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

NCT ID: NCT02501720

Last Updated: 2015-07-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-30

Study Completion Date

2016-03-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Hand Burns Flexion Contracture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Tourniquet Group

Post burn flexion contractures will be released under tourniquet control

Group Type ACTIVE_COMPARATOR

post burn flexion contractures release under tourniquet control

Intervention Type PROCEDURE

post burn flexion contractures will be released under tourniquet control

Contracture release and application of FTSG

Intervention Type PROCEDURE

Post burn flexion contractures will be released and full thickness skin graft(FTSG) will be applied.

Tumescent technique group

Post burn flexion contractures will be released using Tumescent solution

Group Type EXPERIMENTAL

post burn flexion contractures release using tumescent solution

Intervention Type PROCEDURE

post burn flexion contractures will be released using tumescent solution

Contracture release and application of FTSG

Intervention Type PROCEDURE

Post burn flexion contractures will be released and full thickness skin graft(FTSG) will be applied.

Interventions

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post burn flexion contractures release under tourniquet control

post burn flexion contractures will be released under tourniquet control

Intervention Type PROCEDURE

post burn flexion contractures release using tumescent solution

post burn flexion contractures will be released using tumescent solution

Intervention Type PROCEDURE

Contracture release and application of FTSG

Post burn flexion contractures will be released and full thickness skin graft(FTSG) will be applied.

Intervention Type PROCEDURE

Eligibility Criteria

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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.
Minimum Eligible Age

3 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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King Edward Medical University

OTHER

Sponsor Role lead

Responsible Party

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Muhammad Mustehsan Bashir

Associate professor of Plastic Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Muhammad M Bashir, F.C.P.S

Role: CONTACT

923336517745

Omer Iqbal, M.B.B.S

Role: CONTACT

923336871707

References

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Spuy L. Complications of arterial tourniquet. South Afr J Anaesth Analg. 2012; 18: 14-18.

Reference Type BACKGROUND

Lalonde D, Martin A. Tumescent local anesthesia for hand surgery: improved results, cost effectiveness, and wide-awake patient satisfaction. Arch Plast Surg. 2014 Jul;41(4):312-6. doi: 10.5999/aps.2014.41.4.312. Epub 2014 Jul 15.

Reference Type BACKGROUND
PMID: 25075350 (View on PubMed)

Lalonde D. Minimally invasive anesthesia in wide awake hand surgery. Hand Clin. 2014 Feb;30(1):1-6. doi: 10.1016/j.hcl.2013.08.015. Epub 2013 Nov 9.

Reference Type BACKGROUND
PMID: 24286736 (View on PubMed)

Teo I, Lam W, Muthayya P, Steele K, Alexander S, Miller G. Patients' perspective of wide-awake hand surgery--100 consecutive cases. J Hand Surg Eur Vol. 2013 Nov;38(9):992-9. doi: 10.1177/1753193412475241. Epub 2013 Jan 24.

Reference Type BACKGROUND
PMID: 23348603 (View on PubMed)

Al Youha S, Lalonde DH. Update/Review: changing of use of local anesthesia in the hand. Plast Reconstr Surg Glob Open. 2014 Jun 6;2(5):e150. doi: 10.1097/GOX.0000000000000095. eCollection 2014 May.

Reference Type BACKGROUND
PMID: 25289343 (View on PubMed)

Prasetyono TO. Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique. Arch Plast Surg. 2013 Mar;40(2):129-33. doi: 10.5999/aps.2013.40.2.129. Epub 2013 Mar 11.

Reference Type BACKGROUND
PMID: 23533019 (View on PubMed)

Shridharani S, Manson P, Magarakis M et al. The safety and efficacy of epinephrine in hand surgery: a systematic review of the literature and international survey. European Journal of Plastic Surgery. 2014; 37: 183-188.

Reference Type BACKGROUND

Gumus N. Tumescent infiltration of lidocaine and adrenaline for burn surgery. Ann Burns Fire Disasters. 2011 Sep 30;24(3):144-8.

Reference Type BACKGROUND
PMID: 22396674 (View on PubMed)

Other Identifiers

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2335

Identifier Type: -

Identifier Source: org_study_id

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