IDEAS AND INNOVATIONS
A method of limb elevation during burn surgery
Received: 13 June 2012 / Accepted: 30 July 2012 / Published online: 16 August 2012
Abstract Elevation of limbs during burns surgery to access
the posterior aspect is routinely required. We describe a
method of limb holding during burns surgery using sharp
towel clips fixed to the distal phalanges of a patient's hands
or feet. The limb is held in elevation using a sterile crepe
bandage from the towel clips to a hook hung on a rail fixed
to the theatre ceiling. We have used this technique for
patients with extensive severe burns for many years with
no significant damage to the nail beds or the tips of fingers
and toes. This technique is convenient for surgeons as it
allows easy access to hands and feet and the posterior
aspects of arms and thighs. It is cost effective and safe as
it spares an assistant and decreases the risk of potential
Level of Evidence: Level V, therapeutic study.
Keywords Limb elevation
Limb elevation is an integral part of major burn surgery as
access to the posterior aspect of the limbs is routinely
required for debridement of full-thickness and deep dermal
burns, and skin grafting. This is usually challenging as it
takes at least one assistant's pair of hands and is also arduous
for the person elevating the limb. In the current environ-
ment, shift working means there are fewer surgeons avail-
able at any given time, so there is a need for devising ways
to perform tasks efficiently with minimal assistance. This is
of great significance in burns as speed of surgery has a direct
impact on the outcome in major cases.
Limbs are held during burns surgery using sharp towel clips
piercing the nail bed and pulp of the distal phalanges, distal
to insertion of flexor and extensor tendons (Fig. 1a). A
sterile hook is hung on a rail fixed to the theatre ceiling.
Then, the hand or foot is held in elevation using a crepe
bandage from the hook to the towel clips (Fig. 1b). The
limbs are left elevated until the dressings are complete.
When the feet or hands were not burned or the patients did
not have extensive burns that required Burns ITU care, we
did not use the towel clips for limb elevation.
There were 172 patients with burns of more than 30 % total
body surface areas admitted to our regional burn service
from January 2005 to January 2012. We have complete
information of 54 adult patients stored in our database, and
the described method was used to elevate a total of 87 hands
and feet. Debridement of full-thickness and deep dermal
burns and application of split-thickness skin grafts were
performed in one session or more; therefore, this technique
was used to elevate the same limb more than one time.
During the last 7 years, there was no reported complication
or damage to the nail beds or the finger and toe tips that
required reconstruction. The residual minor damage and
marks on the nail bed and digital pulp gradually improved
within a few months (Fig. 2).
A. Farroha (*)
St. Andrew’s Centre for Plastic Surgery and Burns,
Chelmsford CM1 7ET, UK
Eur J Plast Surg (2013) 36:255–256