The effectiveness of extracorporeal shockwave therapy on hypertrophic scar appearance and hand mobility in a severe burn patient
Notice bibliographique
Résumé
After a burn injury, the development of hypertrophic scars may limit the ranges of movement of the involved joints and cause severe disturbance to appearance and daily function of the patient, especially when the burn region involves hands. The use of extracorporeal shockwave therapy (ESWT) on the treatment of hypertrophic scars has been risen in the recent decade. The most recent systematic review by Aguilera-Sáez et al. has demonstrated improvements in hypertrophic scar appearance, pain and pruritus after a course of ESWT. Hence, ESWT was included in treating our severe burn case. To share the local experience and evaluate the effectiveness of ESWT on hypertrophic scar appearance and functional hand mobility in a severe burn patient. A patient suffered from a flame burn involving 27% total body surface area and predominantly full thickness skin burn was recruited at a local physiotherapy out-patient clinic. At post-injury 4 months, right hand flexor retinaculum and left 2nd-5th metacarpophalangeal joints (MCPJs) were chosen as the ESWT sites due to contractures limiting mobility and hand function. At a frequency of once to twice per week, 13 sessions with 2000 shots each session were performed on the right hand flexor retinaculum over 10 weeks, whilst 10 sessions with 1000 shots at each MCPJ per session were done on the left hand across 8 weeks. The parameters of ESWT were: 0 mm penetration depth, 0.124–0.142 J/mm2 energy flux density, and 8 Hz frequency. The outcomes were measured at pre- and post-treatment course of ESWT. The primary outcome measure was the scar appearance measured by Vancouver Scar Scale (VSS). The secondary outcome measure was the functional ranges of movement of fingers, Kapandji score and Patient-Specific Functional Scale (PSFS). A marked improvement in scar appearance on clinical photos was shown on both hands after a course of ESWT with 2 to 3-point deduction on VSS. On the scale of modified VSS, the 6-point reduction on the right hand scar exceeded the minimal clinically important difference (MCID), while the left hand scar also showed a 2-point improvement. Fingers’ ranges of movements also increased by 5 cm in thumb abduction, 20 degrees in MCPJs’ flexion and 3 points in Kapandji score. The patient regained the ability to grasp a cup with 5-mark improvement in PSFS exceeding the MCID. The use of ESWT on the hypertrophic scar improves scar appearance and functional mobility in a severe burn patient. ESWT on burn patients should be considered as one of the treatment modalities and the field for further research.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».