=37.273, -1.457, t =0.859, -0.131; estimated intercept and curve slope=-6.712, -0.573, t =-1.089, -0.248; estimated slope and curve slope=-5.494, -5.988, t =-0.930, -2.512; P >0.05). Among the time-constant covariates, only the severity of burn and the presence of complications had a significant impact on the quality of life of patients at discharge (estimated intercept=-10.721, 5.522, t =-6.229, 1.977, P <0.05 or P <0.01). At discharge and 1, 3, and 6 months after discharge, the level of acceptance of disability had a positive impact on the quality of life of patients (standardized regression coefficient=0.616, 0.669, 0.681, 0.678, t =18.874, 21.660, 22.824, 22.123, P <0.01). Conclusions: The initial levels of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage are relatively low, both with a curve increasing trend over time, and the increasing rate gradually slows down. Patients with complications and serious burns have poor quality of life at discharge, while the acceptance of disability has a positive impact on the quality of life.

Clinical and ethical issues involved in counseling a patient about reconstructive surgery for a traumatic and disfiguring injury require special consideration. This article proposes prioritizing 2 considerations: (1) the influence of traumatic experiences on a survivor's cognitive processes and (2) insights into a survivor's acceptance of his or her posttrauma appearance or consent to high-risk or experimental surgery, which can be gained from dialectical behavior therapy. This article argues that these priorities should be explicitly discussed by plastic surgeons counseling patients whose appearances are altered by trauma., (© 2019 American Medical Association. All Rights Reserved.)

Objective: To examine differences in long-term employment outcomes in the postacute care setting., Design: Retrospective review of the prospectively collected Burn Model System National Database., Setting and Participants: A total of 695 adult survivors of burn injury enrolled between May 1994 and June 2016 who required postacute care at a Burn Model System center following acute care discharge were included. Participants were divided into 2 groups based on acute care discharge disposition. Those who received postacute care at an inpatient rehabilitation facility (IRF) following acute care were included in the IRF group (N=447), and those who were treated at a skilled nursing facility, long-term care hospital, or other extended-care facility following acute care were included in the Other Rehab group (N=248)., Interventions: Not applicable., Main Outcome Measures: Employment status at 12 months postinjury. Propensity score matching and logistic regression were utilized to determine the effect of postacute care setting on employment status., Results: Individuals in the IRF group had larger burns and were more likely to have an inhalation injury and to undergo amputation. At 12 months postinjury, the IRF group had over 9 times increased odds of being employed compared to the Other Rehab group, using propensity score matching (P=.046)., Conclusions: While admitting patients with more severe injuries, IRFs provided a long-term benefit for survivors of burn injury in terms of regaining employment. Given the current lack of evidence-based guidelines on postacute care decisions, the results of this study shed light on the potential benefits of the intensive services provided at IRFs in this population., (Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Returning to work can be challenging for burn survivors. Approximately 28% never return to any form of employment, resulting in lower health-related quality of life. Open communication has been identified as a facilitator for return to work (RTW). To ease the RTW process and promote communication with coworkers and employers a knowledge translation (KT) intervention was developed for burn survivors. Following its implementation, the impact on the RTW process was evaluated. This study was a cross-sectional, mixed methods study where burn survivors included in the KT intervention were compared with a control group. Control group participants were selectively invited so that the two groups' mean age, sex, and percent total body surface area burned were similar. Semistructured interviews gathered information about their RTW process and outcomes. Qualitative data were analyzed through thematic analysis and quantitative data were summarized and compared using Mann-Whitney tests. Overall, both groups were satisfied with their RTW process. Participants from the control group identified more barriers related to support received, particularly at work, and reported more psychological symptoms such as posttraumatic stress disorder, self-consciousness, and discomfort with questions. Many participants from the KT group indicated the KT intervention gave them tools and information to provide others with a better understanding of their lived experience. It is possible that the KT intervention facilitated more open communication by empowering burn survivors to explain their situation on their own, thus reducing the prevalence of social and psychological barriers by allowing them to self-advocate for more support., (© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Injuries to the hands occur disproportionately more frequently in thermal accidents. The aim of ICF-oriented rehabilitation of burn injured hands is to return as much sensory and gripping functionality as possible or to develop everyday practical compensation mechanisms. Often the expectations of functionality and aesthetics for the burn injured are clouded by the clinical picture of edema, epithelial defects, contractures and hypertrophic scarring but, multimodal therapy options and interdisciplinary thinking are the means by which the rehab team can address and alleviate these concerns., Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Prior retrospective studies suggest that physical medicine and rehabilitation (PM&R) acute care consultation improves outcome and reduces acute care length of stay (ACLOS) in trauma patients. There have not been prospective studies to evaluate this impact in burn patients. This cohort study compared outcomes before and after the introduction of a PM&R consultation service to the acute burn program, and the inpatient rehabilitation program, at a large academic hospital. The primary outcome measures were length of stay (LOS) in acute care and during subsequent inpatient rehabilitation. For the acute care phase, there were 194 patients in the preconsultation group and 114 who received a consultation. There was no difference in age, Baux score, or LOS in these patients. For the rehabilitation phase, there were 109 patients in the prephysiatrist group and 104 who received PM&R care. The LOS was significantly shorter in the latter group (24 days vs 30 days, P = .002). Functional independence measure (FIM) change, unexpected readmission, and discharge destination were not significantly different. The addition of a burn physiatrist did not influence ACLOS. However, there was a significant reduction in inpatient rehabilitation LOS., (© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The objective for this manuscript is two-fold: determine the scope of clinical rehabilitation research involving burn-injured persons and assess whether research outcomes include function, return to needed, and desirable routines. Has this research addressed rehabilitation needs of the burn injured?, Methods: We performed a scoping review of literature (1990-2016) using the method of Arksey and O'Malley. Search terms included "rehabilitation", "function", "burn injury" and "work". Two independent reviewers identified articles that met criteria for abstract and full review. Variables of interest were counts of the number of intervention studies, studies performed in outpatient settings/inpatient settings, or both; count of the distribution of outcome measures that included impairment, function, participation, return to prior roles and percent of burns rehabilitation publications as a function of total rehabilitation articles published., Results: Sixty-four articles were selected for review and 22 employed an intervention. Nine articles were intervention trials that used functional measures. Of the 22 intervention trials 3 (14%) were performed while subjects were inpatients, 9 (41%) while they were outpatients, and 10 (45%) while they were both. There were 67 articles that met inclusion for work-related studies. Fourteen were intervention trials, 9 utilized functional outcomes and 5 used impairment outcomes exclusively. Less than 1% of clinical rehabilitation research addresses burns injury and <1% of the randomized trials in rehabilitation relates to burn injury CONCLUSIONS: There are few studies, few intervention trials and among these, very few that use function or return to community based activity as outcomes for people with burn injury., (Copyright © 2018. Published by Elsevier Ltd.)

Background: The management of post-burn pain and pruritus remain a potent challenge because of their bad effects on health-related quality of life (HRQOL). The main purpose of this study was to evaluate the impacts of low-energy extracorporeal shockwave therapy (low-energy ESWT) in the management of pain, pruritus, and HRQOL in patients with burn., Methods: Forty-five adult patients with burn, their age ranged from 18 to 55 years, were included in the study, they randomly assigned into 22 patients in the study group (low-energy ESWT) and 23 patients in the placebo group. The study group received low-energy ESWT (0.05-0.20mJ/mm 2 , a frequency of 4Hz with total shocks from 1000 to 2000 shocks) once per week for 4 successive weeks, while the placebo group received ESWT without energy. Both groups received traditional physical therapy program of selective different exercises (respiratory, range of motion, endurance, strengthening, balance, mobilization, stretching, and gait training) 3days per week for 4 weeks. Numerical Rating Scale (NRS) for pain and for pruritus, Pressure Pain Threshold (PPT), 12-Item Pruritus Severity Scale (12-PSS), and Burn Specific Health Scale-Brief (BSHS-B) were measured before and after treatment procedures in both groups., Results: NRS were decreased significantly in the study group than in the placebo group (P<0.05). PPT, 12-PSS, and BSHS-B scores were improved more significantly in the study group than in the placebo group (P<0.05) while body image and burn associated issues were improved at the same level in both groups (P>0.05)., Conclusion: The findings suggest that low-energy ESWT with traditional regular physical therapy may relive post-burn pain and pruritus, and improve HRQOL, particularly in adult patients with burn., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Background: The objective evaluation of scar quality plays a crucial role in improving burn surgery and scar rehabilitation. Suction-based skin measurements were proposed as a method to objectively determine the mechanical properties of scars, yet their use is limited, in particular for paediatric burn care. A new device was developed which provides essential advantages for scar assessment. The aim of this study was to assess its reliability, intra- and interobserver variability., Methods: The new device, "Nimble", consists of a lightweight probe that measures the negative pressure needed to obtain a predefined tissue elevation, revealing information on the stiffness of the tissue. 29 former paediatric burn patients were included. Three observers measured the tissue stiffness of a predefined location on the scar and on healthy skin using the Nimble, and the established suction device, the Cutometer ® . The reliability of both instruments in distinguishing between healthy skin and scar was assessed by means of the intraclass correlation coefficient., Results: The Nimble successfully differentiated between scar tissue and healthy skin in 92%, the Cutometer in 80% of the patients (p<0.05). Inter- and intraobserver variability of the Nimble (ICCs) were excellent. For the majority of the calculated ICC values the Nimble exceeded the Cutometer ® ., Conclusion: The new device enables reliable and safe measurement of the stiffness of scars. Measurements are less susceptible to patient non-compliance and observer dependency. The Nimble might therefore constitute an easy to use tool for the systematic assessment of scars, thus supporting decision-making in paediatric burn care., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To observe the influences of different follow-up methods on rehabilitation and compliance of patients with severe scar after burns. Methods: From January 2012 to May 2016, medical records of 116 patients with severe scar after burns who were admitted to our unit, discharged after wound healing and conforming to the criteria, were retrospectively analyzed. They were divided into face-to-face follow-up group [ n =59, 45 males and 14 females, aged (36±9) years] and routine follow-up group [ n =57, 44 males and 13 females, aged (35±9) years] based on different follow-up methods they received. On the day of discharge and in post discharge month (PDM) 1, 3, and 6, the Vancouver Scar Scale (VSS) was used to evaluate the hypertrophic scar in joints, Activities of Daily Living (ADL) scale was used to evaluate the disability of patients in the 2 groups. In PDM 1, 3, and 6, Medical Compliance Behavior Questionnaire was used to investigate the medical compliance behaviors of patients in the 2 groups. Data were processed with chi-square test, t test with Bonferroni correction, and analysis of variance for repeated measurement. Results: (1) The VSS score of patients in face-to-face follow-up group on the day of discharge was (11.1±0.7) points, which was close to (11.7±0.7) points of routine follow-up group ( t =2.021, P >0.05). The VSS scores of patients in face-to-face follow-up group in PDM 1, 3, and 6 were (10.5±0.6), (8.6±0.7), and (4.7±0.5) points, which were significantly lower than (11.4±0.7), (10.9±1.0), and (9.4±0.8) points of routine follow-up group respectively ( t =2.034, 2.033, 2.042, P <0.05 or P <0.01). (2) The ADL score of patients in face-to-face follow-up group on the day of discharge was close to that of routine follow-up group ( t =1.781, P >0.05). The ADL scores of patients in face-to-face follow-up group in PDM 1, 3, and 6 were higher than those of routine follow-up group respectively ( t =9.683, 8.584, 9.772, P <0.01). (3) The compliance rates of consisted rehabilitation, reasonable diet, and timing consultation of patients in face-to-face follow-up group were better than those of routine follow-up group respectively ( χ (2)=19.015, 13.251, 8.652, P <0.01). Conclusions: Compared with routine follow-up by phone, face-to-face follow-up can do better in evaluating the scar condition and ADL of patients with severe scar after burns, and improve the medical compliance rates of patients, which is worthy of clinical promotion.

Standard goniometry is the most commonly used method of assessing the range of motion (ROM) in patients with burn scar contracture. However, standard goniometry was founded on arthrokinematic principles and doesn't consider the cutaneous biomechanical influence between adjacent joint positions and skin pliability to accommodate motion. Therefore, the use of standard goniometry to measure burn scar contracture is called into question. This prospective, multicenter, comparative study investigated the difference between standard goniometry, based on arthrokinematics and a revised goniometry protocol, based on principles of cutaneokinematics and functional positions to measure ROM outcome in burn survivors. Data were collected for 174 joints from 66 subjects at seven burn centers totaling 1044 measurements for comparison. ROM findings using the revised protocol demonstrated significantly more limitation in motion 38.8 ± 15.2% than the standard protocol 32.1 ± 13.4% (p < .0001). Individual analyses of the motions likewise showed significantly more limitation with revised goniometry compared with standard goniometry for 9/11 joint motions. Pearson's correlation showed a significant positive correlation between the percentage of cutaneous functional units scarred and ROM outcome for the revised protocol (R2 = .05, p = .0008) and the Δ between the revised and standard protocols (R2 = .04, p = .0025) but no correlation was found with the standard goniometric protocol (R2 = .015, p = .065). The results of this study support the hypothesis that standard goniometry underestimates the ROM impairment for individuals whose motion is limited by burn scars. Having measurement methods that consider the unique characteristics of skin impairment and the impact on functional positions is an important priority for both clinical reporting and future research in burn rehabilitation., (© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To observe the therapeutic effects of Archimedes sling system in the rehabilitation of knee joint flexion dysfunction of patients after deep burns. Methods: Thirty-seven patients with knee joint flexion dysfunction after deep burn, conforming to the study criteria and hospitalized in Burn Rehabilitation Center of Tongren Hospital of Wuhan University & Wuhan Third Hospital from March 2015 to December 2017, were recruited in this prospective controlled study. According to the order of admission, 18 odd-numbered patients and 19 even-numbered patients were enrolled in conventional treatment (CT) group [13 males and 5 females, aged (42±10) years] and sling treatment (ST) group [13 males and 6 females, aged (37±10) years] respectively. Patients in group CT were conventionally conducted with knee joint mobilization treatment, continuous passive motion treatment, and pressure therapy, while patients in group ST were conducted with supine knee joint flexion and extension training and micro-squat short arc resistance training with Archimedes sling system besides CT. Patients in the 2 groups were treated for 6 months, and 1 course of treatment was 1 month. Before treatment and after 6 months of treatment, the knee joint active motion range was measured and the difference value was calculated, the American Hospital for Special Surgery (HSS) knee joint score was used to assess the functional disorder of patients, and the self-function satisfaction of patients were evaluated with modified Likert Scale. Data were processed with independent sample t test, paired sample t test, and chi-square test. Results: (1) Before treatment, the difference value of knee joint active motion range of patients in group CT was (45±11)°, which was similar to (44±12)° in group ST ( t =-0.206, P >0.05). After 6 months of treatment, the difference value of knee joint active motion range of patients in group ST was (89±14)°, which was obviously higher than (75±12)° in group CT ( t =0.897, P <0.01). The difference values of knee joint active motion range of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment ( t =-13.394, -29.459, P <0.01). (2) Before treatment, the HSS knee joint score of patients in group CT was (40±10) points, which was similar to (36±11) points in group ST ( t =0.816, P >0.05). After 6 months of treatment, the HSS knee joint score of patients in group ST was (68±13) points, which was obviously higher than (57±10) points in group CT ( t =0.162, P <0.01). The HSS knee joint score of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment ( t =-12.410, -30.559, P <0.01). (3) Before treatment, the self-function satisfaction scores of patients in the two groups were similar ( t =0.140, P >0.05). After 6 months of treatment, the self-function satisfaction score of patients in group ST was obviously higher than that in group CT ( t =3.103, P <0.01). The self-function satisfaction scores of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment ( t =-11.697, -29.029, P <0.01). Conclusions: The Archimedes sling system can effectively increase the difference value of knee joint active motion range, alleviate the degree of knee joint dysfunction, and enhance the self-function satisfaction of patients on the basis of conventional rehabilitation treatment for patients with knee joint flexion dysfunction after deep burns.

Introduction: For severe burns patient care presents a considerable challenge, necessitating an integrated multi-disciplinary approach that utilises a range of treatments. The period of care post-discharge can be lengthy and complex, and include scar management, occupational and physiotherapies, psychological support, and further surgery. How successfully the patient negotiates this complex care regimen is critical to their long-term recovery and in doing so they would appear to employ approaches recognised as "self-management" in other chronic conditions. However their exact nature and how they are used has yet to be explicitly explored amongst chronic burn patients., Methods: Semi-structured interviews were conducted with 24 patients to discuss their experiences of long-term burn treatment as part of a broader mixed- methods feasibility study of the use of pressure garment therapy in preventing hypertrophic scarring after burn injury. The topic guide included questions on the patient experience of their care post discharge, including pressure garment therapy and other scar management techniques; and their expectations and experiences of treatment and recovery. The data were analysed using an established framework of self-management processes., Results: Burns patients employ many of the same processes of self-management as those experiencing more widely recognised chronic diseases or illnesses. This is despite the prospect of gradual improvement amongst burns patients absent in those with incurable chronic conditions. The key processes of self-management they share are the ability to focus on their illness needs, activate the appropriate resources and coming to terms with the consequences of living with either the physical or psychological consequences of their condition., Conclusion: Modern burn care is technologically advanced and delivered by a highly trained, multi-disciplinary team, yet the level of its success relies on the ability of the patient to independently fulfil a number of health-related tasks and activities once leaving hospital. Considering the potential cost-savings to health services and the prospect of improved outcomes for patients capable of self-management our work is an important first step in more precisely understanding the use of self-management amongst burns patients, and the level of implicit or explicit support currently offered by their care providers., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Background: Untreated or undertreated burns are commonly encountered by plastic surgeons on medical trips in India and represent a major cause of disability. We sought to utilize validated patient-reported outcomes instruments to identify the patient population with the greatest burn-related disability in order to appropriately allocate plastic surgery resources to those in greatest need., Methods: The Quick Disability of the Arm, Shoulder, and Hand, RAND 36-Item Short Form Health Survey, and Burn-Specific Health Scale-Revised, Brief, and Adapted questionnaires were administered via an interpreter during a plastic surgery trip to Jharkhand, India, in January 2018. Demographics, comorbidities, and burn-specific history were recorded., Results: Twenty-eight postburn patients were surveyed (mean age, 17.0 ± 9.2 years; male:female ratio, 1:2.5). Mean time from injury was 4.74 years. No patient had received formal, primary burn care. Mechanism of injury: flame (39%), oil (32%), scalding water (14%), and other (14%). Fifty-four percent were extremity burns; 25%, facial; and 18%, neck burns. The Burn-Specific Health Scale-Revised, Brief, and Adapted demonstrated that the most significantly impacted domains for all patients were body image and skin sensitivity, with more than 80% of patients complaining of issues with skin sensitivity. In addition, children (aged <18 years) had diminished body image domain scores. RAND SF-36 scores were lowest in the energy (73.1 ± 25.0) and general health (76.5 ± 13.8) domains, and females with extremity burns demonstrated statistically significant decreases in their physical limitation domain scores (85.9 ± 17.3, P < 0.05). Females with extremity burns also had statistically significant lower scores in the energy domain (64.09 ± 25.75) as compared with their male counterparts with extremity burns (100 ± 0, P = 0.045). In general, females scored lower than did males in multiple domains, and those results reached statistical significance in the energy (65.9 ± 24.6 vs 93.6 ± 10.9), emotional (77.2 ± 21.5 vs 95.4 ± 11.2), and general health domains (71.1 ± 11.9 vs 90.0 ± 7.5) with P < 0.05. Children demonstrated significantly diminished scores in the emotional (75.5 ± 24.6) and general health (79.1 ± 11.8) domains., Conclusion: These data demonstrate the significant impact on quality of life that untreated burns have in this population. Male and female children with extremity burns and adult women with extremity burns were most significantly affected in multiple domains. Consequently, children and adult women with extremity burns appear to be the patient cohort with the greatest opportunity to impact their quality of life. These data may be utilized to improve patient triage and resource allocation for future surgical trips but could also be of significant benefit to internal health agencies and ministries for the same purpose.

Objective: To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma. Methods: From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient's clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded. Results: Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case. Conclusions: In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient's tolerance, thereby improving patient survival rate.

Global use of the internet has become commonplace, and smart phones have paved the way for technological mobility. Incorporation of smart phone technology has the potential to positively affect health outcomes through use of health-directed applications (apps), particularly for those patients living in medically underserved areas. The Bridge Mobile App for Burn Patients (fka: HealthySteps), is a pilot project that was developed to address the unique recovery needs of patients with major burn injuries who are being discharged from a regional burn center. App content was developed from three focus groups to explore and elucidate on stakeholders' understandings of the bio-psycho-social education and messages that they believed would improve short-term outcomes for newly discharged burn patients. The app will provide burn patients with accessible support 24h a day, seven days a week. Original recovery-stage appropriate bio-psycho-social content, instructional videos and links to burn-supportive web sites are delivered directly to patients' smart phones for the first 90days following discharge. The primary goal for the Bridge App is to decrease unplanned hospital re-admissions, while supporting increased quality of life and resilience in short-term recovery. In addition, the Bridge Mobile App is designed to collect patient data reflecting pain, anxiety, mood, itching, medication compliance, social participation, self-efficacy and return to work on a password protected, HIPPA compliant, encrypted mainframe., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Background/aim: Hands are commonly involved in burn trauma. Occupational therapy in the acute phase aims to reduce the risk of deformities and facilitate return to usual occupations. This study aimed to describe usual occupational therapy care at a major adult burns service, and measure recovery from hand burns in the first six months post-acute hospital discharge., Method: To describe usual occupational therapy care, an audit of patient contact statistics over six months was undertaken, and occupational therapy staff were interviewed. To measure recovery, a prospective cohort study recruited adults hospitalised with hand/upper limb burns at the Victorian Adult Burns Service. Recruitment occurred over a four month period. Functional recovery was measured at three time points: discharge, three and six months post-discharge. Instruments included the Quick Disabilities of the Arm, Shoulder and Hand and the Functional Assessment for Burns., Results: Usual care was calculated to be one 30 minute session of daily occupational therapy. Interventions were described using the Template for Intervention Description and Replication. Participants (N = 10) were aged 22-65 years and were treated for burns ranging from 2% to 40% total body surface area. Scores on the Functional Assessment for Burns suggested high functional independence at discharge. Quick Disabilities of the Arm, Shoulder and Hand scores improved significantly at each time point, with most substantial improvement occurring between discharge and three months. Involvement of the first web-space was associated with poorer recovery in the first three months post-discharge (P = 0.04). Six participants (60%) had returned to work at the three month follow-up, and seven (70%) at six months., Conclusion: The Quick Disabilities of the Arm, Shoulder and Hand was responsive to recovery in the post-discharge period. Further research into upper limb recovery following burns is needed, including exploration of the relationship between recovery and first web space hand burns., (© 2018 Occupational Therapy Australia.)

Objective: To understand health professionals' perspectives of burn care and rehabilitation., Design: Qualitative and semi-structured interviews., Setting: Australian burn and rehabilitation units., Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings., Results: The data portrayed the health professionals' perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care., Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes. Implications for rehabilitation Burn care and rehabilitation remains a complex and challenging area of care. Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase. Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.

Introduction: Burns affecting the head and neck (H&N) can lead to significant changes in appearance. It is postulated that such injuries have a negative impact on patients' social functioning, quality of life, physical health, and satisfaction with appearance, but there has been little investigation of these effects using patient reported outcome measures. This study evaluates the effect of H&N burns on long-term patient reported outcomes compared to patients who sustained burns to other areas., Methods: Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Database collected between 1996 and 2015 were used to investigate differences in outcomes between those with and without H&N burns. Demographic and clinical characteristics for adult burn survivors with and without H&N burns were compared. The following patient-reported outcome measures, collected at 6, 12, and 24 months after injury, were examined: satisfaction with life (SWL), community integration questionnaire (CIQ), satisfaction with appearance (SWAP), short form-12 physical component score (SF-12 PCS), and short form-12 mental component score (SF-12 MCS). Mixed regression model analyses were used to examine the associations between H&N burns and each outcome measure, controlling for medical and demographic characteristics., Results: A total of 697 adults (373 with H&N burns; 324 without H&N burns) were included in the analyses. Over 75% of H&N injuries resulted from a fire/flame burn and those with H&N burns had significantly larger burn size (p<0.001). In the mixed model regression analyses, SWAP and SF-12 MCS were significantly worse for adults with H&N burns compared to those with non-H&N burns (p<0.01). There were no significant differences between SWL, CIQ, and SF-12 PCS., Conclusions: Survivors with H&N burns demonstrated community integration, physical health, and satisfaction with life outcomes similar to those of survivors with non-H&N burns. Scores in these domains improved over time. However, survivors with H&N burns demonstrated worse satisfaction with their appearance. These results suggest that strategies to address satisfaction with appearance, such as reconstructive surgery, cognitive behavior therapy, and social skills training, are an area of need for survivors with H&N burns., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Racial and ethnic disparities in access to inpatient rehabilitation have been previously described for various injury groups; however, no studies have evaluated whether such disparities exist among burn patients. Their aim was to determine if racial disparities in discharge destination (inpatient rehabilitation, skilled nursing facility, home with home health, or home) following burn injury existed in this single-institution study. A retrospective analysis of all adult burn patients admitted to UNC Jaycee Burn Center from 2002 to 2012 was conducted. Patient characteristics included age, gender, burn mechanism, insurance status, percentage total body surface area (%TBSA) burned, presence of inhalation injury, and hospital length of stay. Patients were categorized into one of three mutually exclusive racial or ethnic groups: White, Hispanic, or Black. Propensity score weighting followed by ordered logistic regression was performed in the analytical sample and in a subgroup analysis of patients with severe burns (TBSA > 20%). For analysis, 4198 patients were included: 2661 White, 340 Hispanic, and 1197 Black. Propensity weighting resulted in covariate balance among racial groups. Black patients (OR: 1.58, 95% CI: 1.23-2.03; P < .001) were more likely than Whites to be discharged to a higher level of rehabilitation, whereas Hispanics were less likely (OR: 0.78, 95% CI: 0.38-1.58; P = .448). In their subgroup analysis, Black (OR: 1.88, 95% CI: 1.07-3.28; P = .026) and Hispanic (OR: 1.53, 95% CI: 0.31-7.51; P = .603) patients were more likely to discharge to a higher level of rehabilitation than White patients. Racial and ethnic disparities in discharge destination to a higher level of rehabilitative services among burn-injured patients exist particularly for Hispanic patients but not for Black or White burn patient groups. Further studies are needed to elucidate the potential sources of these disparities specifically for Hispanic patients., (© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Burn rehabilitation medicine in China has made great progress in recent years. This article reviews the development history of burn rehabilitation medicine in China from three stages of the initial period, the starting stage, and the development period by looking back to the history. Besides, the article is written according to the milestone events in the development of burn rehabilitation medicine, such as article publishing, guideline making, monograph publication, establishment of rehabilitation association, rehabilitation conference holding. By summarizing successful experience in the past and analyzing the challenge we face, the authors wish all the colleagues committed to burn prevention and treatment work together to make the burn rehabilitation medicine in China better in the future.

Objective: Severe burns cause hypermetabolic responses and prolonged hospitalization, resulting in loss of body mass and muscle strength. This study aimed to determine whether long-term gains in lean body mass (LBM) after structured exercise programs are functionally meaningful and related to greater muscle strength in severely burned children., Study Design: LBM and muscle strength were measured at discharge and at 6, 12, 24, and 36 months after burn in 349 children. Body composition, including LBM, was measured via dual-emission X-ray-absorptiometry. Peak torque was measured using Biodex dynamometer at varying angular velocities (90, 120, 150, 180°/s). Pearson correlation analysis evaluated the association between LBM and peak torque., Results: LBM progressively increased from discharge (32.5±11.5kg) to 36 months following injury (40.2±12.3kg). Peak torque and peak torque/LBM increased from discharge (56.4±34.0Nm and 1.7±34.0Nmkg -1 ) to 36 months after burn (102.3±43.8Nm and 2.5±0.7Nmkg -1 , p<0.01 for both). LBM and peak torque at all angular velocities showed moderate/strong correlations, with 120°/s being the strongest (all time-points: R 2 ≥0.57)., Conclusion: In severely burned children participating in a rehabilitative exercise program, gains in LBM over time are related to increases in muscle strength, suggesting that gained muscle mass is functional. Measurement of muscle strength at an angular velocity of 120°/s best reflects gains in LBM and should be considered for reliable measure of strength in future studies., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Hand burns cause functional impairment. Leap motion control (LMC), a kind of virtual reality games, employs a novel system that provides biofeedback and training of fine motor function and functional skills. In this study, we hypothesized that LMC would improve burned hand function. Sixteen participants were allocated to either the LMC group or the control group. The LMC group played 20min identical leap motion video games after 40min traditional occupational therapy (OT). The control group received traditional OT for 60min. Both groups received interventions 2 days a week for 4 months. A series of questionnaires were administered, including BSHS-B, QuickDASH, iADL, and Barthel index. Data on baseline characteristics including joint range of motion (ROM), grip and pinch strength, and scar thickness were obtained. Furthermore, we used the Mann-Whitney U test and Wilcoxon signed-rank test for comparison, as appropriate. We found improvements in BSHS-B, QuickDASH, and iADL in the LMC group (all p<0.05) compared to those in the control group. In the LMC-trained hand, the ROM of the thumb IP joint and pinch strength increased, whereas the scar thickness over the first dorsal interossei muscle decreased (p<0.05). In conclusion, leap motion training could help patients with hand burns to increase finger ROM, decrease scar thickness, and improve hand function., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

A major burn is a severe injury with a global impact. Our system of medical evacuation has led to the survival of many severely injured service members. Burn rehabilitation is a complex and dynamic process and will not be linear. Recovery requires a comprehensive, interdisciplinary team-based approach, individually designed to maximize function, minimize disability, promote self-acceptance, and facilitate survivor and family reintegration into the community., (Published by Elsevier Inc.)

Structured exercise programs initiated after acute hospitalization can improve muscle strength and mass, cardiorespiratory capacity, and quality of life in severely burned children. In this retrospective study, we compared the cardiovascular effects of an exercise program incorporating a large number of interval training sessions with a traditional exercise program incorporating a small number of interval training sessions. Severely burned children who completed a large number of sessions (at least three sessions per week, N = 40) were matched to those completing a small number of sessions (a maximum of two sessions per week, N = 40). Maximal oxygen consumption (VO2 max) was measured via the modified Bruce treadmill protocol at discharge, on completion of the exercise program, and at follow-up visits at 6, 12, and 24 months postburn. Both groups were comparable in age (large 13.5 ± 3.0 years vs small 13.1 ± 3.3 years) and percent total BSA burned (large 50.8 ± 14.8% vs small 49.2 ± 13.3%). For both groups, VO2 max increased from discharge (large 22.6 ± 3.8 ml/kg/min; small 22.6 ± 5.0 ml/kg/min) to postexercise (large 29.5 ± 6.0 ml/kg/min; small 28.0 ± 5.8 ml/kg/min), 6 months (large 33.2 ± 5.9 ml/kg/min; small 29.6 ± 7.0 ml/kg/min), 12 months (large 35.0 ± 7.5 ml/kg/min; small 31.7 ± 7.1 ml/kg/min), and 24 months (large 37.0 ± 7.2 ml/kg/min; small 32.4 ± 9.2 ml/kg/min, P < .001). VO2 increased to a greater extent with a large number of interval sessions than with a small number at 6 and 24 months (both P = .021). These findings suggest that a large number of interval training sessions impart a greater benefit on cardiorespiratory fitness than a small number of sessions.

There is a clinical trend toward "early mobilization" of patients with burn injury, however mobility is not well defined in burn care. Burn injuries result in various extents of injury, body areas affected, and types of skin graft surgeries needed-all of which may influence the type, timing, safety, and outcome of mobilization activities. This study surveyed burn clinicians to determine current mobility practices and the influence of skin graft surgery on clinical decisions to mobilize patients. A 32-question survey was electronically distributed to burn clinicians and included questions about postoperative range of motion (ROM) and out of bed (OOB) mobility practices for various skin graft types and locations. For all types of grafts on all body locations, the average time after skin graft surgery that patients resumed ROM activities was postoperative day (POD) 3.87 (±2.04) while OOB mobility resumed on POD 2.54 (±1.38). There was significantly greater variability for OOB mobility compared to ROM (coefficient of variation [CV] 0.71 ± 0.8 vs 0.5 ± 0.05). Time to postoperative ROM was significantly different depending on the type of skin graft placed with sheet skin grafts resuming ROM the earliest. Time to OOB mobility after surgery was significantly different for different body locations with grafts placed above the waist resuming OOB mobility earliest. This study provides a summary of current mobility practices and serves as a foundation for future studies investigating the optimal timing and practical application of mobility protocols that may influence safety and outcome of burn survivors.

The founding and the development of the Burn and Plastic Surgery Association of the People's Liberation Army of China (CPLA) were reviewed. It was in 1962 that the Burn Surgery Association of CPLA was founded on the basis of the Burn Collaboration Group of the Army and it was enlarged to become the Burn and Plastic Surgery Association in 1978. Its members consist of the Burn Units of the four Military Medical Universities, all the major hospitals of the Army, Navy and Air Force, and other military medical services. At present an extensive network for academic communications on burn and plastic surgery has been established within the Army. The association has so far sponsored 14 academic conferences, which in fact were nation-wide gatherings since the participants included most of the colleagues and experts of the field no matter they were civilians or in uniform. In recent years, the research on basic sciences related to burn and plastic surgery is very active and has achieved quite remarkable results.In addition, our communications with the colleagues overseas have also been established and several international conferences on the speciality have consecutively been held by the association.

By looking back the sixty years' history of burn surgery in Hubei province, the achievements and experience of the development of burn discipline in the province were summarized, and the problems of development and trends in the future of burn surgery were discussed.

This article briefly introduces the development history of Department of Burns and Cutaneous Surgery in Xijing Hospital of Air Force Medical University (the former the Fourth Military Medical University) since its establishment more than 60 years ago. The medical staff of the department have been adhering to the treatment concept of the older generation of experts and professors, applying the principles and methods of plastic surgery to the treatment of deep burn wounds. Furthermore, the new techniques in the field of flap surgery, microsurgery, and minimally invasive surgery are applied to repair various complex wounds after burn/trauma and severe scar deformities. Our department has formed our own distinctive technical features and contributed to the development of burn cause in China.

Guangdong General Hospital set up burn treatment specialist group in 1960. It was one of the hospitals which set up the department of burns in the early time. In the past 58 years, Department of Burn Surgery in Guangdong General Hospital has treated more than 20 000 burn patients, with overall success rate of 98.58%, standing at the global frontier. In the past 58 years, under the leadership of professors Chen Huade and Lai Wen and through the unremitting efforts of the colleagues, our department has developed from a burn treatment specialist group to the key clinical specialty of Guangdong province, sample unit of hundred level of laminar burn care ward, unit of chairman of the second and third committees of the Burn Branch of Guangdong Medical Association, the base of the National Good Clinical Practice, and has provided high level of burn treatment service for people in South China.

Burn rehabilitation in China started from compression therapy in the mid-1970s, which showed the dual effects of prevention and treatment of hypertrophic scars. It not only promoted functional rehabilitation but also strengthened the confidence of patients in rehabilitation treatment. Thereafter, more therapies were brought into practice, such as intra-scar injection of triamcinolone acetonide, application of plastic splints, hydrotherapy, exercises with equipment, skin care, local therapeutic massage, active and passive exercises, as well as external use of drugs for inhibiting scars and pigments. Since the beginning of the 21st century, rehabilitation therapies have been gradually increasing. Psychological rehabilitation, occupational therapy, external use of silicone gel, wax therapy and sound, light, electricity, and radiation therapy have been carried out. Many hospitals have established foundations and held summer camps for children. As far as the whole country is concerned, compared with the huge demand, we still face a number of problems such as shortage of working staff, limited working space, capital chain rupture, lack of multi-disciplinary cooperation, untimely treatment, and incomplete rehabilitation. Nowadays, with increasing knowledge of burn rehabilitation and number of practitioners, improvement of equipment and economic situation, the pace of rehabilitation has accelerated, and the overall implementation of burn rehabilitation therapy has shown great vitality. Patients with burn injury involving over 80% total burn surface area (TBSA) of total burn area or full-thickness burn over 60% TBSA were cured and recovered in different levels of hospitals nationwide, which not only reflects the superb level of burn treatment in China but also reflects the overall improvement of rehabilitation level of the country.

For 60 years, through the continuous efforts, the Department of Burns of the First Affiliated Hospital of Anhui Medical University has made many contributions to the treatment of burns in Chinese and Western medicine during the early phase of the establishment of the department. In recent years, we have also made some achievements in acute and chronic wound repair, burn immunonutrition, burn sepsis, and shock fluid recovery. In the future, we will work harder to make due contributions to the Chinese burn medicine.

The Department of Burns and Plastic Surgery of the Fouth Medical Center of PLA General Hospital (the former 304th hospital of PLA) was established in 1958 as one of the earliest specialized burn departments in China. In the pioneering efforts of professor Sheng Zhiyong, an internationally renowned authority in burn surgery and an academician of the Chinese Academy of Engineering, several generations of the department represented by Zhu Zhaoming, GuoZhenrong, Chai Jiake, Yang Hongming, and Shen Chuan'an have worked hard from inheritance to innovation. The Department of Burns and Plastic Surgery has evolved from a simple treatment-oriented department to a military priority built discipline, a military burn research institute, a national key clinical specialty and a national key discipline which integrates treatment, scientific research, achievement transformation, and talent training. At present, our department has 300 beds in total, and we have our own outpatient and emergency service, registration and toll service, 7 operation rooms, medical cosmetics center, hair transplantation center, rehabilitation and physical exercise center, skin care center, and specialized laboratory. In recent years, we have treated more than 70 000 emergency patients and outpatients every year, admitted over 6 500 inpatients annually, and conducted more than 9 000 operations yearly. Our department ranks among the top in the specialized departments with the same size across the country. Our burn cure rate stands at 99.5%, and 50% lethal area is 98% total body surface area, ranking in the international leading level.

Severe burned patient rehabilitation. The rehabilitation of the severe burn requires multidisciplinary care in a specialized rehabilitation center. We present in this article, the care offered in our service, detailing in particular the psychological aspects. Indeed, some patients with severe burns have a psychiatric history, while others will present a status with post-traumatic stress disease following the burn. The general principles of rehabilitation are the establishment of various ways of compression to fight against hypertrophy, as well as the achievement of postures to limit retractions. The organization of chain care minimizes the functional, aesthetic and psychological consequences of burns, and it accompanies the severe burned patients throughout scarring., Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.

Hand burns are unique in their functional, aesthetic and emotional impact on patients. Measuring the progress of a patient's ability to carry out essential and desired tasks, their emotional state, interaction with society as well as scar, pain and itch as their burn heals, has until now relied on the use of a combination of several different tools. We have developed a questionnaire specifically to address the multiple different aspects of the impact of a hand burn on a patient. This has been validated in a study of adult patients with hand burns in a UK unit, by a variety of psychometric tests. Ninety-four patients entered the study and questionnaires were completed over the course of a year at five time points. The total BHOT and DASH questionnaires completed at each time point was as follows: 86 before; 52 healed; 29 at 3 months; 31 at 6 months; 28 at 1 year, i.e. 226 DASH and 226 BHOT questionnaires in total. The questionnaire has been shown to have excellent reliability, criterion validity, construct validity, and responsiveness. The result is the Burnt Hand Outcome Tool (BHOT), a patient reported, quick and easy to use yet comprehensive questionnaire specifically for adult patients with burns to the hand., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Advances in surgical techniques and wound management have improved outcomes for burn patients; however, the psychological impacts on burn survivors have had less attention. There is a higher rate of mental health disorders amongst burns victims, with those with pre-existing mental health conditions likely to have worse outcomes. To implement effective burns care and rehabilitation, knowledge and understanding of mental health issues is required. This position paper discusses the extent to which clinicians currently translate knowledge around mental health and burns into practice to identify enables and inhibitors. Successful knowledge translation requires dissemination and accessibility of information with the capacity and readiness for change. Clinicians and researchers need to identify how translating research to practice can meet the needs of burn survivors. There is a gap in the utilization of evidence concerning mental health and the needs of burns survivors, and we need to understand what we know as compared to what we do. Clinicians are well placed to determine how and why knowledge does not necessarily translate to practice and how they can better accommodate the needs of burn survivors., (© 2018 Australian College of Mental Health Nurses Inc.)

Purpose: In burned children, exercise training increases maximal oxygen consumption (VO 2 max) and can be combined with the nonspecific beta-blocker propranolol to decrease cardiac work. VO 2 max is estimated if indirect calorimetry is not available. We compared measured and estimated VO 2 max in severely burned children treated with or without propranolol to determine the suitability of commonly used formulas in these populations., Methods: Patients received propranolol or placebo (control) during acute hospitalization. VO 2 max was measured during a modified Bruce treadmill test at discharge and compared to values obtained using the Cooper, Bruce, American College of Sports Medicine, and Porro formulas. Pearson correlations and Bland-Altman analyses were used to compare measured and estimated values., Results: Ninety-nine children (propranolol n=46,control n=53) admitted at our facility between 2003 and 2016 were analyzed. Age at burn (propranolol 12±4years, control 12±3years,p=0.893) and total body surface area burned (propranolol 44±15%,control 49±14%,p=0.090) were comparable between groups. Measured VO 2 max was higher in the propranolol group (25.5±6.0mL/min/kg vs. 22.0±4.7mL/min/kg,p=0.002) and was generally lower than estimated values. Age, sex, inhalation injury, body mass index, exercise time, and maximal speed were predictive of measured VO 2 max in the control group. Age, sex, and maximal speed were predictive in the propranolol group. Backward selection yielded the formula [7.63+ 2.16×sex(females=0,males=1)+0.41×age(years)+0.15×maximal speed(m/min)] (R 2 =0.6525)., Conclusions: Propranolol seems to have beneficial effects on cardiorespiratory capacity in burned children. However, estimated VO 2 max with common formulas were too high. The VO 2 max formula reported here is suitable for propranolol-treated children and the Porro formula for non-propranolol-treated children., (Published by Elsevier Ltd.)

Introduction: The advent of consoles that deliver both interactive games and therapy may augment rehabilitation options in burn patients. The Jintronix software combines therapy-specific software and interactive gaming as a form of coaching and records patient performance on the Kinect ® platform. Our objective was to determine the feasibility of a set of Jintronix games and therapy modules in hospitalized adult burn patients., Methods: We conducted a prospective single center feasibility study from August through October 2016. The study enrolled subjects to conduct 1 supervised session with 6 Jintronix modules targeting their burned areas of the body, with an acceptability survey and a safety analysis. We also performed qualitative analysis to detect major themes from free-text responses., Results: We enrolled 20 participants. Eleven (55%) completed all the modules; reasons for incompletion included baseline shoulder abduction pain and poor balance. Participants responded that the activity was comfortable (90%), safe (100%), easy to understand (95%), and improved strength/range of motion (100%). Mean module completion time was 43±10min. Mean pain score was 3.8±2.8 (out of 10) and localized to burned areas. The wall climbing module had 4 episodes of temporary imbalance. Eight (40%) participants recorded fatigue at completion and noted "sweating" or "feeling stretched". Qualitative analysis highlighted that the activity was "fun/cool" and a "good challenge". Negative themes included "inaccurate depth" sensing and "too lengthy" on a specific module., Conclusions: A Jintronix-based therapy demonstrated good acceptability and safety in hospitalized burn patients. Feedback from this study led to software modifications implemented by the Jintronix company. This feasibility study has informed the design of a prospective randomized controlled trial to determine whether a virtual-environment home rehabilitation strategy improves functional outcomes after burn injury., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Background: Psychological disturbances are prevalent in people with burn injuries; however, psychological services are rarely accessiblepost-burn injury in China. The objective of this qualitative study was to explore and conceptualize the obstacles to delivering mental health care in burn injury patients., Methods: The researchers used a grounded theory research approach to interview sixteen burn injury patients, five nurses, four rehabilitation therapists, five medical doctors, and eight caregivers regarding their experiences with current health care services and barriers., Results: An explorative model was generated from the data, and the relationships among the categories were identified. People's beliefs, knowledge, socioeconomic status, cultural understanding of mental health, and social stigma appear to play key roles in the public health approach to post-burn health promotion and post-burn psychosocial interventions., Conclusion: The model proposed in our research highlights the need to focus on the underlying social, economic, and cultural determinants of mental health care. The underlying social determinants of the mental health care gap that is responsible for the ill-prepared health care must be addressed.

In the 60th anniversary of Chinese burn medicine, I am honored to review the development of Department of Burns and Plastic Surgery in the Affiliated Hospital of Zunyi Medical College. The Affiliated Hospital of Dalian Medical college was relocated to Zunyi in 1969 to support the development of southwestern China and renamed Affiliated Hospital of Zunyi Medical College. Only a few medical workers stayed in Zunyi when the State Council decided to reestablish Dalian Medical University in 1978. In the last 30 years, our department made great progress in the field of burns treatment with Chinese and Western medicine and complex wounds repair with flap, especially with perforator flap. We also took the lead to achieve the integrated treatment model, including peripheral vascular intervention, autogenous adipose cells/adipose-derived stem cells transplantation, platelet-rich plasma/platelet-rich fibrin, flap grafting, vacuum sealing drainage, Ilizarov technology, and functional active dressing for the treatment of chronic and ischemic wounds. Our department has become one of the national key clinical subject with certain influence from low ebb.

The change and fixation of dressing are difficult in patients with burn in special sites of perineum, buttocks, and bilateral thighs. Therefore, we designed and made stretch pants by ourselves for dressing fixation after dressing change in patients with burns in abdomen, buttocks, and bilateral thighs. The stretch pants are made by cutting and splicing elastic fabric according to perimeters of abdomen and legs. The stretch pants are used after wound dressing change, which can fix the dressing stably, accelerate wound healing, and reduce the medical workers' labor intensity of dressing change and economic burden of patients. And patients can walk out of bed early. It's especially suitable for dressing fixation of infants and other patients who are unwilling to cooperate. Besides, it's easy to make with low cost and suitable for clinical promotion.

The Department of Burns and Plastic Surgery in Guangzhou Red Cross Hospital of Medical College of Ji'nan University grew up along with the development of burn discipline in China. In the past 60 years, it has developed into a burn specialty with three wards, 100 beds, and nearly 100 medical staff from several beds and surgeons. It is characterized by the treatment of severe burns and is a medical burn center integrating medical treatment, teaching and scientific research. In recent ten years or more, the subject development has closely followed the changes of burn discipline and society and has carried out the construction of sub-specialties. It has formed obvious speciality features in the network construction for severe burn rescue, the construction and management of burn intensive care unit and the comprehensive prevention and treatment of multiple organ dysfunction syndrome for severe burn patients and has enjoyed a good reputation in our speciality. We will continue to maintain the professional spirit of burn medicine workers for emergency and disaster relief for burned patients, keep initiative mind, strive hard to continuously improve the professional and technical level, and strive to establish a regional burn treatment center to make more contributions to the development of burn discipline.

This paper briefly described the establishment and development of Department of Burn Surgery in the First Affiliated Hospital of Naval Military Medical University (the former Changhai Hospital of the Second Military Medical University) over the past 60 years. After several generations of hard work and innovative development, our department has accumulated a wealth of experience and outstanding treatment effects in the treatment of severe burn and trauma patients. We have made great achievements in clinical practice, scientific development, and talent cultivation, as well as making important contribution to the development of burn and trauma medicine in Shanghai and even in China.

In 1958, with the national steelmaking, the number of burn victims greatly increased. With general surgery, trauma, and plastic surgeons as the core, a burn rescue group formed through multi-disciplinary cooperation, which gradually developed into an independent discipline. With great love and responsibility, the vast number of medical and nursing staff of burn discipline learned and discussed in practice, who were constantly improving and daring to break through and innovate. At that time, Qiu Caikang, the steel-making worker, with 89% total body surface area (TBSA) of total burn area and 23% TBSA of full-thickness burn, was rescued in Shanghai Guangci Hospital (now known as Ruijin Hospital, Shanghai Jiao Tong University School of Medicine), which was the first to succeed, rewriting the world record, followed by successful reports from hospitals in Chongqing, Xi'an, Beijing, and other places. The modern Chinese burn discipline has gone through 60 years since its inception in 1958. Several generations have carried out experimental research in combination with clinical practice, established the Society of Burn Surgery of the Chinese Medical Association and academic journals, created a treatment program for severe burns in China with treatment level in the world's leading position, enriching the world's treasure trove of burn medicine!

The Department of Burns and Plastic Surgery of Provincial Hospital Affiliated to Shandong University is the leading team in Shandong province. It is integrated with clinical treatment, scientific research, teaching, personnel training, and medical service for social crisis, which undertakes the tasks of giving lessons and offering chances for noviciate and internship of burns and plastic surgery in College of Medicine of Shandong University. It is not only the training unit affiliated to College of Medicine of Shandong University for master students and doctoral students major in burns and plastic surgery, but also the national training base for specialists of burns and plastic surgery. It is the national key clinical subject of burn surgery. Over the past 60 years, with the concerted efforts of several generations, it has made significant contributions to the development and innovation of burns and plastic surgery in Shandong province and the whole China.

Background: Reliable, clinically acceptable pressure measuring devices are important to accurately record interface pressure. The Pliance X is a device that may overcome previous device limitations (i.e. pressure garment distortion, temperature dependent sensors). This research aimed to identify the test-retest reliability and clinical utility of the Pliance X in children receiving pressure garment therapy post-burn., Methods: Data was collected as part of a pilot longitudinal cohort study. Immediate test-retest reliability was investigated at baseline and analysed using Intra-Class Correlation Coefficients (ICCs). Clinical utility was evaluated at baseline using the criteria of appropriate, accessible, practicable and acceptable., Results: Thirty-one children completed baseline measurements. Participants had a median age of three years (IQR: 1.5, 7.5), and 61% were male. Test-retest reliability of the Pliance X was close to acceptable for clinical use for stationary interface pressure (ICC=0.87, n=27). The Pliance X was appropriate and acceptable for children of all ages who were not distressed., Discussion: Further reliability testing is required, including inter-rater reliability testing. The device's clinical utility could be improved with alternate sensor styles and an instant mean pressure reading to enable immediately clinically useful information on the interface pressure., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)