ABSTRACT
Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.
Subject(s)
Contracture , Plastic Surgery Procedures , Humans , Child, Preschool , Surgical Flaps/surgery , Upper Extremity , Skin Transplantation , Contracture/etiology , Contracture/surgeryABSTRACT
Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.
Subject(s)
Humans , Child, Preschool , Surgical Flaps/surgery , Upper Extremity , Plastic Surgery Procedures , Skin Transplantation , Contracture/surgeryABSTRACT
Burn injury may result in psychological and physical disability. Post-burn contractures, a poor outcome of the wound healing process, may limit the movement at the joints and impair the quality of life of the survivors. To compare outcomes of paraffin wax bath therapy and therapeutic ultrasound in post-burn contractures of small joints of the hand; eighty patients with post-burn contractures were enrolled in this study. Patients were divided into two groups; group I (n=40) was treated with ultrasound therapy and group II (n=40) with paraffin wax bath therapy, while stretching exercises & protocols for massage of the burn scar contracture were the same for both groups. The study participants were assessed for passive range of motion (P-ROM) for the extension at inter-phalangeal (IP) joints of the involved finger at the first contact session and the end of the 8th week of the treatment. The mean age of the patients was 25.62 years in Group-I and 24.67 years in group II. Group-I had 29 (72.5%) males and 11 (27.5%) females and group-II had 37 (92.5%) males and 37.5%) females. After 8 weeks of treatment, Group-I displayed improvement in range of motion with a mean increase of 4.97 ± SD 0.94 degrees while Group-II showed a mean increase of 9.37 ± SD 4.41 degrees with P value of <0.005. Paraffin wax therapy with stretching exercises and massage were more effective as compared to ultrasound therapy with stretching exercises and massage for the management of post-burn contractures of small joints of the hand.
ABSTRACT
A study was carried out regarding 213 patients of either gender and all ages who presented with post-burn contractures. The commonest site of contracture was the neck. 92 patients (43.19%) had received their initial burn injury management in general surgery units in tertiary care hospitals compared to 43 patients (20.18%) in district headquarter hospitals. Only 26 patients (12.20%) were managed in plastic surgery/burn wards, and 52 patients (24.41%) received no regular treatment from any hospital. The majority of patients (n=197) had a history of conservative management, with only 16 patients (7.51%) having a split thickness skin graft for part of their initial burns. None of the patients had the appropriate anti-deformity splintage in the affected parts or any physiotherapy during the acute phase of their burns.
Cette étude décrit 213 patients des deux sexes et de tous les âges qui se sont présentés à cause des contractures dues aux brûlures. Le cou était la partie du corps la plus atteinte comme site de contracture. 92 patients (43,19%) ont reçu leur prise en charge initiale dans une unité de chirurgie générale de l'hôpital pour les soins tertiaires et 43 patients (20,18%) dans les hôpitaux de district. Seulement 26 patients (12,20%) ont été traités en chirurgie plastique tandis que 52 patients (24,41%) n'ont reçu aucun traitement particulier dans aucun hôpital. La majorité des patients (n = 197) ont reçu un traitement conservatif pour les brûlures et seulement 16 patients (7,51%) ont bénéficié d'une greffe cutanée d'épaisseur variable pour une part de leurs lésions. Aucun des patients n'a eu le splintage anti-déformation appropriée ni la physiothérapie nécessaire au cours du traitement dans la phase aiguë des brûlures.
