Axilla

1
Axilla

• Gravity is our number one
• enemy
• Full motion difficult to
• achieve in deep burns
• Frequent exercise is a must
• Position aggressively
• Contracuture possible even
• if axilla not burned
• Brachial plexus injury is a
• real concern

2
Axillary Burns

• Note early banding at anterior axilla

3
Axillary Burns- Positioning

• Important to position in stretch
• Max position
• 90º abd
• 20º hor add

4
Chest Axillary Burn

• Begin positioning plan day 1
• Important to maintain skin length of ant neck
  (challenging in a young child with soft tissue
  approximation)

5
Axillary Burns- Positioning

• Consider individual patient/family needs
• Child on left can be breast fed

6
Elbow

• Good results with cooperative patient
• Number one site of heterotopic bone formation in
  burn patients

7
Frequent functional use of UE
8
Wrist and Hand

• Elevation is critical in decreasing edema
• Depth of burn determines therapy used
• Active motion encouraged in all but very deep
  burns
• Infant hands are especially challenging,
  difficult to splint

9
Contractile Force
10
Thumb

• Special attention to the CMC joint

11
Stretch Multiple Joint Segments

• Special attention to DIPs

12
Early Functional Hand Use
13
Trunk, Buttock and Hip

• Scoliosos and hip contracture can develop if not
  properly positioned
• Splinting usually not
• effective

14
Knee

• Infrequent problems with compliant patient
• Utilize lots of WB exercise for stretch and
  strength

15
Ankle and Foot

• Contractures occur frequently
• Ankle motion may decrease even when there is no
  adjacent burn
• Toe contractures are very disabling

16
Early WBing Most Effective
17
Toes

• ROM limitations impact gait and footwear

18
Head, Face and Neck

• Ears are particularly susceptible to pressure.
• Neck is very prone to contracture, so position
  aggressively
• Face is prone to contracture, so dont forget to
  stretch
• frequently use massage to face

19

• Contractures affecting position of nose and mouth
• Scar bands, contracture restricting cervical and
  jaw motion

20
Facial Contractures Limit Function
21
Facial Interventions

• Dont forget scar massage!

22
Reconstructive Procedures

• Surgery is NOT a fix all
• Post-op intensity of program may increase
• Patient education and communication is critical

23
Severe Elbow Contracture
24
Surgical Release of Scar Tissue
25
Surgical Release

• Previously released toe extension contracture
• Note immature graft at release site

26
Scar Band
27
Reconstruction Z-Plasty
28
Before and After
29
Allopecia
30
Reconstruction Tissue Expanders
31
Before and After