title: Clinical outcomes from a foam wedge splinting program for axillary contracture prevention in the intensive care unit.
abstract: Preventing scar contracture after burn injury is a critical goal during recovery. Although the need for intervention is well-understood, data on specific techniques are limited. The study's objective is to provide data for the use of a foam abduction wedge in terms of safety, effectiveness, and patient and caregiver satisfaction through a prospective, single-arm trial. All patients presenting with a burn injury that required grafting in the axillary region and placed them at risk for shoulder joint contracture were offered inclusion. Patient outcomes were recorded for the duration of their burn intensive care unit admission. Ten subjects completed the protocol with a mean duration of wedge use of 41.5 ± 32.5 days. At discharge, the mean shoulder abduction was 132° ± 38° on the left and 118° ± 22° on the right. The mean shoulder flexion was 132° ± 31° on the left and 123° ± 29° on the right. As much as 90% of the subjects had greater than 90° of shoulder abduction and flexion at discharge. There were no observations of worsening burn injury wounds, graft failure, or new pressure-related wounds. One patient was found to have an upper-extremity peripheral nerve injury that was not clearly associated with the splint. Patient and nursing surveys indicated areas of satisfaction as well as areas for potential improvement. This study illustrates the anticipated clinical outcomes and care issues associated with the use of a specific contracture prevention method used in the burn intensive care unit setting as well as identifying areas for future research.
authors.affiliation: From the *Department of Physical Medicine and Rehabilitation, University of Colorado Denver; †Burn/Trauma ICU, University of Colorado Hospital, Aurora; ‡Department of Physical Therapy, University of Colorado Hospital, Aurora; §Department of Biostatistics and Informatics, University of Colorado Denver; and ║University of Colorado Burn Unit, Department of Gastroenterology, Tumor and Endocrine Surgery, University of Colorado Denver.
authors.forename: Matthew
authors.initials: M
authors.lastname: Godleski
authors.forename: Mary Sullivan
authors.initials: MS
authors.lastname: Holden
authors.forename: Darcie
authors.initials: D
authors.lastname: Luby
authors.forename: David
authors.initials: D
authors.lastname: Weitzenkamp
authors.forename: Sandra
authors.initials: S
authors.lastname: Boimbo
authors.forename: Gordon
authors.initials: G
authors.lastname: Lindberg
mesh_terms: D000328:Adult; D001365:Axilla / Q000293:injuries; D002056:Burns / Q000503:physiopathology / Q000534:rehabilitation*; D002921:Cicatrix / Q000503:physiopathology / Q000517:prevention & control*; D003286:Contracture / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012785:Shoulder Joint / Q000503:physiopathology*; D013165:Splints