Table 5

Interventions

Ref	Author	Intervention summary	Outcomes
Gault technique studies
4	Murphy et al4	Gault’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
12	Kostogloudis et al12	Gault’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
16	Harris et al16	Gault’s+saline (100% of children)	No episodes of skin or soft tissue loss were recorded and no reconstructive surgery was required
17	Andrés 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
21	Casanova et al21	Gault's+hyaluronidase (79% of children)/+saline (14%) with liposuction	No skin involvement in 10 children; blistering healed in one; necrosis resolved in three
11	Ghanem et al11	Gault’s+hyaluronidase (46% of children) with liposuction	Three 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
32	Ching et al32	Gault’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
10	Falcone et al10	Topical fibrinolysin/deoxyribonuclease ointment then debridement	All wounds healed completely with no infections and no functional scar contractions at up to 16 months follow-up. No skin grafts were required
23	Weiss et al23	Wet dressings and repeated economical debridement	Wounds healed well in 15–40 days. Scars were visible but without discolouration
31	Firat et al31	Topical hirudin and antibiotics, then 3% boric acid, then repetitive debridement	Seven 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
30	Onesti et al30	Topical 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
25	Boyar and Galiczewski25	Enzymatic 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
15	Compaña et al15	Topical 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
29	Cho et al29	Topical antibiotic+anti-inflammatory herbal mixture for all children. 1 (20%) debridement. 1 (20%) escharotomy	The child who underwent debridement had a small-sized contracture at 50 days
20	Upton et al20	Debridement and skin grafts. Excision of extensor tendons if infected or devascularised. All children required two or more operations	Two 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 19	Debridement and wound closure: mostly split-thickness skin grafts or delayed primary closure. All children had at least two operations	The 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
22	von Heimburg and Pallua22	Debridement, allogeneic donor tissue grafts and autologous split-thickness skin grafts	After 15 days there was full healing in all five infants
17	Andrés et al17 (late)	Debridement+dermal substitute in 33%	The five late referrals were debrided and received artificial skin. All obtained satisfactory outcomes
13	Sung and Lee13	Multiple punctures using a scalpel blade+hydrocolloid dressing. Then debridement	All children showed favourable results without functional deficits or conspicuous scars
33	Sivrioğlu and Irkoren33	Versajet hydrosurgery for all children. 1 (11%) sharp debridement	Minimal scar formation with no hypertrophic scarring in any patient
Hyaluronidase injections
14	Odom et al14	Injection of hyaluronidase or phentolamine without incisions	No children required surgical intervention for wound healing or had an infection
24	Hanrahan24	Injection of hyaluronidase	Mean harm scores were similar between the group receiving hyaluronidase and the group not receiving it
26	Yan et al26	Injection of hyaluronidase (33%). 1 (6%) required surgical excision of a lesion	All healed and had ‘good outcomes’
27	Myers et al27	Injection of hyaluronidase in 50%	Time to healing averaged 16.2 days (range 1–82 days). No patient required surgical intervention
28	Cochran et al28	Injection of hyaluronidase in 25%	One patient had a prolonged course with swelling and skin peeling of the hand
34	Yan et al34	Application of hirudoid and injection of hyaluronidase	Three children lost to follow-up. Negligible loss of functional movements. One case of scarring and readmission with calcinosis