Comparison of Outcome of Post Burn Flexion Contracture Release Under Tourniquet Verses Tumescent Technique in Children

King Edward Medical University

Status: Unknown

Conditions: Flexion Contracture; Hand Burns

Treatments: Procedure: post burn flexion contractures release under tourniquet control; Procedure: post burn flexion contractures release using tumescent solution; Procedure: Contracture release and application of FTSG

Study type: Interventional

Funder types: Other

Identifiers

NCT02501720

2335

Details and patient eligibility

About

Post burn flexion contractures are common in pediatric age group. Release of contracture and coverage with full thickness skin graft (FTSG) is a widely used procedure for this problem. This procedure is routinely done under tourniquet control because bloodless operative field is essential to visualize important neurovascular structures in hand.

Use of tumescent technique without a tourniquet is gaining acceptance because it avoids complications associated with tourniquet use, maintains a blood less surgical field and decreases operative time. Furthermore use of tumescent anesthesia often results in better surgical outcomes.

Although the benefits of tumescent technique used in wide awake hand surgery are well documented, epinephrine at a concentration of 1:1 000,00 has also been used as a replacement for pneumatic tourniquet for release of hand contracture in infants and adults under general anesthesia. Thus epinephrine 1:1,000,00 in saline solution can be a potential replacement for a tourniquet in hand surgeries done under general anesthesia.

Full description

Post burn flexion contractures are common in pediatric age group. Release of contracture and coverage with full thickness skin graft (FTSG) is a widely used procedure for this problem. This procedure is routinely done under tourniquet control because bloodless operative field is essential to visualize important neurovascular structures in hand.

Use of tumescent technique without a tourniquet is gaining acceptance because it avoids complications associated with tourniquet use, maintains a blood less surgical field and decreases operative time. Furthermore use of tumescent anesthesia often results in better surgical outcomes.

Although the benefits of tumescent technique used in wide awake hand surgery are well documented, epinephrine at a concentration of 1:1 000,000 has also been used as a replacement for pneumatic tourniquet for release of hand contracture in infants and adults under general anesthesia. Thus epinephrine 1:1,000,000 in saline solution can be a potential replacement for a tourniquet in hand surgeries done under general anesthesia.

To the investigators' knowledge no study has so far been done to compare the outcome of release of post burn flexion contractures under tumescent technique with general anesthesia or under tourniquet control with general anesthesia.

Enrollment: 80 estimated patients

Sex: All

Ages: 3 to 12 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Children with post burn flexion contractures involving volar aspect of palm and fingers
• Possible to cover the defect with full thickness skin graft
• age range of 3 to 12 years.
• Patients of both genders

Exclusion criteria

• Children with recurrent post burn contractures.
• Children with any history of bleeding diathesis or coagulopathy.
• Children with any co-morbid condition making any contraindication of general anesthesia.
• Patients having previous history of vascular insufficiency like Raynaud's disease or phenomenon, severe peripheral vascular disease and peripheral neuropathy.
• The patient having allergic hypersensitivity to epinephrine, lidocaine.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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80 participants in 2 patient groups

Tourniquet Group

Active Comparator group

Description:

Post burn flexion contractures will be released under tourniquet control

Treatment:

Procedure: Contracture release and application of FTSG

Procedure: post burn flexion contractures release under tourniquet control

Tumescent technique group

Experimental group

Description:

Post burn flexion contractures will be released using Tumescent solution

Treatment:

Procedure: Contracture release and application of FTSG

Procedure: post burn flexion contractures release using tumescent solution