Table 5

Interventions

RefAuthorIntervention summaryOutcomes
Gault technique studies
4Murphy et al4Gault’s+saline (11% of children)Three children suffered injuries, which led to significant tissue necrosis, delayed healing and prolonged morbidity. None of these were washed out due to delayed referral
12Kostogloudis et al12Gault’s+saline (100% of children)Seven children developed superficial blistering and epidermolysis, while six developed necrosis, all post-treatment. All wounds healed within 25 days. One case of distal foot ischaemia resolved after treatment
16Harris et al16Gault’s+saline (100% of children)No episodes of skin or soft tissue loss were recorded and no reconstructive surgery was required
17Andrés et al 17 (early)Gault’s+saline (67% of children)Seven of 10 treated with Gault’s technique avoided necrosis and recovered fully. Three developed minor necrosis. Tthe remaining five were debrided and received artificial skin and obtained satisfactory outcomes
21Casanova et al21Gault's+hyaluronidase (79% of children)/+saline (14%) with liposuctionNo skin involvement in 10 children; blistering healed in one; necrosis resolved in three
11Ghanem et al11Gault’s+hyaluronidase (46% of children) with liposuctionThree children had tissue necrosis—two were late referrals; unclear if the other one received washout. There was satisfactory healing with no requirement for surgical intervention
32Ching et al32Gault’s+hyaluronidase (62% of children)Of the 62% of children washed out, none developed complications. One calcinosis cutis and one ischaemic toe requiring amputation among children receiving no treatment
Debridement+further surgery
10Falcone et al10Topical fibrinolysin/deoxyribonuclease ointment then debridementAll wounds healed completely with no infections and no functional scar contractions at up to 16 months follow-up. No skin grafts were required
23Weiss et al23Wet dressings and repeated economical debridementWounds healed well in 15–40 days. Scars were visible but without discolouration
31Firat et al31Topical hirudin and antibiotics, then 3% boric acid, then repetitive debridementSeven children required split-thickness skin grafting and two required fasciocutaneous flaps. All recovered well, with scar development in four. Minor functional loss in the hands or feet as a result of scar formation was managed by physiotherapy and pressure garments
30Onesti et al30Topical collagenase, then debridement and then hyalomatrix PA (dermal substitute)18 children healed fully after 21 days. Four had pathological scars and four had debilitating scar contractures needing secondary surgery
25Boyar and Galiczewski25Enzymatic or autolytic debridement before mechanical debridement and application of dehydrated human amniotic membrane allograft (dHAMA)Complete closure of significant wounds with minimal soft scars and normal pigmentation
15Compaña et al15Topical steroids, Burow’s solution and silver sulfadiazine for all children.
3 (60%) then underwent debridement followed by split-thickness skin grafts
Successful healing in two children. One died of other causes
29Cho et al29Topical antibiotic+anti-inflammatory herbal mixture for all children. 1 (20%) debridement. 1 (20%) escharotomyThe child who underwent debridement had a small-sized contracture at 50 days
20Upton et al20Debridement and skin grafts. Excision of extensor tendons if infected or devascularised. All children required two or more operationsTwo children experienced contractures, two had extensor loss, one had hair loss, one had loss of motion and one required further reconstruction
18
19
Linder et al18 19Debridement and wound closure: mostly split-thickness skin grafts or delayed primary closure. All children had at least two operationsThe mean time for wound closure was 49 days (range 10–85 days). Three children died before wound closure. At least one patient needed a split-thickness skin graft. One child developed sympathetic dystrophy syndrome. Some children developed permanent joint stiffness
22von Heimburg and Pallua22Debridement, allogeneic donor tissue grafts and autologous split-thickness skin graftsAfter 15 days there was full healing in all five infants
17Andrés et al17 (late)Debridement+dermal substitute in 33%The five late referrals were debrided and received artificial skin. All obtained satisfactory outcomes
13Sung and Lee13Multiple punctures using a scalpel blade+hydrocolloid dressing. Then debridementAll children showed favourable results without functional deficits or conspicuous scars
33Sivrioğlu and Irkoren33Versajet hydrosurgery for all children. 1 (11%) sharp debridementMinimal scar formation with no hypertrophic scarring in any patient
Hyaluronidase injections
14Odom et al14Injection of hyaluronidase or phentolamine without incisionsNo children required surgical intervention for wound healing or had an infection
24Hanrahan24Injection of hyaluronidaseMean harm scores were similar between the group receiving hyaluronidase and the group not receiving it
26Yan et al26Injection of hyaluronidase (33%). 1 (6%) required surgical excision of a lesionAll healed and had ‘good outcomes’
27Myers et al27Injection of hyaluronidase in 50%Time to healing averaged 16.2 days (range 1–82 days). No patient required surgical intervention
28Cochran et al28Injection of hyaluronidase in 25%One patient had a prolonged course with swelling and skin peeling of the hand
34Yan et al34Application of hirudoid and injection of hyaluronidaseThree children lost to follow-up. Negligible loss of functional movements. One case of scarring and readmission with calcinosis