Uniplanar external fixation for care of circumferential extremity burn wounds in adults

The optimal management of circumferential extremity burns remains a challenge. Elevation of the extremity to decrease wound swelling and avoid pressure at the point of contact on new skin grafts is a standard objective but can be frequently difficult to accomplish. Although various forms of elevation have been proposed, our purpose was to evaluate the safety and efficacy of the uniplanar external fixation (UEF) device in providing extremity elevation and stabilization while optimizing skin grafting. Intraoperative application of either upper or lower extremity UEF was performed at the time of eschar excision and application of split-thickness autografts. Inclusion criterion was that patients should be over 16 years of age with third-degree circumferential extremity burns that were planned for autologous skin grafting within 48 hours after their injury. Patient consent was obtained in every case. Eight patients aged 17 to 62 with circumferential extremity burns were reviewed. No pin-tract infections were observed, nor were any of the skin grafts lost due to shearing. Peripheral nerve and arterial injuries were not encountered. Only one patient with an oversized arm secondary to morbid obesity had a pin pull-out. No other patient developed adverse sequelae from the surgery or from the placement of the UEF device. The UEF device provides a safe and effective means for elevation of extremites in patients with circumferential extremity burns undergoing skin grafting. This allows for optimal access for skin grafting, dressing changes, and postoperative positioning. Shear injury and pressure necrosis of the fresh grafts is minimized. Increasing the number of pins in obese patients should be considered to avoid the complications of pin pull-out.