Measurement and management of swelling after hand burn injury

INTERVENTION: Compression through the use of different methods of application of cohesive bandage ‐ 3M Coban ‐ for the management of hand oedema Group One ‐ spiral Coban application to the fingers and to the hand Group Two ‐ spiral Coban application to the fingers and figure‐of‐eight application to the hand Group Three ‐ cylindrical pinch application to the fingers and spiral application to the hand Group Four ‐ cylindrical pinch application to the fingers and figure‐of‐eight application to the hand Each application method will be applied for a 24 hour period prior to reassessment and change of dressings, and that method will be reapplied at the change of dressing. The compressive bandaging will be applied by the ward physiotherapists as per the allocated method. The compression bandaging will be assessed prior to the next removal of dressings to monitor adherence. CONDITION: Hand burns PRIMARY OUTCOME: Oedema as measured by bioimpedance spectroscopy and volumetry SECONDARY OUTCOME: Cost of intervention ; ‐ The time taken to apply each method of compression will be recorded, and calculated against the salary of the physiotherapist applying the compression as a measure of cost of time ; ‐ The cost of the materials used to apply the compression will be recorded Hand range of movement with compression in situ ; ‐ Composite finger flexion as measured by the distance from the little fingernail/finger tip junction to the distal palmar crease on making a fist ; ‐ Thumb opposition ‐ as measured by the Kapandji scale Integrity of compression ; ‐ Burn wound exudate leakage from dressings may result in a loss of integrity of the cohesive bandage applied to manage oedema ; ‐ Photographic recording of compressive dressings to record wound leakage into dressings ; ‐ Recording of number of separations of the compressive bandaging Patient reported outcome ; ‐ The patient will complete the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire (Quick‐DASH) ; Pressure exerted by compression, as measured by pressure sensors placed beneath the cohesive bandage. ; Pressure will be assessed at rest, with active hand range of movement, and with passive range of movement INCLUSION CRITERIA: Burns including a portion of the hand