Objective: Continued evolution in the use of BTM in our adult burn service compelled us to re-evaluate and update our therapy guidelines.
Method: A retrospective case note review was conducted on burn patients admitted acutely or for reconstruction and managed with BTM from March 2022 – September 2024. Data collected included days to commencement of range of motion (ROM) and mobilisation/ambulation post BTM application, %TBSA BTM loss, reason for any BTM loss and distance mobilised prior to SSG.
Results: 22 patients (23 procedures) were included in the study period. Overall, ROM began at mean of 4.0 and 2.3 days post upper limb (UL) and lower extremity (LE) BTM application, respectively. ROM was slightly later when accounting for acute burn admissions only (e.g. excluding reconstruction patients) at a mean of 4.3 and 2.4 days for UL and LE BTM respectively. Mobilisation for the overall cohort began at a mean of 3.4 days after BTM application. For those with LE BTM not delayed by a lengthy intubation period (intubated <7days) mobilisation commenced, on average, at 2.1 days after BTM application and larger areas (>10% TBSA) of LE BTM were associated with slower commencement of mobilisation compared to smaller areas (<10% TBSA) of LE BTM (mean 2.6 days vs 1.3 days). Partial BTM loss or removal occurred 6/23 (26%) of cases, however this loss was not associated with therapy interventions. During the BTM integration phase a good return to function can be achieved with 71% of those with LE BTM able to mobilise >50m prior to the commencement of SSG.
Conclusion: ROM and mobilisation guidelines have been revised and simplified. Active ROM (passive ROM if sedated) can begin gently within 3-5 days and mobilisation can commence safely within the first 2-3 days post BTM application.