comparison of outcome of post burn flexion contracture release under tourniquet verses tumescent technique in children

Conditions: Hand Burns; Flexion Contracture

Summary: 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.

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.

Eligibility criteria:
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.

Keywords: burn hand flexion contracture tourniquet tumescent technique children