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Page 4 of 6 Gupta et al. Plast Aesthet Res 2018;5:46 I http://dx.doi.org/10.20517/2347-9264.2018.66

(A) Hard cervical collar (B) Preparing the modified neck splint

(C) Modified neck splint
Central part of the collar is cut
in a shape of inverted "U"

Half doughnut shaped foam is
cut and prepared

Foam is fixed to the cut edge of
the collar with the help of
micropore tape

Figure 5. Design map for modified neck splint. A: Hard cervical collar; B: preparing the modified neck splint; C: modified neck splint

large). Hard cervical collars are better for burn patients as compared to soft cervical collar because of ease of
[5-8]
application over bulky dressing and ease of cleaning the collar stained with soakage from the wounds .
In some burn patients it is necessary to secure the airway early (at the time of presentation). Indications
[9]
of early tracheal intubation mainly include : (1) overt signs and symptoms of airway obstruction; (2)
extensive burns to the head and neck; (3) inability to protect airway from aspiration; (4) significant toxicity
from carbon monoxide or cyanide; (5) respiratory failure; (6) extensive burns (> 40% of total body surface
area); and (7) hemodynamic instability. In selected patients tracheostomy is preferred over translaryngeal
route for tracheal intubation. Indications of tracheostomy in burn patients mainly include : (1) need for
[9]
prolonged mechanical ventilation; (2) burns that will require multiple anesthesia for surgical procedures;
and (3) extensive laryngeal oedema making translaryngeal intubation difficult. Tracheostomy tube should be
removed once the need for prolonged or repeated intubation is over.

Putting cervical splint in patients with tracheostomy is difficult and often deferred. This has a negative
effect on outcome and increases the need for neck reconstruction in future . Modified prefabricated neck
[3]
collars are designed for tracheostomized patients but they are costlier and not readily available in market.
Philadelphia collar is having socket for tracheostomy but it is designed for cervical trauma and not for burns
patients. Philadelphia collar does not give freedom of lateral rotational movement of neck.

Our modification of hard cervical collar is very simple and easy to adapt at any burn care centre. It is low
cost, light weight, well supported, provides appropriate position and pressure, allows for physiotherapy and
comfortable. We observed good compliance and pain relief in the patient to which modified neck splint
was applied. It was possible to provide routine tracheostomy care comfortably with the patient wearing the
modified neck splint. We look forward to use this modified neck splint in other neck burn patients with
tracheostomy from the first day.