Techniques for Patient Positioning During Burn Surgery: A Systematic Review

INTRODUCTIONPatient positioning in the operating room remains a challenge for burn surgeons; burn surgery involves critically ill patients who require close monitoring, difficult exposures, and careful handling of grafted areas. Various techniques to optimize intraoperative positioning during burn surgery have been described in the literature. The aim of this review was to outline these positioning techniques and report on their complications. METHODSA systematic review was performed by 2 independent reviewers using PubMed, Scopus, and OvidSP MEDLINE databases. Articles were included if they described intraoperative techniques to position patients undergoing burn surgery. The primary variable of interest was complications related to positioning during surgery. RESULTSThe search identified 1855 nonduplicate citations, of which 29 underwent full-text review, and 10 met inclusion criteria. Three studies described overhead suspension techniques, including a hook-and-pulley system, ceiling chains, weighted IV poles, and mounted crossbars; no complications were reported. Six studies described limb fixation techniques, including Steinmann pins, finger traps, wrist/ankle wraps, towel clips through eschar or distal phalanges, and external fixators. Complications included one case of hardware failure of external fixation and several pin site infections. Four studies described table modification techniques, including a modified Stryker frame, a fracture table, the Mayfield headrest, and the recliner position; no complications were reported. DISCUSSIONNumerous techniques have been described to improve patient positioning during burn surgery. No major complications were identified in this systematic review. Most techniques use standard operating room equipment and can aid in safe and easier operations.