Daily General Anesthesia for Treatment of Severe Wound Contractures in a Severely Burned Child
Published on: 2018-01-29
A 2-year-old child was treated at our institution for 60% Total Body Surface Area (TBSA) scald burns to her lower body and trunk secondary to Non-Accidental Trauma (NAT), or intentionally afflicted abuse. She required several surgeries and multiple autologous split-thickness skin grafts. This girl developed contractures over both knees and ankles because of hypertrophic scarring from these grafts. Aggressive passive range-of-motion (ROM) therapy was given during her initial burn dressing changes under general anesthesia (GA,) resulting in improvement in the contractures. Typically, once the patient no longer requires mechanical ventilation the ROM therapy would only be continued awake with mild pain medicine, often resulting in limited progress. However, in this patient, after the grafts had healed, we continued to administer GA for the therapy until she was able to ambulate and could tolerate the passive ROM with only slight discomfort. Extensive and aggressive physical therapy can be administered to contracted patients facilitated by the relaxation and hypnosis of GA administered by an anesthesiologist.