What is the best support surface in prevention and treatment, as of 2012, for a patient at risk and/or suffering from pressure ulcer sore? Developing French guidelines for clinical practice.

INTRODUCTION: The use of support surfaces in the prevention and treatment of pressure ulcers prevention is an important part of care for a patient at risk and/or suffering from sore(s). OBJECTIVES: Define which support surfaces to use in prevention and treatment of at-risk and/or pressure sore patients. METHODOLOGY: A systematic review of the literature querying the several Pascal Biomed, PubMed and Cochrane Library databases from 2000 through 2010. RESULTS (GRADE A): In prevention, a structured foam mattress is more efficient than a standard hospital mattress. An alternating pressure mattress is more effective than a visco-elastic mattress limiting the occurrence heel pressure ulcers, but those that do occur are more serious. A low-air-loss bed is more efficient than a mixed pulsating air mattress in prevention of heel pressure ulcers. Some types of sheepskin can reduce sacral pressure ulcer incidence in orthopedic patients. Use of an overlay on an operating table limits the occurrence of peroperative and postoperative pressure ulcers. An air-fluidized bed improves pressure ulcer healing. DISCUSSION: The data in the literature are not always relevant and do not suffice to dictate a clinician's choices. We are compelled to recognize the methodological limitations of many studies, the lack of corporate interest in conducting such studies and the relatively small number of available trials. However, the effectiveness of some support surfaces reaches a sufficient level of evidence, especially when they are associated with postural, hydration and nutritional measures. CONCLUSION: Support surfaces are recommended in prevention and treatment of patients at risk and/or already suffering from pressure ulcer, and their use should constitute part of an overall preventive or curative strategy.

Heterotopic ossification of the elbow in patients with burns. Results after early excision.

Heterotopic ossification which may develop around the elbow in patients with burns may lead to severe functional impairment. We describe the outcome of early excision of such heterotopic ossification in 28 patients (35 elbows), undertaken as soon as the patient's general and local condition allowed. The mean age at operation was 42 years. The mean area of burnt body surface was 49%. The mean pre-operative range of movement was 22 degrees in flexion/extension and 94 degrees in pronation/supination. The mean time between the burn and operation was 12 months with the median being 9.5. The mean follow-up period was for 21 months. At the last review, the mean range of movement was 123 degrees in flexion/extension and 160 degrees in pronation/supination. Clinical evidence of recurrence was seen in four patients, occurring within the first two months after operation. Nevertheless, three of these elbows gained 60 degrees or more in flexion/extension and in pronation/supination. Based on this experience, we recommend early surgical treatment of heterotopic ossification of the elbow in patients with severe burns.

[Burns and rehabilitation]. / Brûlure et rééducation.

Necessary principles of rehabilitation for burn patient are based on empirical findings recently corroborated by discoveries about healing pathophysiology. Risks are assessable immediately from the extensive, depth and situation of the burns, problems appear only if the dermis is affected: retraction, hypertrophy and losses of substances. To cutaneous problems it is necessary to add those linked to the prolonged immobilization and to complications of the resuscitation. To be effective, re-education has to be precocious, continuously suited to cicatricial processing and to the different therapeutic steps: resuscitation, surgical treatment, processing in a re-education and rehabilitation center, steady at home and processing of the sequelae. The processing rests on the repressive cloth port 23/24 hours during more of a year, the port of orthesis of immobilization and segmental posture (to stretch the dermis permanently) and the mobilization of articulations to avoid their stiffening. The cooperation of the patient is essential, it needs the share of therapies as well as the totality of problems and difficulties met by the patient, that they are physical, psychological, social, family or occupational. The steady has to be insured by a pluridisciplinarity team during at least the two necessary years for the cicatricial maturation.